Pandemic’s next wave is imminent: Is Kashmir prepared this time?

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As the daily cases of Covid-19 infections drop across India, with the vaccination drive still lagging behind, experts fear that the country of more than a billion may soon go through a third and yet another devastating wave of the pandemic.

Randeep Guleria, the director of the All India Institute of Medical Sciences (AIIMS), New Delhi, warned that the third wave could hit India in the upcoming six to eight weeks.

“We need to work aggressively to prevent another large wave till vaccination kicks in,” Guleria warned.

In Jammu and Kashmir, a region that lags behind in its regional healthcare infrastructure, to reduce the chances of a third wave, vaccination is the only answer, suggested Mohammad Salim Khan, Head of the Department (HOD), Community Medicine at Shri Maharaja Hari Singh (SMHS) hospital Srinagar.

As of June 2021, around forty lac people, or thirty percent, have received the first shot of Covid-19 vaccine in J-K, he said quoting the government’s numbers. As per the government vaccination data around thirty-five lac people have received the first dose of vaccination while only around six lac people have received the second dose. “What is required is that those who haven’t gotten themselves vaccinated, should come forward and get vaccinated to protect their families,” he said.

Recently, “Delta Plus” was detected in India. It is a sub-lineage of the Delta variant, an existing variant identified in India last year. Many scientists believe that the mutation coupled with the existing features of the Delta variant could make the virus more transmissible. On 23 June, the first case of Delta Plus variant of coronavirus was detected in Jammu and Kashmir.

The term ‘wave’ is often used to describe the upward and downward trend of the number of infections in any pandemic, containing a peak, over a prolonged period of time.

“Then as the mutations happen, the virus becomes more virulent and the cases increase. Therefore, a second wave occurs,” Khan said. “Similar pattern is followed as more waves continue to occur.”

As seen in the previous pandemics, around four or more waves are seen till an immunity is created amongst the masses, either by natural infections or by immunization, Khan explained. “The more the people are vulnerable, the more the virus gets aggressive in nature,” he said.

The administration formed an advisory committee to tackle the probable third wave in May 2020.

In its report, the committee, headed by Mohammad Sultan Khuroo, eminent Kashmiri doctor, said that the next wave could occur within six months of the decline of the second wave and called for intensive surveillance till December 2021.

“It is speculated that the population segments involved in the first and second wave may be less affected or not affected at all. So children, pregnant women, and the suburban population need to watch out more closely,” Khuroo wrote in the report.

The government will be employing a surveillance protocol to monitor and block the Covid-19 third wave has been devised based on several principles including sequencing, travel advisory policy, Covid-19 appropriate discipline, serosurveys to evaluate population susceptibility and aggressive and vaccination policy and program.

“With all this, our endeavour should be to change the status of a possible Covid-19 third wave in J&K from a fact to fiction,” the report noted.

However, the preparedness and the lessons learnt, if any, would be only clear in hindsight, The Kashmir Walla analysed the previous regional trends.

First and second wave

Kashmir reported the first case of Covid-19 in March last year after an elderly woman, with international travel history, tested positive in Khanyar area of Srinagar.

In the next few months, the cases continued to surge in the first wave. By September last year, Kashmir reached a peak when the valley continued recording around 1,700 cases on a daily basis, the highest till then.

The numbers then quickly dropped to a hundred daily cases and no deaths reported for days on stretch during February 2021. The guards were lowered. And grand invitations were sent to tourists to visit Kashmir from across the country.

Then the second wave hit, paralysing the healthcare infrastructure of metropolitan cities like Mumbai and New Delhi.

On 1 April, J-K had 2,874 active cases of the infection — 2,150 cases were concentrated in Kashmir. The Srinagar city with more than a million residents remains the worst-hit in Kashmir.

In Kashmir, the second wave reached its peak in May when the cases recorded on a daily basis reached 5445 in a single day — marking yet another grim milestone.

Till 1 March this year, the death rate in J-K had reached 1958, 1233 deaths reported in Kashmir. By mid-May, the death rate across J-K increased by around 2000 as it reached 3090 on 15 May. In the next fifteen days, J-K reported around 900 more deaths and the death rate reached 3939 on 1 June when the peak of the second wave had started coming down.

Till 24 June, J-K recorded 345 new deaths and the death toll reached 4284. 2197 out of these have been recorded in Kashmir.

During the second wave, hospitals along with the help of several non-profit organizations in J-K managed to keep the fragile healthcare system afloat, even as there was a high inflow of patients in need of oxygen and Intensive Care Unit (ICU) beds.

News, visuals, and SOS messages circulating across social media platforms revealed the helplessness of people begging for hospital beds and oxygen to save the lives of their loved ones while crematoriums and graveyards overflowed with dead bodies of Covid-19 patients.

By the end of May, from a daily case count of more than 1,500 cases, the stats dropped to less than 1000 in the middle of June.

From 1 June to 24 June, the active cases in J-K dropped from 33276 cases to 6537 cases, an 80 percent dip in the active positive cases.

In J-K, experts, however, have constantly been warning the public to not let the guards down and to maintain Covid-19 appropriate behaviour in order to protect the region from a similar situation witnessed in states such as New Delhi and Maharashtra, where the second wave left the healthcare system in shambles.

‘Increase the guard’

After the first wave of Covid-19, people across J-K were “complacent and unaware about the nature of the virus,” said Khan, HOD, Community Medicine at SMHS hospital, Srinagar.

However, after witnessing the second wave, he assured that the lessons have been learnt by people as well as the administration. “There was a scarcity of ICU beds or oxygen or medicines. All these things were taken care of by the government and people here didn’t suffer as badly as they did outside,” Khan added.

“The preparation on the part of the government is adequate till now,” he added. “The vaccination drive is also going on so if more and more people get vaccinated then the chances of a devastating third wave are less.”

With the risk of an upcoming third wave, medical experts have been pushing more and more people to get vaccinated as it can help reduce the impact of the upcoming wave. “An aggressive vaccination program in all eligible groups is a powerful tool to evade the possibility of a possible third wave,” Khuroo has written in the report.

“Around 93 percent of deaths were in the populations who did not take any vaccine, 7 percent in those who had taken one dose of vaccine, and no deaths in the population who had taken both doses of vaccine,” he mentioned further.

Many believe that the third wave may impact children more as during the first wave most of the cases included elders and during the second wave, many young people got infected and even died due to Covid-19. However, as we reached the end of a second wave, people above the age group of 18 have been getting vaccinated. But the children still remain unvaccinated.

However, Khan said that many children tested positive even during the second wave of Covid-19 and not many children got admitted to hospitals. “In order to prevent children from getting infected during the third wave, adults should get vaccinated,” he said. “The elders need to know that they should get vaccinated to protect the children of the family.”

In the action plan devised by the advisory committee, Khuroo has suggested that the development of variants in J-K needs to be monitored through the process of sequencing of the SAR-COV-2, the agent for Covid-19.

The advisory committee has also laid emphasis on the creation of a policy for travel advisory, planning and testing of all visitors to J-K. Moreover, serosurveys should be done at regular intervals in defined population groups to evaluate susceptibility and degree of herd immunity in the population.

Mir Mushtaq, the spokesperson of Directorate of Health Services Kashmir, said that the predictions of a third wave are speculations based on the behaviour of the virus. The healthcare department’s staff was more widely seen on ground, visiting hospitals and far-flung areas to create awareness about the vaccination and to check on the situation of district and sub-district hospitals, Mir said.

“Following the directions of the Director of Health Services of Kashmir, we have gone to the door of the people. Instead of people coming to us, we are going to them,” he said. “That has been a game changer.”

The healthcare department has also been training doctors, paramedics, anesthetists and medical officers for ICU management, resuscitation of pediatric patients, and on how to create pediatric ICUs, Mir told The Kashmir Walla. He added that the preparations are being done at a grassroot level including the district level hospitals.

Based on the shortage of oxygen and hospital beds seen in various states of India during the second wave, the administration has taken measures to sustain the oxygen supply, said Mir. “We don’t see a shortage in the future even if a third wave comes.”

Mir said that the people need to continue believing that even after a decrease in cases, Covid-19 virus has not gone anywhere and is a “hidden enemy”. “Standard Operating Protocols are universal, whichever wave is there,” he said. “We need to increase the guard even more than before.”

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