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How to prepare for the third wave of COVID-19

As data shown by medRxiv in Karnataka that a third wave of COVID-19 is imminent in the state even if the strongest non-pharmaceutical interventions (NPIs) are implemented and 1,67,000 persons are vaccinated each day.

This is corroborated by evidence from other countries. It took nearly eight weeks in U.K. to go from second to third wave, 17 weeks in Italy, and 23 weeks in the U.S. Some people are still debating whether there will be a third wave. It is not a question of ‘if’ but ‘when’. In all likelihood, the next wave might be in late November or December in India. There are several actions that India needs to take to prepare and tackle the next wave.

Vaccination

Data from several States indicate that the average age of mortality is reducing in several States and stabilizing at 30-45 years. This suggests that vaccination might have already offered survival advantage to those above 45 years and above. This was the main objective of providing vaccination: preventing deaths and limiting serious morbidity requiring ventilation or oxygenated beds.

Extraordinary efforts will have to be made to secure vaccines for vulnerable people. The vaccine supply constraints are likely to ne resolved by the end of July. Micro- planning for vaccination should be strengthened. For this, health workers and volunteers need to go house to house and prepare lists of all eligible beneficiaries. Next, efforts should be made to help in registering and vaccinating the vulnerable.

At least 10 million people should be vaccinated each day and to reach this pace it is important to develop a strong mobilisation strategy, address the concerns of the vulnerable, and improve access to vaccination sites. A string focus on the bottom-up micro planning, similar to what was adopted during the measles-rubella elimination programme can be helpful.

The period between waves

It is during these periods that surveillance needs to be meticulous. One of the critical aspects of surveillance is to sustain aggressive testing, especially in symptomatic individuals, keep a close watch on the seven-day moving average of the test positivity rate (TPR). A TPR of less than 5% indicates that the disease is under control. Another important factor of surveillance in genomic sequencing to keep watch on the emergence of new variants of SARS-CoV-2

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The surveillance programme in the country needs strengthening, a strict review should guide the early identification of clusters. Timely investigation and early containment of outbreaks should be the mainstay of preventing of cases and deaths. Preparing for the next eave involves developing a standardized definition for minimum cases to be detected in each part of the country. Base on the available data, states can aim to detect and review ,say, 1,000-1,300 cases per million each month provided adequate testing is done.

Use data driven interventions

When true figures are suppressed during a pandemic, the data get skewed. As a result, modellers make unreliable projection, and Wrong policies and programmes are formulated. Hence, data should be made freely available to experts and tell the ‘truth’. Systematic collection, compilation and analysis of clinical, epidemiological and laboratory data is important in decision making.

The COVID-19 pandemic is associated with a high-attack rate among the household contacts. Therefore, non-pharmaceutical interventions represent the cornerstone to halting transmission. These include avoiding mass gatherings, closing schools, isolating those with infection, contact tracing And implementing infection prevention strategies in healthcare settings. These are critical to achieving at least 50% reduction in transmission.

To reduce the number of deaths we should immediately create adequate capacity to handle the search more paediatric issues and specialist care are needed to handle a complex disorder namely multi system inflammatory syndrome enhancing patriotic specialise beds and ICU can help in managing diseases in the community.

Many patients who have recovered from active COVID-19 infection are experiencing long term residual effects of the disease both physically and mentally. it is necessary. To address these issues in all hospitals through counselling at the time of discharge and by establishing post covid care clinics and services. every effort should be made to strengthen the human resources and infrastructure in rural and vulnerable areas.

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