COVID-19 second wave leaves doctors in Kerala baffled
Public health experts and and infectious diseases specialists warn that Kerala must be ready with its mitigation plan
The intensity of the second wave of COVID-19 that is sweeping across the States is beginning to be felt in Kerala, where the case graph has begun to rise.
Public health experts and infectious diseases specialists warn that though the State has started an aggressive vaccination drive in the 45-plus age group, it should be ready with its mitigation plan to counter the second wave, which appears to be more severe, intense and fast-paced.
“We still do not have adequate knowledge about the virus and should be very careful about extrapolating its behaviour during the last wave. Unlike in the first wave, we find that the virus is creating more immune mischief now so that our margins for treatment are much narrower and the time to respond, much less,” says Subramanian Swaminathan, an infectious diseases specialist at Global Hospital, Chennai, and a governing council member of the Clinical Infectious Diseases Society.
Relaxation of norms
Premature declarations about India conquering the pandemic seems to have lulled people into relaxing wearing of masks and physical distancing norms, one of the reasons for the current surge in cases, he feels.
“What is worrying is that the burden of infection this time has shifted to the younger age group, who currently do not qualify for COVID-19 vaccination. More than a third of my patients are less than 50 years and I have many younger patients in ICUs, with significant COVID and lung injury,” Dr. Swaminathan says.
In Tamil Nadu, he says the rising trend in cases began early February but that it has “really taken off” in the past 10 days. Hospitals in Chennai are struggling to provide beds for everyone.
“My patients are younger, mostly unvaccinated and their disease progression unpredictable, with many worsening in a matter of hours, requiring oxygen. The response to steroids has been unpredictable too and even though the drug Tocilizumab is effective, the therapeutic window of opportunity seems to be quite small. I am also seeing more symptomatic cases and more women patients than before,” he says. The same is being reported by doctors in Ahmedabad and Mumbai too.
Dr. Swaminathan suggests that the government should network with various treatment centres, collate clinical data and put together a harmonised treatment protocol so that more lives can be saved.
It is still not clear if it is the emergence of new variants that has fuelled the current surge in cases, even though the Union Health Ministry contends that “the variants of concern have not been detected in numbers sufficient to either establish a direct relationship or explain the rapid increase in cases in some States”.
“Part of the spread could of course be due to the emergence of mutant variants. We have little information on the clinical relevance of many variants of interest, even though the E484Q and L452R mutations in Maharashtra or the N440K in Kerala are said to confer immune escape and increased infectivity to the virus,” says R. Aravind, Head of Infectious Diseases, Thiruvananthapuram Medical College.
However, the arrival of vaccination seems to have fuelled a false sense of security among people and it is the lax behaviour and violation of mask wearing and physical distancing norms that have suddenly escalated the current transmission, he feels.
“The only cheerful bit here is that the vaccines work and that our healthcare providers are now vaccinated. We have not seen serious diseases in anyone who has completed at least three weeks after the first dose. Accelerating the pace of vaccination is imperative, but we may not have much time,” Dr. Swaminathan adds.