8^thMay, 2021, 11am-12pm

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 cases and deaths in south Asia region 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 especially in rural areas. Complacency set in when cases declined in February. The virus mutated fast to its advantage. Only 2.6% population has been vaccinated so far.
• There is a huge demand and supply gap in view of the sheer large number of the cases. Health system seems to be collapsed.
• We have not learnt from the previous wave. The third wave is inevitable given the current situation – covid-inappropriate behavior and reduced vaccination pace, virus mutations, rural areas (which are vulnerable pockets), immune evasive variants.
• Total 16.5 Cr vaccine doses have been administered. This number is still very low, given the huge population that needs to be vaccinated to achieve herd immunity.
• 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.
• The time of occurrence of the third wave is still speculated; it could be wider and deadlier, will it affect the young healthy individuals third wave and children more , remains to be seen.. There is adaptive pressure on the virus in order to survive. Will the virus evolve further? Will it be as transmissible as now or more?
• 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 super spreader events and crowds, early detection of new variants. Asymptomatic and infected persons may lose immunity in 6 -8 months.
• Possible prevention and mitigation measures: Prepare incrementally and implement what has been learnt from the second wave. Community awareness needs to be increased. Other measures include aggressive vaccination, microplanning (communication and surveillance strategy), oxygen generation plants at health care facilities, rapid genome sequencing of virus, continued collaboration, budge and funding and political will.
• Three pillars to disrupt the chain: best behaviour; quick vaccination; isolation, testing, tracking, treatment and containment.
• Never lose sight of the current wave.
• Whenever there is lockdown, the immunization 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 clinical 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 and NICU beds. 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 and home management 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 workforce is going to be a bigger problem in the future. Plan and identify now ways to increase healthcare workforce including doctors and nurses.
• All hospitals should increase their bed strength and equipments (such as oxygen supplies, ventilators,).
• Community involvement and their participation are very important.
• There is an urgent need to discuss strategies to upgrade and strengthen primary health care
• An integrative approach should be adopted; there should be only one source of authentic information.
• We need to act now and not just plan.

Participants

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