Human history has taught us that every viral pandemic, be it the Plague, H1N1, or Spanish Flu has three waves. The first wave catches the public unawares and nonpharmacological interventions of social distancing, masks, sanitization, and lockdowns are initiated. Pharmacological interventions are also ramped up. This slows the pandemic temporarily. Once things are better, due to social and economic reasons, the lockdowns are eased and people return to normal life. Social distancing recommendations are ignored and people take sanitization and masking regulations lightly.

This leads to a sudden spurt in cases causing a second wave. Also, the virus gets smarter and more evolved producing more virulent and resistant strains. This makes the second wave much more devastating than the first wave. The third wave happens after vaccination and herd immunity is achieved. It is much milder than the first two waves. Those who are inadequately vaccinated or immunocompromised form the bulk of the third wave. The third wave usually has more economic and less medical impact.

The COVID -19 pandemic is already following the above three- wave pattern and unless the human race acts sensibly and reasonably, we are all in for devastating consequences.

The common man has very little technical knowledge about the COVID- 19 virus and the implications of the second wave, so here are some answers to the frequently asked, top ten questions:

Why is the rate of infection higher in the second wave?

After the first wave has passed, the lockdowns are released and the people have a false sense of security. They go back to their pre-pandemic behavior, throwing caution to the winds, enabling the faster spread of the virus. Educational and commercial establishments are opened. Religious and social congregations are held. Political rallies and elections are held. This exposes more people to the virus and the efficiency of spread is increased. In addition to this, the virus also starts evolving and undergoes mutations, and forms new strains.

What are the characteristics of the new strain of coronavirus?

There are multiple strains (or variants) of the coronavirus that have been identified recently. The UK variant, the South African variant, the Brazil variant, and the Indian variant. While the Indian variant is a virus with a double mutation, the other variants underwent a single mutation. The common characteristic of all these new strains are that they multiply faster. They are more infectious and more toxic. They are better equipped to fool the human immune system and evade it. They also have a different set of symptoms.

Is a vaccinated individual still prone to infection? If yes, at what duration?

Even the best vaccines do not provide 100% protection. Studies have shown that most COVID vaccines have a protection rate of approximately 70%. This means that if 100 people are vaccinated, only 70 are protected while 30 are still prone to infection. Even the 70 "protected" people can still get the infection if they are exposed frequently (like health care personnel) but it will be much milder. As the virus evolves and new variants appear, this 70% protection would reduce further. In fact, the vaccines will have to themselves evolve to protect from different, new variants. Designing different vaccines for different strains is not practically feasible. The current estimates are that the vaccine can protect one for a period of 12 months. After that, a repeat dose or a booster dose of the vaccine might be needed. Hence vaccination will never completely protect one from COVID.

What are the new symptoms observed?

In the first wave, the symptoms were mainly respiratory with cough, breathlessness, sore throat, and a running nose. This is because the virus entered the body through the respiratory system. The new variants are now able to enter the body through the gastrointestinal system as well. Hence loose motions, vomiting, and abdominal pain are being reported more often. Some patients have single symptoms like just fever, just body ache, just tiredness, or just weakness. Frighteningly, some patients are coming to the hospitals with heart attacks, brain strokes, blood clots, and kidney disease as their first symptom. Other associated symptoms like loss of smell, loss of taste, red eyes, etc remain common to both waves. Some individuals have no symptoms at all and remain asymptomatic.

When is the second COVID wave likely to come down?

It is speculative but estimates are that the second wave will last three to six months. This is provided all appropriate measures are followed by the people and the authorities.

Are children more prone to COVID?

Children are more prone to respiratory viral infections due to their immature immune systems and their close contact during play. They are also more susceptible to COVID 19 infections and can be super spreaders. Luckily, they have milder disease and recover faster. Unlike adults they also have less residual damage to the lungs and other organs.

Are medications or vaccinations different for various strains?

No. Treatment options and vaccinations are the same for all strains.

Any changes in quarantine/isolation rules for different strains?

The quarantine and isolation rules remain the same irrespective of the strain of the virus. The recommendation is to isolate for 14 days from the onset of symptoms or a positive RT PCR COVID test (if asymptomatic). Also, there should be no fever for at least 7 days before de –isolating oneself.

Is there any gender bias for getting infected by the new strains?

No. There is no gender bias. People of either sex are equally vulnerable to infection by the new strains.

What advice should be given to the general public?

Get vaccinated as soon as possible. Follow social vaccination as well like social distancing, masking, hand sanitization, and self as well as environment sanitization. Keep your surroundings clean. Avoid or minimize social gatherings. Keep yourself fit and healthy by lifestyle changes. Do not believe false narratives on social media. Above all, have a positive attitude. Though the war is still going on, it can be won if we all cooperate and pull together.

Dr Ravi Andrews

Dr Ravi Andrews is a Senior Nephrologist at Apollo Hospital, Hyderabad.

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