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US based experts predict about the third wave peak in India
by Vaishali Sharma January 8, 2022
According to a US-based health specialist, India would see a peak in the number of COVID-19 cases by next month, with the expectation of reporting five lakh instances per day. However, "the severity of the variation will be less this time in the nation than Delta variant," he said.
Dr Christopher Murray, Director of the Institute for Health Metrics and Evaluation (IHME) and Chair of the Health Metrics Sciences at the University of Washington said: "You are entering the Omicron wave, as many countries around the world are, and we expect that there will be more cases per day at the peak than you had in April last year for the Delta wave, but Omicron is much less severe."
"So, while you will have many cases and set records probably for cases. It should be less of an impact on the severity of the disease. We currently have in the models that we will release later, we expect about five lakh cases at the peak, which should come in during the next month," he added.
As many experts in India say that the country has hybrid immunity due to which Omicron will be less effective, Dr Murray said: "What we know from a place like South Africa where there was a tremendous amount of prior infection, both Delta as well as Beta. Vaccination doses provide considerable protection for severe disease, from hospitalisation and death, which is why we think there will be many Omicron cases in India, but much less hospitalization and death than you had in the Delta wave."
Speaking about the number of hospitalizations and severity due to the variant, he said: "We expect that 85.2 per cent of infections will have no symptoms. They will be asymptomatic, but amongst the cases, we still expect quite a number of them to end up in hospitals and in terms of death, cases will be much reduced. So we expect that the peak of hospital admissions in India will be about a quarter of what you had for the Delta wave, and deaths should be less of what you saw for Delta."
According to some experts, further spread of Omicron may lead to other mutations. Talking about it Dr Murray said: "The thing about mutations is that they're random. So, the more transmission there is, the more potential there is for mutations to occur. But in the setting of this rapid transmission of Omicron, it's going to be very difficult in the next month or two for a new variant to meet Omicron because it's so transmissible."
Dr Christopher Murray further spoke over the new variant with multiple mutations in France.
"There are mutations all the time, and you can identify variants with many mutations but the thing that we look for, is that within, you know, 30 to 45 days after a new mutation appears, has it spread as it spread like Omicron, so far, that mutation has been around for quite some time in France. And it has not spread so we are not currently learned about that mutation."
"Omicron is 90 to 95 per cent, less severe, but there is still a segment of individuals, particularly older individuals who will get sick. So, there will be an increase. It's just a much smaller increase in hospitalizations," he said.
Omicron driven third wave in Feb
by Pragati Singh December 18, 2021
written by Pragati Singh
NEW DELHI: India's daily Covid-19 caseload, which is presently at 7,500 infections, is projected to rise after the Omicron takes over as the dominant type, according to members of the National Covid-19 Supermodel Committee, who also forecast the third wave in India early next year.
Vidyasagar, who is also the head of the National Covid-19 Supermodel Committee, said that India will have Omicron's third wave but it will be milder than the second wave.
"In India, the third wave is expected to come early next year. Because the country already has widespread immunity, it should be milder than the second wave. There will, without a doubt, be a third wave. We're now averaging roughly 7,500 instances each day, with that number expected to rise if Omicron begins to supplant Delta as the main variation".
Vidyasagar, who is also a professor at the Indian Institute of Technology (IIT) in Hyderabad, said that it's unlikely that India will see more daily cases than the second wave.
"It is extremely unlikely that the third wave will see more daily cases than the second wave. Please remember that the Government of India started vaccinating ordinary Indians (i.e., other than front-line workers) only starting March 1, which was just about the time that the Delta variant hit. So the Delta variant hit a population that was 100 per cent vaccine-naive, other than the frontline workers."
He further said that according to a sero-survey, a tiny fraction has left that hasn't come into contact with delta virus, "Now we have sero-prevalence of 75 per cent to 80 per cent (prior exposure), first dose for 85 per cent of adults, both doses for 55 per cent of adults, and a "reach" for the pandemic of 95 per cent (meaning that only a tiny fraction of the public has not come into contact with the virus
When will the third Covid wave strike India, and will it be less severe than the first two? When will Covid third wave hit India and will it be milder than previous two? IIT scientist weighs in
by Pragati Singh December 7, 2021
With the introduction of Omicron, a new variation of SARS-CoV2, the third wave of coronavirus might peak in February, with up to 1-1.5 lakh cases per day expected in the nation, but it would be milder than the second wave. According to Manindra Agarwal, an IIT scientist who worked on the mathematical projection of Covid-19's trajectory,
In Maharashtra, two additional persons tested positive with the Omicron type of Covid-19, bringing the total number of cases in the state and country to 11 and 23, respectively.
The country had detected 17 cases of the Omicron variant on Sunday – nine persons in Rajasthan capital Jaipur, seven in Maharashtra's Pune district and a fully vaccinated man who arrived in Delhi from Tanzania.
He said in the new forecast, the new Omicron variant has been factored in. "With the new variant, our current forecast is that the country could see the third wave by February but it will be milder than the second wave.
So far we have seen that the severity of Omicron is not like the one seen in the Delta variant," Agarwal told PTI.
He, however, said a close eye is being kept on cases in South Africa where many cases of this variant have been recorded. Agarwal added that as of now South Africa has not seen a rise in hospitalisation.
He said a fresh set of data on the virus and hospitalisations would help in getting a more solid picture. "It looks like although the new variant has shown high transmissibility, its severity is not like the one seen in the Delta variant," Agarwal said.
The first two Omicron cases in India were reported in Karnataka last Thursday, where a 66-year-old South African flyer and a 46-year-old Bengaluru doctor with no travel history had tested positive.
He said as observed during the spread of delta, a mild lockdown (night curfew, restrictions on crowding) can bring down beta substantially. That will significantly reduce the peak value, he added.
The Department of Science and Technology (DST) backed Sutra-model had earlier said the third wave of coronavirus could hit the country by October if a new variant, more virulent and transmissible than the Delta, emerges.
However, till November end, there was no new variant. It had then revised its forecast to November.
On November 26, the World Health Organisation (WHO) named the Covid-19 virus variant detected in South Africa and some other countries as Omicron.
The WHO has also classified the Omicron variant as a 'Variant of Concern'.
Experts have expressed possibilities that owing to the genetic modification in the virus, it may possess some specific characteristics. While the transmissibility of infection seems to have increased because of this new variant, there is still not enough clarity on whether or not it will cause severe disease and whether it will evade immunity.
SDMC installs oxygen plant at Nehru Nagar hospital anticipating Covid-19 third wave
by Vaishali Sharma October 18, 2021
The South Delhi Municipal Corporation has constructed a pressure swing adsorption (PSA) oxygen facility at the Chest Clinic and TB hospital in Nehru Nagar, South Delhi, in anticipation for a probable third Covid-19 wave.
This is the local body's third PSA oxygen plant this month, following the ones that were launched last week at Tilak Nagar Colony Hospital and Poornima Sethi Multi Speciality Hospital in Kalkaji.
SDMC constructed the plant in conjunction with Rotary Club and PHD Family Welfare Foundation, according to standing committee chairperson B K Oberoi.
"This plant can generate oxygen at approx 350 litres per minute. It will provide oxygen to 40 bedded Covid wards and on normal days it will provide oxygen to tuberculosis and other lung-disease patients."
Rajpal Singh, chairman of the central zone, stated that Prime Minister Narendra Modi has made an effort through the PM Cares Fund to establish up PSA oxygen plants around the nation in order to avoid an oxygen shortage in the third wave of Covid-19.
Must wait for everyone to get both doses before discussing booster, says Dr Anil Arora
by Vaishali Sharma October 4, 2021
"If we keep on giving boosters to those who have a controversial role in prevention of disease, we are trying to put the cart ahead of the horse. Those who are at high risk of infection like transplant recipients, can lay their hands on the vaccination, it is a good alternative, but not across the board. Let everybody be vaccinated with the second shot before talking about the boosters," stated Dr Anil Arora, Senior Consultant from Institute of Liver Gastroenterology of Sir Gangaram Hospital, in an exclusive interview with Medically Speaking on administration of booster shots for Covid-19.
Here are a few snippets from the interview:
Tell us really about the tumour, which had been removed by you during the 100th live webcast surgery through an endoscopic invasion. Tell us a little more about the same layman's terms.
Dr. Anil Arora: This was a patient who had been going around with the tumour in the summer for almost a year. He had earlier been reluctant to get operated because of the ongoing covid-19. He went to a surgeon who thought the tumour was superficial and maybe it was may be amenable to endoscopy. So, we spent about six hours and fortunately, we were able to remove the whole tumour without any surgery from within the stomach. This is a new technique, called endoscopic submucosal dissection. That is not new in terms of Indian scenario, but to have an early malignancy in the stomach is uncommon in Indian scenario. Most of our patients come late in the course of the illness and they are not fit for endoscopic surgeries. So, this is one of the uncommon varieties of early stomach cancer, which has been very well handled by endoscopic removal without having been subjected to surgery at all.
Many people are delaying their much required surgeries due to this endemic fear of Covid. Even though the top experts and scientists have said that the third we may actually not come the number at an all-time low, why is this fear still remaining?
Dr. Anil Arora: If you look at the devastating effects of the Covid-19 second wave, it has still not been off of our conscience. People have been affected mentally, physically, socially and economically. People are still recuperating. This is once in a century pandemic. I think most of us will never be able to see it again. And we have experiences and then we are the lucky ones we have survived. We're still trying to come out of the ripple effects of the second wave.
Do you think that a booster shot is needed perhaps at a later stage at least for the comorbid?
Dr Anil Arora: Anybody who is immunocompromised, or has not had the exposure to protective jabs certainly needs a vaccination. And those who have not got the antibodies made, they are the subgroup of the patients who will certainly need boosters. But having said that, the disease tends to spread among those people who have not been vaccinated. If you look at the Indian data, only one fourth of the population has got the second jab, they still do not have adequate protection.
If on top of that due to lack of availability of the vaccines, if we keep on giving boosters to those who have a controversial role in prevention of disease, we are trying to put the cart ahead of the horse. Those who are at high risk of infection like transplant recipients, can lay their hands on the vaccination, it is a good alternative, but not across the board. Let everybody be vaccinated with the second shot before talking about the boosters.
Talking about the gallbladder gangrene, a rare case you saw, how could it develop? How is it post-Covid symptom?
Dr Anil Arora: See we recently reported a large number of complications occurring in the peri-Covid era, primarily after recovery from Covid. We reported white fungus, black fungus, cytomegalovirus induced colitis and finally we were baffled by influx of the 5 patients with severe inflammation of the gallbladder, leading to the gangrene, four out of which, developed perforation of the gall bladder requiring emergency surgery. We believe that the antigens, which may be persisting in the body or antibodies which have been formed against the virus, may have an affinity for the wild of the epithelium. Now Ace 2 receptors which are conducive to the entry of the virus into the alveolar cells of the lung, which is the most important site of involvement of the covid-19 infection or equally prevalent, in abundance in the bile duct epithelium. So, we believe the combination of effect of Ace 2 receptors will dysregulated immune mechanism would have resulted in severe inflammation involving the bile duct epithelium, as well as compromising the vascular supply causing vasculitis. Combination of the two-event resulting in the double whammy resulted in acalculous cholecystitis, which means these patients had inflammation of the gallbladder, even in the absence of the stones. Acalculous cholecystitis to a stage where it almost lead to gangrene requiring surgery is almost unheard of in covid. We reviewed the literature, there have been five to seven more cases reported in the world literature and we thought we will make everybody conscious of it.
What really is the reason for a condition like this developing? Isn't it quite fatal as well as whatever little I understand of it?
Dr. Anil Arora: Of all the cases of cholecystitis is 10% likely to occur in the absence of the gospels and the typical and classical setting for acalculous cholecystitis is a sick patient who is in ICU on prolonged ventilation. Surprisingly these were the patients who had recover from covid, they were at home and presented with fever and symptoms of cholecystitis. So it was not the traditional causes of acalculous cholecystitis in gallbladder gangrene. So, the lesson is, if you have symptoms of inflammation of the gallbladder after recovering from the covid, even in the absence of the gall stones, do not ignore it. Maybe a timely intervention with IV fluids and antibiotics may herald the progress of disease to gangrene requiring surgery.
October 4, 2021 0 comment
Covid News and UpdatesNational & International News
Delta Wave Can Peak in United States But Viruses Expected To Become Endemic
by Pragati Singh September 15, 2021
Washington: The latest Delta-powered coronaviral wave in the US could soon peak, but experts warn against self-indulgence and expect that the virus will become a part of daily life in years to come.
The average daily rate for seven days on Monday was 172 000, the highest of which was despite the slowing growth rate and cases falling in most states based on figures compiled by the Covid Act Now tracker.
However, over 1,800 people still die each day and more than 100,000 remain hospitalised with serious Covid – a grim reminder of the challenges faced by the authorities when faced with misinformation and polarised politics.
Bhakti Hansoti, an associate professor in emergency medicine at John Hopkins University and expert in Covid critical care, told AFP she saw the US following a similar trajectory to India.
Countries in western Europe have also seen similar downturns in their Delta surges.
But while Hansoti breathed a sigh of relief when the spring wave ended, "I'm a little hesitant this time around," she admitted.
The possible emergence of newer variants of concern and the advent of colder weather leading to more socialization indoors could lead to a rebound, "unless we learn from the lessons of the fourth wave."
Angela Rasmussen, a virologist at University of Saskatchewan in Canada, added she was not certain the fourth wave was over.
"If you look at the fall-winter wave, there were periods in which there was a steep exponential increase, and then it looked like it was falling — and then there would be another increase."
To ensure gains are sustained, rapidly increasing the number of people vaccinated is vital. Currently 63.1 percent of the eligible population over-12 are fully vaccinated, or 54 percent of the total population.
This places the United States well behind global leaders like Portugal and the UAE (81 and 79 percent fully vaccinated), despite its abundance of shots.
The administration of President Joe Biden last week announced a number of new measures to ramp up the immunization campaign, including new vaccine requirements on companies of over 100 employees, but the impact is yet to be clearly seen.
Beyond vaccinations, experts want to see other interventions continue.
Thomas Tsai, a surgeon and health policy researcher at Harvard, said hotspots need to follow through on masking, adding that the US should also look to other countries that have adopted widespread rapid testing for schools and businesses.
Such tests are available either for free or at a very nominal cost in Germany, Britain and Canada but remain around $25 for a two-pack in the US, despite the Biden administration's efforts to drive costs down through a deal with retailers.
Of course, the impact of all measures depends on their uptake, and in this regard, a clear and consistent pattern has emerged of two Americas: liberal-leaning regions are far more compliant than conservative.
Prior to the Delta wave, some experts declared that, between the percent of people vaccinated and those who had gained immunity through natural infection, the country was approaching the point of herd immunity.
Rasmussen said those predictions had proven incorrect and it remained too early to say when this threshold would be reached.
"There are still parts of the country where the adult vaccination rate is less than 50 percent," she noted.
Though Delta has out-competed all previous variants and is currently dominant, SARS-CoV-2 continues to evolve rapidly and virologists fear that more dangerous variants might emerge.
"I don't want to be a doomsayer, but I also want to have some humility, because I don't think we know a lot about the basic function of many of these mutations," said Rasmussen.
Covid News and UpdatesInterviews
Analyzing state-specific data eligible to avoid third wave: Dr Samiran Panda, ICMR Scientist
by Vaishali Sharma September 7, 2021
"We need to look at where the second wave was descending since an increase will almost definitely be noticed from there, which may be regarded an early sign of the third wave. However, this necessitates a thorough examination of state-specific data," claims top scientist of the Indian Council for Medical Research (ICMR), Dr Samiran Panda.
In an interview with Medically Speaking, Dr Panda talked about the possible threats of the third wave and increasing number of daily cases in India amid the festive season.
Everyone wants to know whether the third wave is going to hit or not? And if it does, what does it mean for the common people and when will it arrive or is it already here?
Dr Samiran Panda: Short answer to this is that yes there is a possibility of the third wave hitting us. The question, however can be broken down to smaller parts and should be asked at state level because India does not have a uniform state-wise vulnerability. Many states in India did not get affected as severely as Maharashtra, Kerala or Delhi. 80% of the recorded infections were recorded by only 10 states and people there developed good immunity against the infection. Thus, the possibility of third wave hitting strong in these states is lower compared to other states. These states also had quick vaccination which boosted their immunity fairly. State-level data should be analyzed on the terms of the intensity of first and second wave and the vaccination.
We are seeing 60 % to 70 % of daily cases coming from Kerala. Would you say that third wave has arrived there already?
Dr Samiran Panda: We realized that around 44% of the individuals in Kerala, particularly from the areas participating in the 4th round of the Sero-survey had presence of antibodies in them which means that they were also exposed to the infection. Looking at the other side of this, 56% of the people were not infected which means that Kerala was successful in containing the infection. Hence, we are not surprised on the fact that Kerala is experiencing surge of infection.
We need to look at where the second wave was descending since an increase will almost definitely be noticed from there, which may be regarded an early sign of the third wave. However, this necessitates a thorough examination of state-specific data.
Which states are at a higher risk of entering the third wave?
Dr Samiran Panda : Infections might happen to anyone even after the vaccination but will not push us to the severe stage of the disease. In a particular state vaccination has again good coverage then people will still get infected if they do not observe covid appropriate behaviour. Vaccine against Covid-19 in India are not infection preventing vaccines, they are disease modifying vaccines. Hospitalization or need of oxygens or even unfortunate event of deaths will be less in those states where 50-60% of the people have been vaccinated.
Would you say there is a tentative time line for the upcoming third wave, or would you say that it is not inevitable?
Dr Samiran Panda : Virus needs an opportunity where suspectable people come in contact with infected individuals and in the situation that the population density is very high.
We saw a surge in cases last time after the festivals like Holi and people went out to places like Kullu-Manali. Would you say that this time too the third wave would be experienced after festivals like Ganesh Chaturthi?
Dr Samiran Panda: If the height of the wave is in the question, I would still expect the height of this wave to be lower than the second because we did not have vaccinations happening back then.
If the population density increases during festivals with Covid appropriate behavior not being followed, we can always expect rise in cases. We must not forget our health is in our own hands.
Recorded number of infections and recorded number of symptomatic infections where more people are going to hospital requiring oxygen are two different things. Second scenario where the number of advanced stages of disease are at a large, is a scenario which can be considered as a wave and we do not want that.
Is it possible to avoid it?
Dr Samiran Panda: Each state needs to look into the epidemiology of the infection. It is possible to avoid the rise in cases through the state-specific data analysis.
We have seen a new variant emerge known as "C.1.2 and MU" which could be a variant of concern and as reports suggest many vaccines may not be as effective on it. Is there any real danger of it spreading in India?
Dr Samiran Panda: while delta was spreading, we looked into the magnitude of its spread. We realized that all the variants were neutralized by the …… collected by the vaccine recipient which is a good thing. Talking about the variants from other countries, we need to have a surveillance which could happen at three levels: at the airports, at the state level and at the district level.
As yet we have not recorded this new variant. Any new variant is identified as variant of interest or variant under investigation. As far as India is concerned, C.1.2 has not made an entry into the nation. If it results in large number of cases and deaths are being reported due to the new variant, it will be identified as a variant of concern.
NCDC is the focal institution that will conduct this genomic surveillance which sees whether the new variants are appearing or not.
There are certain variants like the Delta Plus on which the vaccines are not effective. What does this mean for our country?
Dr Samiran Panda: Any variant that gets identified as the variant of concern must be tested against the serum collected from a vaccine recipient and see if the serum is able to neutralize the new variant. Many laboratory experiments have shown that the vaccines made in India have been able to handle the variants called Delta or Delta Plus.
Since we are talking about the various mutation of covid, the possible third wave is stressing people. If it comes, will it be as effective as second wave or will it not be considering the number of cases in the second wave, immunity building etc.?
Dr Samiran Panda: If the third wave occurs, then, according to the models which we studied at ICMR, the third wave should not reach the heights as we had seen in the second wave, which is a good thing, but we should not let our guard down because, post vaccination, it's possible for us to get infected. We won't get to the severe point of the disease, but others can get infected, which is not good.
Is there any fear regarding increase in covid cases as children have better immunity but the can be carriers?
Dr Samiran Panda: Although children got infected but it is not clear whether they got it from school or not. And according to a National Sero-survey we saw that 55 percent of the children were already exposed and infected because they had presence of antibodies during the survey. So what can be done to avoid further spread is that before or during the opening of schools the parents and the school staff should get fully vaccinated and all the required precautions should be taken. Moreover, people should know that preventing children going from school is like robbing their life opportunities from them because they are the future of the country.
There are few reports about the booster shots, many countries started it already. What do you think about it whether India needs a booster shot?
Dr Samiran Panda: In India, we turned out to be lucky to have Covaxin and Covishield and many people have achieved natural immunity through natural infection. It does not make any sense to talk about booster dose as many eligible and prioritised groups of Indians are receiving vaccines and preferably two doses.
In the case of these present variants, it is all dependent on discussion related to neutralizing antibodies. But we must not forget that it's just not about neutralizing antibodies after vaccination or post infection which matters. There is another arm of immunity, which is called cell-mediated immunity, and we are not measuring them.
I would say let's not panic, and let us get fully vaccinated and then see what is the scientific data is telling us. For India, booster dose should not be the centre of discussion.
What would you tell the audience about the safety majors one should take as we are also approaching the festive season?
Dr Samiran Panda: If we celebrate a little low key so may be can celebrate better in coming years. So my appeal to everyone is get vaccinated keep the covid appropriate behaviour and so by doing this we can win this war against Covid-19 in India. So all of this is in your hand. Stay home and stay safe.
Right approach towards children as schools reopen
by Pragati Singh September 5, 2021
Experts suggest honest dialogue and recitation of rules like "I wear a mask when in class and on the grass' alleviating parents' anxiety regarding reopening of schools.
Are we prepared to take the on sought of the third wave as far as the children are concerned?
Dr Krishan Chugh: our hospitals are conducting drills on the strategies to control the third wave. We are preparing our action plan to treat n number of patients. We know that the hospital bed ratio to the population ratio is not in our favour even when it comes to children.
In the last wave, many children produced antibodies, and the number is pretty large. Is this the reason for the confidence?
Dr Smita Malhotra: sero positivity rate is evident in children. We should emphasize that all children take influenza vaccine before going to school which will provide an additional protection till we are able to vaccinate them against Covid. Any child who are immunocompromised should take online classes which would be a prudent option for everyone.
As a career counselor, what would you tell the patents of high school students to alleviate their anxiety?
Dr Amrita Dass: There is a digital divide even in urban areas. It is important for parents to make informed decisions and discussions where they hear medical point of view also is very useful. Places where SOP's and Covid protocols have been followed are the safest places today. Sending kids to school on alternate days with parents' permission is very essential. I attended webinars with schools from Maharashtra, Uttar Pradesh, Himachal Pradesh and Uttarakhand where they have been reopened and initially the attendance was at 50% attendance which later went up to 60% and for the senior students it was 80% because the board exams will not be held online this time unless there is something unforeseen.
Would you say that the parents joined with your association would be convinced with these points?
Sumit Vohra: we agree as parents that we go to public places but there the children are under parents' supervision. When in school, kids are the responsibility of the school faculty. It is a doubt among the parents whether the schools will follow SOP's properly or not. Had this hype of third wave not been created, parents would have been much assured about sending the kids to school. We are aware that we need to send our children for practical exams and offline board exams but then we would prefer waiting for 10 to 15 days and then allow our kids to go to school.
Dr Prakamya: we do want to protect our children and that comes out from a very legitimate point of parenting but at some point of time we need to let out children venture out. At some point we need to use this as an opportunity to develop resilience among our child. Even in the urban strata, there are a lot of children with special needs, with learning disabilities, ADHD. These children need special educators and counselors for their all-round development. Adolescent is a stage where the brain is undergoing synaptic transformation and this is an important time to intervene and provide them an environment for social and mental development. Instead of being problem-oriented, we should be more solution-oriented, which brings me to having an honest conversation between the parent and the ward, and the school administration and children.
It is difficult to teach the concept of wearing mask to a 2 or 3 year old but can students in class 9 and 10 be taught with the help of a constructive dialogue in the school and at home?
Dr Shweta Sharma: we can trust our own children to follow SOP if not school authority and if you have that bond and trust with your children, they are going to follow up this thing. Schools are second parent to the kids and they are more responsible for the overall development of the children. Therefore, trust is all the more essential.
Dr Amrita Dass: there is a policy intervention I would state here. I believe authorities should prioritize vaccinating children atleast above 12 years of age as soon as possible. Government of UP has already started this and I would urge all state governments start doing this early as possible.
Is basic vaccination more important than the so called Covid vaccination?
Dr Krishan Chugh: No vaccine other than the Covid vaccine can provide significant protection against the Covid virus. Only proper vaccine with proper dosage at proper interval can ensure that children are reasonably safe. Fortunately some vaccines like Covaxin and Zydus Cadila will be approved by the regulatory authorities to be used for children soon. But once these vaccines are approved for children, they should not be used for adults except for those who have received the first dose of the same vaccine. This will ensure that we have enough vials for kids.
We have seen more number of critical cases among adults. Would you not agree with the government for prioritizing the elderly first, then 18 above and children at last?
the last wave we have seen many mortalities among the 30's and 40's and fortunately children have been spared of that fatality till now. Adults have been prioritized all over the world, not just India. Even the scientific evidence suggest that this is the correct protocol to be followed.
What is your advice for policy makers, parents and students?
Dr Smita Malhotra: I think it is in the individual's hands. Children are smarter and wiser now and they can be taught how to be responsible. If each individual in the society learns to be responsible, it is not a difficult pandemic to control.
What would you like to suggest parents like Mr Vohra?
Dr Prakamya Singal: we need to be more solution-oriented and I think the best precaution against Covid is to wear mask. But how do they wear mask for a 4-5 hour stretch? Children will behave casual and it is natural so I believe we should first ask our children if they are comfortable wearing the mask that they have. They can be engaged in mask making activities, they can use their favorite colour, have their favorite cartoons on it.
We can use the initial days before the schools open up to ease them and help them get used to the sensation of wearing a mask. We need to give out clear rules and revise them on the daily basis before they leave for school to ensure that they follow the precautions. We can recite something like, 'I wear a mask in the class and on the grass'.
Would you agree the same method would work for 6 or 7 standard students?
Dr Shweta Sharma: Yes the same method would work because if we see children as individuals, they are efficient. Thus, please trust your ward, they will take care of their hygiene and you do not need to repeat the instruction again and again because since the last two years we have been repeated the same message.
What would you say about this Dr Dass?
Dr Amrita Dass: where schools are open, students being responsible and parents being engaged has made a difference. So let us be more pragmatic about it and look ahead and bring in all the stakeholders. Schools do care about the kids as much as the parents and want to ensure that they do not have to be kept at home again. Let us trust the stakeholders.
Dr Chugh, what would you about the increasing numbers in Kerala which might probably be adding to the anxiety of the parents?
Dr Krishan Chugh: it is not just the schools that led to increase in Kerala, I believe Delta Variant was the major cause. It is the virus that is going to decide. Science is predicting that the change in the virus is not going to be a major one.
Would you suggest parents to have a healthy dialogue with the kids or maybe engage with the schools directly?
Dr Shuchin Bajaj: prediction is not our work but we have a graded action plan. Currently the positivity rate is less than 0.04% and our action plan will start when it arrives at 0.5%. Our mistake during the last wave was that we started after it crossed 5% and then it was too late. The government will be more cautious this time and lockdown will be imposed at 0.5% positivity and schools will be shut down first. Let us trust the government on this.
What do you think is a right approach as we eventually have to send our children to schools?
Sumit Vohra: the parent should take the initiative and the schools should build trust among the children ensuring that there are no mishappenings and children do not catch virus. Let us see for 10-15 days if the SOP's are being followed properly. If the schools build up the confidence, parents would easily send their kids to school.
WHO South-East Asia Health Ministers to discuss COVID
New Delhi: Next week, the WHO South East Asia Region's health ministers will meet for deliberation on the ongoing pandemics and actions to "build better" essential health services so that universal health coverage can be achieved.
The 74th WHO South East Asia Regional Committee will be held from 6 to 10 September. Nepal will host this meeting.
The session of the Committee will include Dr Tedros Adhanom Ghebreyesus, WHO Director General, Dr Poonam Khetrapal Singh, Regional Director, Health Ministers and Senior Health officials from Member States, UN Agencies, partners, donors, representatives of civil society, etc.
Strengthening public health emergency preparedness and response, accelerating progress for prevention and control of non-communicable diseases, and ending viral hepatitis, HIV and STI are among other key issues that will be discussed at the annual meeting. This meeting will be held virtually for the second consecutive year in view of the pandemic.
Monitoring progress on universal health coverage, revitalizing school-health, and the regional framework for vaccine action plan will also be tabled for discussion.
The meeting will also take stock of the progress being made in the region on resolutions adopted at previous Regional Committee meetings. The session will also cover measles and rubella elimination by 2023, improving access to essential medical products, the South-East Asia Regional Health Emergency Fund and strengthening health systems to accelerate delivery of services for non-communicable diseases at the primary health care level.
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Next 6 to 8 weeks is a period to assess the impact of reopening schools, it's a dynamic situation: Experts
In several areas, schools have reopened with rigorous coronavirus precautions in place. Students will now physically attend classes in states such as Delhi, Uttar Pradesh, Madhya Pradesh, Rajasthan, and Tamil Nadu. In light of the pandemic, precautionary measures such as physical separation, staggered lunch breaks, obligatory masks for instructors and children, and the use of sanitizers have been implemented. Still, parents are apprehensive about sending their children to school.
In a conversation with Medically Speaking, a parent put forth his concern regarding the reopening of schools saying, "Experts foresee a third wave, but how can parents expect their children, who are most likely in elementary school or even high school, to send their children to such a situation? When it comes to third wave, the school faculties are also a little sceptical."
He said, "What assurance do you have that the SOPs will be followed in the schools? How can I expect a nursery child to maintain social distance or a KG child to ensure that his or her tiffin is not shared with anyone? There is no transportation provided by any of the schools, which causes a great deal of hardship for parents. What about that?"
Dr Smita Malhotra, Senior Consultant, Pediatrics from Apollo Hospital, answers, "Let us also keep in mind that everything must be viewed in context. We can't pick and choose which of our fears to deal with. You've all seen the images from when we first launched tourist destinations like Manali, when restaurants were completely booked. We are up and about when we have to enjoy it, but we are anxious when it comes to school. Everyone is attending meetings, parties, and get-togethers to celebrate festivals. In life, there is always a risk-benefit ratio that must be considered. Currently, the statistics are constantly low. So if not now, then when? This is the moment when we must go outside; it is an opportunity for us to witness what occurs. It's always a dynamic scenario, where we can always close back down if there's a surge."
"As we all know, children are susceptible to a variety of anxiety disorders, it is quite tough to persuade them to follow the procedures, and they must attend school for 6-7 hours, which is an extremely long period of time. We need to come up with some ways that are both practical and offer a reasonable level of safety. For example, if we have to instruct them to wear a mask at least when they are in class with each other and not on the playground, where they may be separated, they must wear a mask that covers their nose and mouth," said Dr Krishnan Chugh, Principal Director, HOD, Pediatrics from Fortis, Gurgaon.
He added, "After each period, we need to give them a 10-minute break so they may remove their mask, take a big breath, put it back on, and return to class. The other is that there should not be as many children in the class as there were previously, which implies that if a class previously had 40 desks, we should now limit it to 20 or even less."
According to Dr Chugh, "India is a massive nation. What is true in Delhi may not be true in Kerala, where the second wave is still ongoing. We will have a solid notion of what needs be done till Diwali when we open schools while keeping our children secure. The schools should thereafter be shut for at least 3 to 4 weeks to assess the impact of the Diwali celebrations, and then reopened if no spike is seen."
While talking about whether the schools should start offline classes for 6th standard onwards, Dr Malhotra explained, "I believe we should reopen because we are seeing a lot of youngsters with a variety of health problems as a result of being locked indoors for over a year and a half. We've seen a lot of kids with psychiatric difficulties, weight issues, and stomach concerns that aren't caused by anything organic. They have a lot of problems, so they need to go on with their life, and I believe that youngsters, as we all know, have the lesser sickness and that the people around them are fully vaccinated."
In contrast to this, Dr Shuchin Bajaj, Founder of Ujala Cygnus Group of Hospitals mentions, "Since everything else has reopened, we've already passed the deadline for reopening. We've already seen that children in Delhi have a nearly 60% sero positivity rate, so we're confident that they'll have a mild disease. However, as you pointed out, everyone around these children, whether teachers, sports staff, or parents, needs to be vaccinated as soon as possible, because the pre- and post-covid eras will be very different. We need to educate kids how to follow covid protocols once they enter school."
In assurance to the parents' anxiety, Dr Bajaj said, "Unfortunately, we are overlooking the fact that the great majority of Indians do not have access to all of these resources, resulting in a significant digital gap. We are overlooking all of the students who do not have access to phones or other digital gadgets in order to attend class. We're overlooking those who only have one smartphone at home and their father to take it to work. I simply want to comfort parents who are worried that if their children can carry the virus home, so can you."
"If you don't go out, if you don't work, if you stay at home all the time, it's reasonable to expect your children to do the same, but if you go to the office, to parties, and then expect your children to stay at home because there's a risk of them contracting the virus, that's completely unreasonable. Even if you are concerned, rest assured that all schools will make it voluntary for you. It is not mandatory for you to send your children to offline lessons, but please enable children who require a physical environment, are developing psychological difficulties, are obese, or are losing confidence to do so," he added.