HCFI Round Table Expert Zoom Meeting on “Preparing for the third wave in India”

President CMAAO and HCFI

8^th May, 2021, 11am-12pm

Participants: Dr KK Aggarwal, Dr Suneela Garg, Dr Mahesh Verma, Dr Ashok Gupta, Dr Alex Thomas, Dr Girdhar Gyani, Dr Anita Chakravarti, Dr Jayakrishnan Alapet, Dr DR Rai, Mrs Upasana Arora, Dr KK Kalra, Dr Anil Kumar, Ms Ira Gupta, Dr S Sharma 

Consensus Statement of HCFI Expert Round Table

• The second wave in India is very aggressive vis a vis the first wave. The number of daily cases has crossed 4 lakh and daily deaths are more than 4000. Ninety percent of deaths in south Asia are contributed by India. Now children are also being affected. About 40% cases are being reported from rural areas.
• There is still lot of ignorance about the disease. Complacency set in when cases declined in February. The virus mutated fast to its advantage. Only 2.6% population has been vaccinated.
• There has been a collapse of the healthcare system in view of the sheer number of the cases. 
• We have not learnt from the previous wave. The third wave is inevitable given the current situation – covid inappropriate behavior and reduced vaccination. 
• Yesterday, there were more than 36 lakh active cases; recoveries were more than 1 cr 76 lakh.
• 11.81 vaccine doses (1^st dose) were administered yesterday in the 18-44 years category. Total 16.5 Cr vaccine doses have been administered. This number is still very low, given the huge population.
• Some states like Punjab, Jammu & Kashmir, Assam, Himachal Pradesh, Puducherry, Meghalaya, Tripura, Nagaland and Arunachal Pradesh are showing an increasing trend, which is a cause for worry.
• Some reasons for the third wave: Previous infections and vaccinations can cause the virus to mutate, lowering the guard, we are still far from achieving widespread immunity, rural areas are vulnerable pockets, immune evasive variants, the virus can break through the enhanced host immunity.
• The third wave is inevitable although the time of its occurrence is still under speculation; it could be wider and deadlier, there is likely to be community spread, will it be as ferocious as the second wave or will it affect the fitter individuals, remains to be seen. Breach of immunity of 1^st and 2^nd wave is likely. There is adaptive pressure on the virus in order to survive. Will the virus evolve further? Will it be as transmissible as now? 
• The third wave is typically smaller, but multiple parameters together can be exponential.
• Potential factors influencing the third wave: proportion of vaccinated persons, prevention of superspreader events and crowds, early detection of new variants. Asymptomatic and infected persons will lose immunity in 6 months.
• Possible prevention and mitigation measures: Prepare incrementally and implement what has been learnt from the second wave. Awareness needs to be increased. Other measures include aggressive vaccination, microplanning (communication and surveillance strategy), herd immunity, oxygen generation plants at health centers, rapid genome sequencing, continued collaboration, budge and funding and political will.
• Three pillars to disrupt the chain: best behavior, quick vaccination, tracking, isolation and containment.
• Never lose sight of the current wave.
• Whenever there is lockdown, the immunisation program should not suffer.
• There should be strict punishments for noncompliance to lockdown guidelines, especially in vegetable markets etc.; paramilitary and military forces can be involved to implement this. 
• Not wearing mask should be made a criminal offense.
• The third wave is more likely to affect children; if this happens, arrangements will have to be made for parents to stay with the child in the hospital. Another concern is lack of vaccination for children. We need quick trials for children. Canada has authorised Pfizer vaccine for children aged 12 years and above. We need to have standard protocols for management of children and start preparing pediatric ICUs. Pediatric formulations of different medications will be needed. Sample collection will be a challenge with children.
• Challenge is huge: supply chain management, infrastructure
• There should be an inventory for everything such as oxygen, drugs, ICUs.
• Vaccinate as fast as possible.
• Waste management guidelines for Covid facilities have to be strictly enforced. 
• Expand telemedicine and teleconsultation services. Teaching videos should be developed as manuals for pediatric patients.
• Lack of adequate number of healthcare workers is going to be a bigger problem in the future. Human resources are a must. 
• All hospitals should increase their bed strength and equipments (such as ventilators).
• Community involvement and their participation are very important.
• There is an urgent need to discuss strategies to upgrade and strengthen primary health care setup.
• An integrative approach should be adopted; there should be only one source of authentic information.
• We need to act now and not just plan.

Dr KK Aggarwal

President CMAAO, HCFI and Past National President IMA