Dr. Shyam P Lohani

The second wave of the COVID-19 pandemic was unavoidable and the reason for this is that the country had not reached the level of herd immunity with only small percentages of the total population infected in the first wave. With slightly more than 1 per cent getting two shots of vaccine and about 6 per cent getting only one shot, there was a large section of society that was susceptible to the virus.
People started becoming careless with the precautionary measures when the curve was coming down during the first wave. The 3-4 months respite was misleading and people thought that we got rid of the virus. There were huge gatherings without any restrictions and in cities, people showed laxity in wearing masks, and maintaining social distancing.

Second wave
Variants are a common thing in all viruses. They have a natural tendency to mutate. It has been reported that the UK variant of the virus can cause a faster rate of infection i.e., causes up to 70 per cent more infection than the original virus. There have been reports of double mutant variant found in India being even more infectious and have already spread to more than 45 countries. We have to consider three factors in case of any new variant. The question is whether the variants increase the rate of infectivity, mortality and have the potential of re-infecting people who have already been infected.
The second wave was always going to happen. The question was the size of the second wave. We have to consider a few things: One, the size of a wave is only known to us by increased number of testing. We are doing far more testing than we did one year ago so the wave appears to be bigger; it is not necessarily bigger than the first wave.
Second, COVID-19 cases are going up quite fast and that is because a year ago the country was under a lockdown. So the rate of increase was much slower because the transmission was slower. After the first wave, it remained unrestricted for quite some time; therefore we are seeing the result of taking our guard off and without restrictions, COVID-19 behaved as anticipated i.e., sharp rise in the number of infected.
Although only a small percentage is known to have reinfection, it may be due to the fact that the first infection of the Coronavirus provided good immunity. Thus, the reinfection rate of the disease has been very low as well as the disease severity. At this point of time, our healthcare facilities are already overstressed as they were during the first wave of the pandemic. The oxygen scarcity has caused hospitals to deny new admissions. It is a myth that case fatality rates are lower in Nepal.
In Nepal, the virus has already killed nearly 6,000 people so far. However, we lose more people yearly to other diseases. It does not mean that we should take COVID-19 infection lightly. The number of infections reported daily as of now is grossly underestimation of what is the real scenario. It is obvious that everyone is not getting tested. Also, we don’t have testing capacity to take on all of these people.
People without the comorbidities such as diabetes, hypertension, cancer, COPD or obese may not be at high risk of severe disease due to COVID-19. It is here important to understand that COVID-19 is an infectious disease but it is actually a disease which causes more harm to those having non-communicable disease conditions. Those people with pre-existing disease condition should be given preference to vaccination and obviously take extra precaution.
There should be restrictions that are highly localized. This is what I had argued for the first wave, but, then I thought that the government had only one choice in the absence of evidence of where the disease was and what would happen without healthcare facilities or with healthcare manpower not knowing what to do. They chose a nationwide blanket restriction in the hope of curbing the spike in the infection and it did.
Lockdowns or any kind of restrictive measures are not very useful once the virus has started transmitting because then it is a two-week cycle of transmission. It is advisable to impose the restrictions where COVID-19 will spread now rather than as a response to a spike in cases.
It is advisable that the government may restrict gatherings and impose night curfews. The need of the hour is to educate people about COVID-19 appropriate behaviour and utilise community participation approach for practicing so. Testing, tracing, isolation and treatment of COVID-19 patients are the keys to check the spread of the viral infection, but lockdown or strict blanket prohibitory orders is not an answer.

Mass immunisation
Vaccination is part of the strategy and it is eventually the final strategy. Moreover, at this time until mass vaccination reach herd immunity level or about 70 per cent of population get vaccines, it is really going to have to be people taking precautions themselves. Knowing the science of the virus and its variants and the consequences of the disease are the most important.
Generally, the vaccines do not prevent transmission. The biggest value of the COVID-19 vaccine is reducing severe disease and mortality. People may still get milder forms of the disease but if we get the vaccine, it significantly lowers our chance of dying from the disease. That is the great value of the vaccine. Therefore, it is called upon all stakeholders to work as one point agenda to get vaccines as soon as possible and resume mass vaccination campaign. At the same time, it is also urged to ensure oxygen supply uninterrupted to the hospitals treating COVID-19 patients. Mass vaccination is the only solution to limit the morbidity and mortality from the probable third and subsequent waves.

(Professor Lohani is the founder and academic director at Nobel College. lohanis@gmail.com)