Doctors say hasten vaccination and include those under age 18; warn of preparing for paediatric patients
Despite 80 per cent of Israelis having received both doses of the vaccine, the country reimposed the wearing of masks. Pic/AFP
With the threat of the new Delta and Delta Plus variants of COVID-19 that have hit some countries, looming large over India, health experts talk about the likely impact here. Though the state government has come up with new directives, only time will tell the extent of impact of the new variants which are expected to hit in the next three to four weeks.
Dr Wiqar Shaikh, professor of Medicine, Grant Medical College and Sir JJ Group of Hospitals, has expressed serious concerns regarding a report in the Wall Street Journal (WSJ) on June 25, which said that half of the adults infected in Israel in a fresh outbreak of the Delta variant had received two doses of the Pfizer vaccine. This is alarming, he said. Dr Shaikh said that the report suggested that approximately 90 per cent of the new COVID-19 infections were caused by the Delta variant. This has prompted the Israeli government to reimpose the requirement of masks and the imposition of fresh curbs is being reassessed. Israel had around 10 new cases of COVID-19 per day for most of June 2021, which jumped to more than 200 cases per day last week.
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Dr Fazal Nabi, Jaslok hospital
Dr Shaikh added, "Israel has a population of 93 lakh and since last year COVID-19 has infected more than 8.4 lakh of whom more than 6,000 have died. He said that interestingly enough, 80 per cent of Israelis above the age of 16 years have received two doses of the Pfizer COVID-19 vaccine, while only 22 per cent or 36 crore of the population have received the vaccines in India till date."
Dr Shaikh quoted Sharon Peacock, chairman, COVID-19 Genomics, UK, who said that the Delta variant (B.1.617.2) is approximately 40 per cent to 50 per cent more infectious and more transmissible than the original COVID-19 virus. The Delta variant is today present in at least 60 countries around the world and in fact, more than 1,700 cases of the Delta variant have been detected in the USA. India has now begun to report cases of the Delta plus variant, which is a further mutation of Delta.
Dr Shaikh referred to an article in the Lancet on April 10, which concluded that the AstraZeneca COVID-19 vaccine is less effective against the Delta variant. He further quoted that the WHO on June 22, said that COVID-19 vaccines are less effective against the Delta variant.
What does all this imply for India? Dr Shaikh said, "India will need to be very vigilant regarding the third wave as also the Delta variant which was first detected here." Dr Shaikh expressed greater concern regarding the Delta plus variant (B.1.617./.1/AY.1) which is expected to be part of the third wave. He said that COVID-19 vaccine manufacturers will urgently need to modify the vaccines to ensure that they are effective against both the Delta variant and the Delta plus variant. In the light of the WSJ report, Dr Shaikh concluded that a serious effort needs to be done in India as a joint public: government collaboration, so that COVID-19 fades away at the earliest.
Many Indians work in Israel, and few people this paper spoke to confirmed that they have been directed to wear masks from the coming week. Israel was amongst the few countries that had vaccinated its people and lifted the COVID-19 restrictions.
A native of Kerala - who did not wish to be identified - based in Israel, said, “There have been cases of COVID again, on Friday, nearly 160 cases were reported. The government of Israel has now made it compulsory for people to wear masks when they venture out and even at home. Also, the vaccine programme will continue. We are taking regular precaution. COVID was under control in Israel a few months ago, and people here would adhere to the safety directives.”
Sherly Benny, 47, sister-in-law of Soumya, who hails from Kerala and has been working as a caregiver in Ashdod city of Israel for decades, said, “Everything was normal until recently when Cochin Jews settled in Israel for decades, organised a memorial for my late sister-in-law, Soumya Santosh from Idukki, Kerala. She was killed in the Hamas missile strike at Ashkelon on May 11. The event was organised at a community centre in Tazo, near Jerusalem and was attended by many Indians based in Israel. A fund raiser to support Soumya’s son Adone’s education was also announced, said Sherly.
“In India we have 500 million children, roughly 25% already have COVID antibodies by natural infection. The third wave will be seen not only in children, but also adults who do not have antibodies,” said Dr Fazal Nabi, director of the paediatric department, Jaslok hospital.
“With the past experience of the first and second wave, most of the countries will have to face the evolving new delta variant, including India. The only difference during the third wave is that a large section of the population will have developed antibodies either by infection or vaccination, so we do not expect them to develop severe or complicated COVID infection. Only way of preventing this is by hastening the vaccination programme and including the under 18s,” said Dr Nabi.
The health ministry in coordination with the paediatric task force including the Indian Academic of Paediatrics (IAP) have laid down guidelines for COVID management and started training medical personnel and paramedical staff.
“Despite our preparedness, it will be tough to handle a large number of severe complicated COVID cases, which are unexpected. Till today God has been kind to the young population as we are seeing milder cases. It is challenging for the medical fraternity to prepare for the third wave because children need different sizes of catheter tubes and airway connections including ventilators,” explained Dr Nabi.
Dr Santosh Bansode, Head of the Department, Emergency Medicine, Wockhardt Hospitals, Mumbai Central, said, “The Delta variant is spreading in many countries and research shows that its infectivity is more than the alpha variant and it is also infecting vaccinated individuals. If it starts spreading here in India, we will get bigger third wave. Also, as speculations are made by various experts that children will be more affected in the third wave, we might get more paediatric patients. We must keep in mind that 33% of the Indian population is between 1 to 18 years of age which is a huge number.”
“Since we suffered lot in the second wave, we have increased number of oxygen beds and our oxygen production. But if the third wave is bigger than the second wave, then again, we will face shortage of beds and oxygen. Also, how many paediatric ICUs do we currently have? What is our capacity to treat mass paediatric patients? We must prepare ourselves for it,” Dr Bansode said.
The doctor added, “We must try our best to avoid the third wave by taking more precautions now. I can understand that unlocking is important but we must unlock slowly and increase the speed of vaccination. We must continue using masks, sanitisers and social distancing”.
Dr Bansode concluded, “We must increase awareness among people about the Delta variants. We must take care of children and unvaccinated people as they are more vulnerable. Precaution is always better than cure. Since now we know about the spread of the Delta variants in other countries, we must take immediate and strict precautions to avoid its spread here in India.”
How to tackle the third wave
According to Dr Nabi, following points may be looked into, along with already slated line of action
- Train medical and paramedical staff
- Procure medical equipments and paediatric store items
- Vaccinating under 18s
- Helping and guiding parents, family physicians and paediatricians
- Highlighting large number of mild cases and recovering severe cases by the media, instead of highlighting only complicated cases which leads to parents’ anxiety
- Educating parents through TV channels
- Timely financial support from the government, institutes and hospitals to form paediatric teams
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