“But what was before us we know not,

And we know not what shall succeed…

Haply, the river of time—-!”

Nineteenth century poet and critic Matthew Arnold, in his famous poem “ The Future “ puts so aptly — unpredictability of future. We did not know SARS COV 2 before and don’t know how will it end but pandemic will end for sure if we trust and follow science. After tumultuous second wave of SARS COV 2 running amok in most parts of our country and killing lakhs of people and torturing even more, the fear for third wave is quite understandable.

Fortunately Government appears far more serious this time as if amending for the mistakes in second wave and trying to do things right beginning from revised vaccination policy, allocation of vaccines to states at zero cost, solving distribution knots and making vaccine access reasonable. Eased regulatory approval for vaccines made outside India such as Sputnik, Johnson and Johnson, Moderna’s mRNA, has increased the availability of vaccines in India which has a very large population to cater to. The just arrived zydus india - made plasmid DNA vaccine in our portfolio, is another shot in the arm, which shows increasing prowess of Indian R & D capabilities.

There has been significant effort recently to counter the influence of groups against vaccination by involving opinion leaders and applying social pressure. The anticipated arrival of third wave contemplates sudden increase in case loads of covid within a limited time period leading to undue stress on the system and resulting higher fatalities. This can happen after two to four months from now but it can be impeded if we speed up the vaccination rate to reach a target of one crore jab a day which is possible and we have recently shown it too with better co coordinated efforts! In the meantime we should keep building appropriate infrastructure. Tracking the virus variants by genetic sequencing, tracing the contacts, isolating and treating them appropriately remain a challenge. At the same time reminding people of the importance of COVID appropriate behaviour which is the most powerful protection mechanism irrespective of viral variants.

Predicting surge of third wave will much depend on appearance of newer variants such as delta , delta plus and future variants of concern . Much will depend on degree of infectiousness and fatality rate of the virus variants, pitted against susceptible population or those with adequate acquired immunity due to vaccination or asymptotic infection in the past within the defined geographical location. Most Current Sero - surveys (antibodies present in population under scan) carried out in Maharashtra and some other parts of India , suggest  about fifty percent people have developed pre formed antibodies against the aforesaid virus. Thankfully the recently detected, Delta plus variant, which has infected just around one hundred person till today ,shows that Delta plus is not much different from the Delta variant.

If at all the third wave finally arrives, it will be only because of careless behaviour on the part of people in general and enforcement agency in particular. Children and adolescents below the age of 18, pregnant ladies and disabled people, are the most likely target of the third wave because none in the above group are covered by vaccination so far. However, there are some sero surveys which have shown that over 50 per cent children have developed protective antibodies against SARS COV 2 and therefore they are likely to stay protected if there is third wave. However, It is high time we should immunise the uncovered population as early as possible with safe and efficacious vaccine which we are likely to obtain within next few weeks as trials are in advanced stages with favourable result indicators.

Sad to see that even in our country there are people who are against vaccination and they continue to mislead people by wrongful interpretation of the situation. They must be isolated by all forward looking people amongst us because they endanger not just themselves but it weakens overall immunity of our society, the herd immunity.

Fortunately Children who suffer from COVID SARS 2, are relatively less in number and the severity of the illness is also proportionately less. However , a small fraction do get a peculiar form of the disease known as “multi system inflammation in children (MIS- C ) syndrome-    “. This is characterised by high fever with excessive weakness ,vomiting with pain abdomen ,red eyes and red lips, rose berry tongue and very rapid heart rate generally seen in children in 2 to 15 age group . Usually cough with or without mucoid expectoration , unusual muscle ache may herald onset of this virus disease .

Early intervention by a paediatrician is very critical as it may be life saving . The treatment of MIS-C is different from adults and requires besides steroids, high dose intravenous immunoglobulin which is not favoured in adults. COVID treatment in pregnant ladies is not much different from other adults but here outcome much depends on well-being of foetus. Govt of India has just informed that Vaccine is safe for pregnant women and can get vaccinated as any other adult . However , it will be wise to completely isolate her for the entire period of pregnancy and parturition.

The author is former Professor and Head of medicine, RIMS, Ranchi.

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