COVID-19: Vaccine impact and the delta mutation
We certainly have paid a very high price during the second wave. It was truly devastating and never in my 50 years of practising medicine have I seen devastation like this in the Healthcare industry. Obviously, because of the lessons learnt during the second wave and the advent of vaccinations that have happened in the recent past, I think we will be in a much better position to tackle the third wave. Now as most of us are aware, about 70% of our population has already been exposed to the Coronavirus as per the recent sero-surveillance reports, which means only about 30% population is still vulnerable and with the accelerated vaccination program almost reaching 1 crore a day I am sure a lot more people will be vaccinated in the near future which means that very few people will be left vulnerable.
The other good news is that the second wave was as devastating as it was because of the extremely infectious delta mutation and fortunately for us that hasn’t changed. So, if the Delta mutation doesn’t change to something more aggressive and more infectious and we continue with the pace of vaccination and most importantly COVID appropriate behaviour, the third wave will be easier to handle and certainly would not be as serious. COVID-19 impacting children
It is also important to know that in the third wave people who have not been vaccinated are the children and the younger age group. So, they are more likely to get the infection. However, the good news is we have seen that the children usually do not get serious disease due to Coronavirus and we have also seen that most of them can be treated as outpatients like the minor flu and it is interesting to know that even in the second wave, the Sero-surveillance showed a fair number of kids actually were infected with the virus but it did not become a major problem because they never got into the hospital’s ICU and fortunately the mortality was very low. This does not mean that we should not prepare for the third wave.
Certainly, we should prepare and since the paediatric population has not been affected so far and have not been vaccinated, we will certainly have to take some extra measures for the paediatric population to be taken care of. This certainly means strengthening our paediatric emergency rooms, paediatric ICU’s, digital health to make sure that children and the parents of the children can get in touch with the paediatricians because most of the cases of COVID in children can be managed over a video call and rarely it is necessary for them to come to the hospital. These measures will be taken and are being taken not only by the Manipal group but also by the various governments. I do believe that we will come out in a much better fashion if and when the third wave comes.
COVID-19: Lessons learnt and way forward
A few lessons that we have learnt from the COVID-19 pandemic is how do we handle a pandemic better than what we did in the first and the second waves. The lessons that we learnt are:
- We need to strengthen our healthcare system. Unfortunately, healthcare was never given the importance that it deserved before the COVID times. It is only now that we have realised that our health care is as important or more important than the defence armed forces and the economy of the country. Because debilitated healthcare which cannot handle a pandemic will debilitate the country including its economy and devastate the citizens. So certainly, I think we need to spend a lot of effort and money on improving our infrastructure and health care, improving rural health care, and semi-rural health care, and semi-urban health care, and certainly we need to spend more time on digital health care.
- Private-public Partnership. Because what we found was that digital health care got a good boost during the COVID era and a lot of management of COVID happened through digital health and we were able to access even remote areas of the country and of the state and manage to manage our patients better. A simple example of this is when COVID hit us, the Karnataka government along with many private sector hospitals including ours came with a private-public partnership where our doctors specialised in the field of intensive care, pulmonology, emergency medicine, so on and so forth had a video conferencing facility with all the district headquarters hospitals of Karnataka and just this one measure decreased the mortality of COVID by 50% and these are things that we need to continue. We need to improve our primary healthcare centres. We certainly made significant progress in our labs and the testing which was very minuscule at the beginning of the COVID ramped up very quickly and now we have a huge number of labs that can test millions of people. So, I think these are some of the things we have learned from the public health measures.
- Need for Vigilance. And from a hospital standpoint of view, I think, few things that we learned is that we have to be constantly vigilant. If there are any new cases of any kind of a viral illness or of any kind of any illness which is likely to be pandemic, we need to be alert and take precautionary measures. Previously in the hospital set-up, I think measures that we had taken like screening of patients for fever, screening for their symptoms, maintaining social distancing not only in the lobbies, in front of the admission counters, even in the elevators, and also in the crowed OPD areas went a big way in preventing the spread of disease. We also put up tents outside the hospital run OPDs, and also some kind of a drive-in centre for testing for COVID. All these would minimize the exposure of COVID patients to other patients. Certainly, we separated COVID patients from non-COVID patients in the ward. It was a challenge but over a period of time, we managed quite well even though we were hit very hard during the second wave. So for the future, our lessons are in general, I think we should cut down on the outpatient visits, make sure that the hospital is not crowded, have facilities even outside of the hospital in case there is a sudden rush of patients, maintaining social distancing, masking as much as possible and probably we should have an infrastructure where COVID or any pandemic for that matter can be interchanged with non-pandemic patients at short notice. This is something that we need to look at in all future hospitals
- COVID and its Complication. Many things that we learnt with COVID is that COVID is not going to go away. Initially, everyone said that it is probably the flu and just like HINI it will be coming on a seasonal basis. But we know that COVID has been with us for almost 18 months or more now, and there are no signs of COVID going away. So, we have to learn to live with COVID. There are a lot of new things we have learnt about COVID. We initially thought it is an acute illness, and after you have been cured of illness you are back to normal. But we have learnt as we have rightly pointed out about a condition called long-COVID where the long-term effects of COVID are seen and some of them can be devastating. We have seen people have had heart attacks, pulmonary embolism, gangrene of the legs, gangrene of the intestines, respiratory illness, lung fibrosis requiring a lung transplant, and even some patients have developed diabetes. So COVID is not something that is a very simple disease.
- We have to be aware even after the patient is discharged from the hospital, we need to have follow-ups and most hospitals like ours have a protocol for follow-up of patients after COVID where they are not only interviewed by the health care workers but certain tests specific for COVID and certain tests to look for complications of COVID are done. And one of the important things we learnt is that it is not just the COVID alone that bothers us but also, we have found that the COVID along with its treatment cost a devastating epidemic of what is called a black fungus or Mucor mycosis in medical terms. That was quite devastating. I had never seen that many numbers of Mucor mycosis in recent times. As a transplant physician, I used to maybe see one or two patients with Mucor mycosis in a year but this time we saw hundreds of Mucor mycosis cases in a matter of weeks, which again was devastating because no country can cope with a hundred-time increase in the number of any kind of illness at short notice.
- Vaccinations: The advent of vaccinations for COVID in my opinion was the greatest tool that we developed in our fight against COVID. And what is important to know is that what would normally take about 8 – 10 years to develop, our scientists were able to bring out in a matter of about 8 -10 months which is a great credit to their work in helping us fight COVID. In India, of course, the vaccination started in right earnest sometime in January of this year. And though there were some initial hiccups, the pace has picked up and we vaccinated more than a crore of people or 10 million people in a day a few days ago, and we have now covered more than 60 crores of people with at least one dose of the vaccine. And at this rate hopefully, by the end of this year, we will complete the vaccination and that will take us a long way in preventing the spreading of COVID. However, two things that we need to be very clear is that firstly, we need to have enough vaccines available. Secondly, I would certainly urge our citizens to get rid of vaccine hesitancy. The vaccine is safe, the vaccine is needed, the vaccine prevents serious disease and also slows down the spread of the disease. So please have no hesitation in taking your vaccine.
- No one is safe till everyone is safe. The biggest lesson that we have learnt in the COVID times is that no one is safe till everyone is safe. The world is one and we cannot say that I’ll take care of the city of Bangalore, and I don’t care what is happening outside Bangalore. We need to not only take care of our locality, our city, our state, our country but every state and every country in this world, rich or poor. Because unless everyone is safe against COVID no one is safe and that’s the message that we should carry and I do hope that all the countries involved, the WHO (World Health Organization), and the UNO (United Nations Organisation) work in this direction.