India Covid second wave coronavirus
People cremate bodies of victims of coronavirus at a crematorium in New Delhi, India Image Credit: Reuters

Highlights

  • During an outbreak, epidemiologists refer to “waves” of infections to analyse different periods of spikes and drops in cases. 
  • They analyse the role social distancing policies and vaccinations play. 
  • Europe, East Asia, Latin America — and now Africa — are getting hit by either a second or third wave of the pandemic.
  • Some countries may be edging towards a much grimmer situation as people throw caution to the wind due to the so-called “COVID fatigue”.
  • Virologists call for a “Delta Wall” of vaccinations against the variant  that's currently dominant.
  • A highly infectious new variant, known as Delta Plus, has also emerged.

DUBAI: Time is running out, say virology experts. Vaccinations need to be ramped up everywhere, not just in rich countries. The highly transmissible virus is mutating fast, with new variants gaining even more transmissibility.

Vaccinations have proven unbelievably effective, but the much-needed vaccines are not being produced and distributed fast enough — it’s not a small world, after all.

Today, top epidemiologists say this much: the planet needs a “Delta Wall” — via vaccinations, in addition to social distancing measures. These are the two big weapons at man’s disposal to flatten the curve of the oncoming new “wave” of infections and deaths. Now, there’s the “Delta plus” variant of the SARS-CoV-2, too.

Customers line up at a store at the Bhagirath Palace wholesale medicine market in New Delhi, India, on Wednesday, May 5, 2021. The coronavirus wave that plunged India into the world's biggest health crisis has the potential to worsen in the coming weeks, with some research models projecting that the death toll could more than double from current levels.
Image Credit: Bloomberg

Here’s what we know so far:

What is a COVID-19 wave?

“Waves” are a concept in epidemiology, that literally mimic the physical movement of the sea over a given time. Guided by data scientists, epidemiologists track the numbers, interventions and length of time during which the “wave” is seen over a specific geographic location (district/country/region).

They also analyse the role health policies such as social distancing play in delaying or “flattening the curve” of the present wave.

What countries had been hit by the 'third wave'?

The third wave has hit most of the world, from Asia, to Europe, the Americas and, now, Africa. A big factor in this are the variants, mutations of the original SARS-CoV-2, including the Alpha, Beta, Delta, Kappa and the new "Delta Plus" strain.

Delta Plus
Image Credit: Seyyed dela Llata / Jay Hilotin / Gulf News

Africa: Shortage of vaccines, medical equipment

In Africa, there is worrying increase in cases and deaths, even as cases drop, especially in North America. The improving situation in other parts of the world “masks a worrying increase in cases and deaths in many countries," Tedros Adhanom Ghebreyesus, the director-general of the World Health Organisation (WHO) said recently. “The steep increase in Africa is especially concerning because it is the region with the least access to vaccines, diagnostics and oxygen,” he said.

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In this Friday, Nov. 13, 2020 file photo, people queue to be tested for COVID-19 at the Livingstone Hospital in Port Elizabeth, Eastern Cape Province, South Africa. Image Credit: AP

In many parts of the continent, governments face alarming shortages of funds and vaccines. The rate of coronavirus cases is rising — in Togo, Gambia, Sierra Leone and Senegal, there is a shortage of vaccines and medical equipment. Conflicts in Ethiopia, Mali and the DR Congo are not helping the situation.

In Uganda, the number of new daily cases has shot up in the past month and had reached 1,400 by June 15, according to Our World in Data. Ugandan President Yoweri Museveni announced a strict lockdown on June 6. In the neighboring DR Congo, President Felix Tshisekedi warned of a "fatal third wave”.

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Paramedics Michael Makhethe, right, and Clive Moleso working from the Saaberie Chishty ambulance service, transfer a COVID-19 patient to the hopistal in Lenasia, South Africa, Thursday, Jan. 7, 2021. Image Credit: AP

According to the Africa Centres for Disease Control and Prevention (Africa CDC), more than 35,000 COVID-19 cases have been registered in the DR Congo so far and 845 people have died. However, the numbers are rising at an alarming pace. “The situation is serious, our hospitals are overcrowded,” local reports. In South Africa, the beginning of winter saw a doubling of infections, according to the WHO.

Europe: Exponential growth in infections

Germany: After reopening schools in late February and allowing hairdressers and some shops to resume business in March, German Health Minister said in May that the country had broken the third wave of the coronavirus pandemic. This week Germany recorded its fewest new cases since August last year. In all, Germany has recorded 3.7 million cases and 91,082 deaths.

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A teacher, wearing a protective face mask, teaches schoolchildren in a classroom at Lepeltier primary school in La Trinite, near Nice, amid the coronavirus disease (COVID-19) outbreak in France, April 26, 2021. Image Credit: Reuters

France: France entered its third national lockdown in early April to tackle a surge in cases of COVID-19. All schools and non-essential shops were shut till the end of April. New daily infections in France fell to 3,200 last week, the lowest level since August 2020 and well below the upper limit of 5,000 cases President Emmanuel Macron had set as his goal late last year. This prompted the government to lift the requirement of wearing masks outdoors, although it will still be required on public transport, in stadiums and other crowded places.

Italy: Italy became the first western nation to be hit badly by COVID-19 in early 2020. In March 2021, Italy entered a strict three-day lockdown to try to prevent a surge in COVID-19 cases over Easter, as the country battled a third wave, with about 20,000 new cases a day. Non-essential movement was banned, but people were allowed to share an Easter meal at home with two other adults. For the second year, Pope Francis delivered his Easter message to an empty St Peter's Square. The country has since made a recovery, and facemasks will no longer be compulsory from June 28.

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Passengers, wearing protective face masks, walk through the international arrivals hall after arriving in Terminal 5 at London Heathrow Airport in London, UK, on Monday, May 17, 2021. Image Credit: Bloomberg

UK:  Experts have differed over whether the country is experience a third wave of the coronavirus, but some have said that there are signs the UK is in the early stages of a third wave of infections. The main reason for this wave has been the "exponential growth" in cases due to the Delta variant. The country has now extended restrictions which were due to end on June 21.

Portugal: The country is fearing a fourth wave of the coronavirus pandemic may take hold with the highly-contagious Delta variant now accounting for more than 60 per cent of new cases in the capital. Lisbon is among a dozen places that did not move into the final phase of easing the lockdown that much of the country has enjoyed, AFP reported. Travel between the capital region and the rest of Portugal was banned from last weekend to try to halt the spread of the infection. "We are trying to delay its (Delta variant) arrival in other regions of the country so that people can protect themselves more through vaccination," Health Minister Marta Temido said Monday. More restrictions may be necessary, she added, at a time when many European countries are easing such curbs for summer.

East Asia: Second and third waves

In the early part of the outbreak, mainland South-east Asia were star performers. Vietnam, with its SARS experience still fresh, had one of the lowest coronavirus infections in the world. Elsewhere in the Asean — Thailand, Brunei, Singapore, Malaysia — also did well in curbing transmission. Laos and Cambodia, too, kept the outbreak mostly at bay even as wealthier European, North American and Latin American states saw cases spike by the millions, with hundreds of thousands of deaths.

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People wearing masks as a precaution against coronavirus outbreak, wait for public transport in Jakarta, Indonesia, Thursday, Dec. 3, 2020. Image Credit: AP

Indonesia and the Philippines were early exceptions, as the region’s two populous nations saw higher cases. East Asia’s initially low COVID case count made some scientists wonder whether people in the region had some natural immunity to the virus.

Now, many Southeast Asian states are facing fresh surge in cases — a second or third wave — with certain countries like the Philippines (7-day average of 5,780 cases), with total cases to 1.37 million and 23,809 deaths, while Indonesia posted 7-day average of 12,195, bringing total cases to 2.02 million and 55,291 deaths on Tuesday, June 22, 2021.

As the Philippines grapples with one of Southeast Asia’s worst outbreaks, President Rodrigo Duterte threatened to jail anyone who refuses a coronavirus vaccine. Thailand, meanwhile, opened the island of Phuket to vaccinated tourists, hoping for an economic boost after the pandemic devastated the tourism industry.

Copy of Virus_Outbreak_Japan_Vaccine_Explainer_63981.jpg-f2031-1613535720745
A Tokyo hospital staff checks the condition of Pfizer Inc's COVID-19 vaccine with delivery staff at the hospital in Tokyo, Japan, Tuesday, Feb. 16, 2021. Japan’s COVID-19 vaccinations are beginning Wednesday, Feb. 17, after the government gave belated first approval to a shot co-developed by Pfizer Inc. Japan rolls out its COVID-19 vaccination campaign Wednesday, Feb. 17, after the government gave belated first approval to a shot co-developed by Pfizer Inc. that the U.S. and many other countries started using two months ago. (Kimimasa Mayama/Pool Photo via AP) Image Credit: AP

In Japan, the third wave of infections hit around January 2021, a full year after the first case was reported on January 16, 2020. On January 28, 2020, the first case of domestic person-to-person transmission was reported. A month later, with infections discovered on the Diamond Princess cruise ship off Yokohama, Japan saw its first death caused by the coronavirus. Then daily numbers rose: after exceeding 100 in March, it surpassed 700 in mid-April 2020. With restrictions, the first wave died down at the end of April 2020.

The second wave hit in late June, when numbers started on the upswing again and peaked in early August. The situation tapered off, but the numbers began kicking up again by November. It’s Japan’s third wave of the epidemic. A year after the first case, Japan’s COVID case load topped 310,000. It took just five more months for that number to more than double, to 788,000, with 14,451 deaths (as of June 23, 2021).

DELTA PLUS: Delta variant of coronavirus with K417N mutation
WHAT IS DELTA PLUS? The variant, called "Delta Plus" in India, was first reported in a Public Health England bulletin on June 11. It is a sub-lineage of the Delta variant first detected in India and has acquired the spike protein mutation called K417N which is also found in the Beta variant first identified in South Africa.

Some scientists worry that the mutation, coupled with other existing features of the Delta variant, could make it more transmissible.

Where has the Delta Plus variant been found?

As of June 16 at least 197 cases has been found from 11 countries - Britain (36), Canada (1), India (8), Japan (15), Nepal (3), Poland (9), Portugal (22), Russia (1), Switzerland (18), Turkey (1), the United States (83). India said on Wednesday around 40 cases of the variant have been observed in the states of Maharashtra, Kerala and Madhya Pradesh, with "no significant increase in prevalence". The earliest case in India is from a sample taken on April 5.

Britain said its first 5 cases were sequenced on April 26 and they were contacts of individuals who had travelled from, or transited through, Nepal and Turkey. No deaths were reported among the UK and Indian cases.

What are the worries?

Studies are ongoing in India and globally to test the effectiveness of vaccines against this mutation. "WHO is tracking this variant as part of the Delta variant, as we are doing for other Variants of Concern with additional mutations," the world body stated. "For the moment, this variant does not seem to be common, currently accounting for only a small fraction of the Delta sequences ... Delta and other circulating Variants of Concern remain a higher public health risk as they have demonstrated increases in transmission," it said, according to Reuters.

"The mutation itself may not lead to a third wave in India - that also depends on COVID-appropriate behaviour, but it could be one of the reasons," said Tarun Bhatnagar, a scientist with the state-run Indian Council for Medical Research, according to Reuters.

VARIANT OF CONCERN:
A variant can be labeled as “of concern” if it has been shown to be more contagious, more deadly or more resistant to current vaccines and treatments according to the world health body. The WHO said that Delta is the fastest and fittest and will “pick off the most vulnerable”.
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Medics wearing special suits to protect against coronavirus prepare to treat a patient with coronavirus at the City hospital No. 52 for coronavirus patients in Moscow, Russia, Thursday, June 17, 2021. Confirmed COVID-19 cases in Moscow have hit a daily record and increased nearly 30% from the day before. Mayor Sergei Sobyanin said this week that Moscow was seeing the effects of new virus variant that is "more aggressive, more difficult to tolerate, spreads faster." In response, Moscow authorities imposed an 11 p.m. curfew on bars and restaurants. (Denis Grishkin, Moscow News Agency photo via AP) Image Credit: AP

What did Indian ministers and scientists say about COVID third wave?

Having been hit by a deadly second wave, a section of Indian experts have warned of a coming third wave of infections. India’s principal scientific adviser K. VijayRaghavan, for example, recently said the country should be ready for a third wave. "Phase 3 is inevitable, given the high levels of circulating virus," he said. "But it is not clear on what timescale this phase 3 will occur... We should prepare for new waves." Dr Randeep Guleria, chief of All India Institute of Medical sciences, echoed the warning, estimating that a third COVID wave is inevitable in India and he expected It to hit the country in six to eight weeks.

There are naysayers, too. Indian Health Minister Harshvardhan said there could can be no certainty about a third wave. “But mutation of the virus could put children at risk,” he said. A possible third wave of the coronavirus infection could take place if people flout outbreak norms like maintaining hygiene and wearing masks, Maharashtra health minister Rajesh Tope said warned. "The second wave hit very hard and all health systems came under stress. There may be some 5,000 unreported deaths in the state, which would be included in the overall report as soon as information verification is completed," Tope said.

"Nobody can predict a third wave. But by wearing masks and maintaining appropriate behavior, we can postpone its arrival and keep the impact to a minimum," Tope said.

Is there scientific data to prove third COVID wave could hit India?

Top virologists in India have downplayed fears of a third COVID wave in the subcontinent. "There is no scientific data to predict a fresh surge," Dr Vijaya, a virologist and retired professor of microbiology, told Indian meidia. Another well-known virologist Dr T Jacob John allayed fears of a third wave and said unless there is a completely new variant of the coronavirus emerges, there is "nothing to fear". But scientific data tend to be "retrospective", usually after facts are collected or after an event, such as a  fresh outbreak.

While there no evidence Delta Plus could trigger a third wave in India, given the receding present wave, the situation may be aggravated as people throw caution to the wind and flout appropriate protocols.

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A heath worker takes nasal samples to test for COVID-19 in New Delhi, India, Tuesday, Nov. 3, 2020. Even as India's overall coronavirus cases continue to fall, health officials say that New Delhi is in the grip of its third and worst wave of infections yet. Image Credit: AP

Third wave in India: Can it be stopped?

Data analysts from the Indian Institute of Technology-Kanpur (IIT-K) came up with statistical models. They shared 3 likely scenarios for a third wave, using data from the second wave. The method used is known as susceptible-infected-recovered (SIR) model — an epidemiological model that computes the theoretical number of people infected with a contagious illness in a closed population over time. It did not take into account vaccination rates, that had been ramped up, as well as the new variant, particularly Delta Plus.

The Delta variant is the currently the most dominant in India as well as 90 other countries. Indian epidemiology experts say the situation is perilous. Dr Randeep Guleria, chief of All India Institute of Medical Sciences (AIIMS), told reporters that a third wave is “inevitable” in India. To stop it, vaccinations must be accelerated using shots that have good efficacy record. 

A third wave can be stopped, Niti Aayog's Dr. VK Paul said, if COVID-appropriate behaviour is adhered to — and the majority of people get vaccinated. “Why will there be a third wave if we follow COVID appropriate behaviour and get ourselves vaccinated? There are many countries where even second wave has not arrived; if we follow COVID appropriate behaviour, this period will pass,” Dr Paul added.

Delta and “Delta plus” variants: What’s the difference?
Delta plus (B.1.617.2.1/AY) is a variant of Delta, which is also treated as a variant of concern. The combination of features from other, earlier variance could make Delta plus adapt better to pull off an “immune escape”. Virologists consider Delta plus as highly infectious.

There’s a rising concern in some experts that Delta plus shows resistance against monoclonal antibodies therapy, too. There is also a concern among the medical community that the new variant may be able to bypass immunity provided by both vaccine an earlier infection Is Delta Plus more transmissible?

Delta plus has a mutation code K417N, which was first sequenced in the Beta (B.1.351) variant (first seen in South Africa). Because it also has all the other features of its predecessor Delta (), it is seen us being a lot more transmissible, according to some scientists. The K417N mutation is within the receptor binding domain (RBD) of the spike proteins of the coronavirus.

What makes it not worth it is that this mutation is also found in the Beta variant of concern. Latest data show that the new variant is still low in India and delta is the dominant variant in the subcontinent at the moment.

There are several states that have reported seeing Delta plus in new cases: Maharashtra, Tamilnadu, Kerala, Punjab and Madhya Pradesh. Indian health experts are studying the potential transmissibility and severity of the delta plus.
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FILE - In this June 11, 2021, file photo, students wait to receive the Covishield, Serum Institute of India's version of the AstraZeneca vaccine, during a special vaccination drive for students traveling overseas, in Hyderabad, India. Starting June 21, 2021, every Indian adult can get a COVID-19 vaccine dose for free that was purchased by the federal government. The policy reversal announced last week ends a complex system of buying vaccines that worsened inequities in accessing vaccines. India is a key global supplier of vaccines and its missteps have left millions of people waiting unprotected. The policy change is likely to address inequality but questions remain and shortages will continue. (AP Photo/Mahesh Kumar A, File) Image Credit: AP

How is India doing with vaccinations?

There are good signs coming out of India. On June 22, 2021, India recorded less than 50,000 new coronavirus infections, the lowest in 91 days. Also on Monday, India ramped up vaccinations, administering 8.6 million doses of COVID shots in one day. This sets a new national record on the first day of a fresh policy that offers free vaccines for all adults. India had a very slow start with vaccinations but the government hopes to speed up a vaccination drive.

At the moment, less than 20% of the population (1.3 billion) have received at least one dose, with less than 5% fully vaccinated. India’s health officials say all of the roughly 950 million adults could be fully vaccinated by the end of the year.

1.3b


India is relying on shots manufactured at home, from the Serum Institute and Bharat Biotech, which have promised to deliver 1.3 billion doses from August to the end of the year.

India's vaccination blitz was the most COVID-19 shots given in a single day in any country besides China. The boost will probably be temporary — currently available supplies suggest that it would be difficult to sustain such a pace over the coming weeks.

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Passengers wearing face masks alight from a metro in Sydney on June 23, 2021, as residents were largely banned from leaving the city to stop a growing outbreak of the highly contagious Delta COVID-19 variant spreading to other regions. Image Credit: AFP

Will the 'Delta Plus' variant trigger new wave of infections around the world?

It's not known. The number of Delta Plus cases is currently low in most countries, including India. But while the currently low number does not indicate any dominant trend, it needs close tracking. The Delta variant which is responsible for the current second wave that has hit India, was found in low numbers ahead of the surge.

Are the current vaccines able to contain Delta plus?

At the moment, no data exists to confirm this.