Second COVID-19 Surge: Challenges and Handling

Abstract

Coronavirus disease 2019 (COVID-19) pandemic is ongoing for more than a year and now we are facing the second wave. The sharp jump in the number of cases being reported, and possibly some change in the disease profile have seriously challenged the available infrastructure to breaking point; its adverse impact on the quality of care is being reflected in the outcomes. Once again, the medical fraternity is facing challenges of managing overwhelming emergencies in background of inadequate resources [1]. The situation is very grim with significant shortage of trained manpower, hospital beds (all type, more of ICU beds), drugs, and oxygen. Let us analyze the possible reasons and whether we could have avoided this situation and get ready to face such problems in future. In the current surge, a common perception is that children are more frequently being affected in second surge and they are relatively sicker, unlike the scenario in 2020. The data collected in Integrated Disease Surveillance Programme (IDSP) and the Indian Council of Medical Research suggest that the proportion of individuals 0–10 y age and 11–20 y age among the confirmed COVID cases has not changed much since last year [2]. In view of the increase in overall cases, the absolute number of children affected has increased. Overall, the outcomes in children continue to be good [2]. Multiple factors seem to have contributed to the increase in overall numbers of cases as well as cases in children: poor compliance of the population to COVID-appropriate behavior, large gatherings across the country, no strict action to break the spread of infection in households and community, opening up of schools/colleges, and possibly a mutant strain that is more contagious. There was a significant discordance between the messages being given by the authorities and their other actions, allowing/promoting inappropriate behaviors. The behavior of the population seems also to have been influenced by the fact that the recovery rate is more than 98%, an underestimation of the potential severity, and an attitude that even if one is diagnosed as COVID-19 infection, he/she will not be isolated in hospitals as happened in the first surge. In addition, the approval of vaccines may have given a misplaced sense of hope, further encouraging lowering of guard. Before the first COVID-19 surge in India, media and social media played overenthusiastic role, and various experts who did not have adequate knowledge but were media-savvy played an important role in creating hype to make COVID19 equivalent to death. Gradually media started reporting very high recovery rate and low case fatality rates, which improved public confidence, but over a period of time, also led to lowering of guard. Community fatigue setting in along with economic stress, further led to increased risk-taking behaviors in context of COVID-19. A lesson learnt is that role of electronic media cannot be denied but there is a need to take balanced, mature approach keeping in mind the ramifications of actions. After a few weeks into the pandemic, it had become clear that we needed to learn to live with COVID-19 for months to year, as it is going to stay with us. Going by the records of previous pandemics, a second or third surge was always on the cards. Specifically, in the previous pandemic of Spanish flu in 1918, there was more devastating effect of pandemic during the second surge [3]. A few experts warned of a similar course with COVID-19 as well. However, the response ofmost countries, including ours, was less than desirable even after Europe and America had seen the surge. Even when the surge started in Maharashtra and Kerala in India, there seemed to be a lack of proactive measures to build capacity and arrange resources to face the surge in other parts of the country. These warning signals were ignored or not given due regard. Response of leadership and policymakers from other parts of India and experts were confined to reassurance, only suggesting that our city/state is fine, the infection rate is much less than the other states [4]. Even large gatherings have been promoted in various parts of the country. Another lesson learnt is that if an * S. K. Kabra [email protected]