A near certainty in the form of a third wave cannot be abandoned by plateauing Covid cases. The country might witness the rise in cases from the second week of August, subsequently achieving a peak around September. The hues and cries around the mammoth shortage of oxygen, and vaccines at the peak of the second wave, will likely remain a challenge for upcoming waves. The arduous task of preventing the virus juxtaposes with the complacent behaviour of citizenry and their escapism in travel besides the utopian impossibility of physical distancing.
The active cases had plateaued consistently for 55 days till the first week of July. The upward trajectory is being seen from the end of the first week of July when there were 46,000 cases reported with 817 new fatalities.
An ideal positivity rate shall be below 5%, as per the prescribed criteria of the WHO and ICMR. But as per the recent government findings, there is more than a 10% positivity rate in 73 districts, and 65 districts reporting above 5% are signs of danger. The Northeastern states, Maharashtra, Kerala, Tamil Nadu, Odisha, Andhra Pradesh, and the Himalayan region are indicating an upward surge. The experts and various studies have predicted that the third wave will have a likely impact on children from the age of 12-18.
In the first wave, the daily cases peaked up to their maximum in September 2020, around 90,000 cases were reported, and the daily average death for the month remained around 1000. From September 17, 2020, the cases started to decline along with a falling number of deaths till late February. The cases picked up pace from February 18, 2021, and by the beginning of March, the nation was in the grip of the second wave. The highest numbers were reported on May 6 when the reported cases reached 4,14,818 and the daily average death count was around 4000.
The mutation(s) of the virus made the general population, especially the young ones susceptible, unlike in the first wave. The ferocity of the second wave created havoc in terms of the shortage of oxygen. In the initial days of the first wave, i.e at the beginning of March last year, the nation required only 700 MT per day, while at the peak of the first wave, the oxygen requirement quadrupled to 2900 MT.
Similarly, In the initial days of the second wave, the demand had already increased to 3,842 MT per day, subsequently leading to an explosive demand of 11000 MT at the beginning of May.
The increased supply of medical oxygen forced the industrial output to be transferred to medical uses which led to the surge in the cases of mucormycosis (black fungus) in the second wave since the chambers, cylinders, and transport tanks were often not cleaned as per the protocols.
K.Vijay Raghvan, the Principal Scientific Adviser to the Prime Minister in May said that the 3rd wave is inevitable, though its time frame was not known then. A recent forecast study by the State Bank of India named, “Covid-19: The race to finishing line“, says the wave is likely to hit India by mid-August, while the peak may come in September. The report also claims based on the global trends that peak cases in the third wave will likely remain 1.7 times more than that at the peak of the second wave.
If at the peak of the second wave the “registered cases” were more than 4,00,000, then according to the predictions of the SBI’s report, cases close to 7,00,000 might be seen as a peak for the upcoming “third-wave”. Accordingly, the oxygen capacity will be thrice of what it was at the peak of the second wave.
Most patients still recover on their own without any hospitalization, but 5 % of the cases require hospitalization. If at the peak of the second wave, the daily average cases were more than 3,50,000, we were admitting close to 18000 on a daily basis. Then in the third wave, especially with a low vaccination number, the daily admission at the peak could be near 40,000.
Apart from the SBI report, the SUTRA model emphasized that the peak will hit somewhere between October and November if there is complacency in following the covid protocol (which is the case). However, the sutra model warned that if a new virulent emerges, the infections will be much faster. The previous patterns of the waves show that there has been only a gap of 5 months between two peaks, though this reduction in the gap is ascertained to the delta variant.
The addition of the triple mutant virus and the likelihood of the Lambda variant entering India from several countries of Europe like Germany, France, Italy, and the UK cannot be ruled out since we still have frequent visitors from these nations.
No governance model could have prepared for the explosion of oxygen requirements in the second wave, but ”now that we have seen what the capacity should be, Are we prepared?”
Vaccination is the most effective weapon against the third wave. The speed of vaccination peaked from May 15 to June 21, 2021. The country celebrated International Yoga Day on the 21st of June, since then the vaccination rate has been consistently declining except on odd days. More than 9 million doses were administered on the 21st of June.
As of July 8, 2021, we have administered just 3 million doses approximately. The lack of supply is clearly visible, the combined production of both doses is still hovering around 60-70 million per day, at this pace, the journey is far ahead.
While in the second wave, we were airlifting oxygen tankers and running oxygen express around the country since most of the oxygen plants were situated in the East. In April, we had only 1200 cryogenic oxygen tankers, subsequently, we were informed by the centre that the number of oxygen tankers stands currently in excess of 2,000 amounting to about 30,000 MT of liquid oxygen. Whereas our daily demand rose to around 11000MT at the peak of the second wave.
On July 8, in a high-level meeting on the possibility of the third wave, over 1500 oxygen plants are in the process of being installed in the country. Out of which, 1200 PSA are sanctioned at government hospitals with PM CARES funds. The prime minister further said that these PSA should be installed at the earliest. Along with the above mentioned PSA, many corporates have taken the initiative of helping the general public and government in a difficult situation.
Corporations building PSA plants
The setting up of more oxygen plants and procuring an adequate number of cryogenic tanks is a matter of urgency. An alternative has emerged in the process, the setting up of pressure swing adsorption (PSA) is easy to set up when compared with the oxygen plants. The cost and time of setting up a PSA is also less and requires only a 200sq ft area. The government can look forward to lending concessional loans to small and medium hospitals that will encourage them to cooperate and be a part of this initiative.
The prevalent use of covid medication like Remdesivir, Ivermectin, Azithromycin, Favipiravir, and Plasma has been discarded by the medical fraternity time and again. But its use has been happening even after the acclaimed studies have shown otherwise. The hues and cries around Remdesivir in the country are well known, this huss puss should be avoided. The medical students’ stipends should be raised, there have been protests in the country for the same. There is also the requirement for change in the medical workforce since the fraternity is broken beyond repairs.
The recent views from the hill stations like Manali, Shimla and Mussoorie is yet another proof of our shambolic civic sense, for those enjoying their escapism, “sawari saman ki khud zimedaar hein”, don’t blame the government for your failures.