Chances of 3rd Wave 'Very Low' Yet Reopening Schools Shouldn't be Rushed: Top Scientist

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Chances of having a nationwide third wave are "very low" and if it happens, it will be far smaller compared to the second wave, former ICMR scientist Dr Raman Gangakhedkar told in an exclusive interaction.

The epidemiologist, who was the face of the Indian Council of Medical Research (ICMR) during government briefings on Covid-19 last year, said the decision to open schools should not be rushed as some latest studies suggest long term side-effects of COVID19 infection among children, as well.

"There should be a decentralized approach to open schools. Decisions (to open school) should be taken based on the number of cases in a certain area."

The top scientist, who retired from ICMR in June in 2020, believes that Covid19 may end up like an influenza virus — the one that came as a pandemic and now circulates in our environment causing regular cold and flu, seasonally.

"With vaccines, people might remain asymptomatic or get mild symptoms after infections. They may not go for testing due to which the number of infections, with the time, fall," he said.

According to the fourth serosurvey, around two-third of the population has developed antibodies. "There is a wide range in the seroprevalence of antibodies against Covid-19 from Madhya Pradesh (78%) to Kerala (44%). It suggests that there is a variation in the proportion of people who are vulnerable to Covid in different states."

Since the basic drivers of this infection — population density, mobility, migration and adherence to Covid appropriate behavior —differ between states and if the third wave is to occur, its timing, places and intensity will differ, he said while adding that "the focal outbreaks will occur in vulnerable areas before Covid becomes endemic, eventually."

As vaccine coverage would increase, India would report fewer cases of hospitalisations, severe disease, and death.

"However, we will continue to record an increase in the number of infections because the vaccines do not confer 'sterilizing immunity' that can prevent infections as well. These vaccines are disease-modifying but not capable of protecting people against infection," said Gangakhedkar.

‘No reason to worry unless we find new strain’

"While the number of cases could possibly go up, there is no reason to worry unless there is a new strain against which these vaccines don't work," said Gangakhedkar.

Dr Gangakhedkar, who was involved in the prevention and control strategies against the HIV epidemic in India, said that right now, there is no such variant insight that has the potential to cause the next wave.

"The newer variants of interest, Lambda, Mu and C.1.2 appear to be mutating rapidly but are yet to stabilize to gain fitness better than delta. Also, the symptomatic reinfection rate is very low, around 0.2%."

However, he added, there is a need to follow Covid appropriate behaviour irrespective of our vaccinations status as it is the best protective measure against acquiring new infection even if one is exposed to new variant/s. "Every adult should take a vaccine to minimize the risk of death due to Covid."

The central government, Gangakhedkar said, should monitor numbers requiring hospitalisations and deaths due to Covid19 infection, very closely, rather than the number of infections.

"The virus will spread in areas where the first and second wave may have been less intense. The virus will affect those who are still not vaccinated, especially the older individuals and those with chronic morbidities, though it may cause infections in many."

"These focal outbreaks of infection will keep happening in one or the other part of the country but I don’t think there will be a rise in the number of cases across all states," he said.

Children going back to school

Till now, we understand that the children have a stronger innate immunity that protects them from developing the severe Covid19 disease, the top scientist said.

They tend to develop asymptomatic or mild infections, mostly. "However, we should not ignore the recent studies and research papers that point towards the long covid or post Covid19 syndrome noticed in children as well. We need to be cautious," he said in an alarming tone.

"In adults, we have seen that Covid-19 infections lead to the unmasking of diabetes, obesity, memory fogging, insomnia and several other problems. Covid19 can impact almost every organ in the body during infection."

"Hence, for children, we need to take baby steps," Dr Gangakhedkar advised.

The study quoted by Dr Gangakhedkar involves samples of more than 6800 children and young people who reported symptoms such as tiredness, headache, shortness of breath even after three months of testing positive.

"There should be a decentralized approach to open schools. The decision to open schools should be taken by district administrations based on the number of new infections observed — in the blocks — in the last two weeks. We need to understand the local epidemiology and then decide."

"We must understand that in India, children's health is a sensitive issue. Education is as important but a balanced approach is ideal," he said.

He suggested that the central government needs to form guidelines to open schools for the states to share with district administration the criteria for opening the schools in a calibrated manner.

"Covid is teaching us so many things and this is what I understand through my experience. For Covid related decisions, no one can be cent per cent sure what will work best and what won't work at all. We need to continue to learn and be flexible in our approaches."

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