Expected third COVID wave: Time for proactive action

After being first detected in South Africa, Omicron variant has very aggressively spread across globe. The United Kingdom is the worst hit in Europe, with 25,000 confirmed Omicron cases as on December 18.^[1] In many countries, it is the dominant strain now, and in many countries, it is expected to be the dominant strain by the start of next year.^[1] With rising cases, restrictions are again being imposed in many European countries.^[1-3]

Back home, as on December 20, 2021, reported Omicron cases crossed 150 marks in India.^[4] These are mere reported cases, number may be quite high giving the fact that genome sequencing is not conducted routinely. It is expected that this variant will spread very rapidly in India.^[5] Daily case load in India is expected to increase once the Omicron starts displacing Delta as the dominant variant, which is expected by February next year. National COVID-19 Supermodel Committee had predicted the third wave in India early next year.^[6]

Our current experience with Omicron suggests that this variant is infecting people who had a prior infection at a much higher rate than the previous variants. Preliminary reports suggest that it is also causing an increase in vaccine breakthrough infections; however, it’s too early to confirm if those infections are likely to lead to severe disease.^[5]

In India, it is expected that the third wave should be milder than the second wave due to a large-scale immunity present in the country now. Although numbers will definitely increase, it is extremely unlikely that the third wave will see more daily cases than the second wave.^[6]

According to a sero-survey report, in India, only a tiny fraction has left that has not come into contact with Delta virus. Now, we have seroprevalence of 75–80% (prior exposure), first dose for 85% of adults, both doses for 55% of adults, and a “reach” for the pandemic of 95%, thereby meaning that only a tiny fraction of the public has not come into contact with the virus, in India.^[6]

Daily case load will depend on two behavioral factors related to Omicron variant – first – what is the extent to which Omicron bypasses natural immunity obtained by prior exposure to Delta, and second – what is the extent to which Omicron bypasses the immunity conferred by vaccination. As both these factors are currently unknown, it is expected that even in worst scenario India will not have more than 2 lakh cases per day in case the third wave grips the country.^[6]

The current experience with Omicron variant suggests that though the variant is more infective, it is less virulent. Nonetheless, with case load in the range of 2 lakh per day, compounded with misinformation spread through social media and panic created is likely to squeeze the health facilities and put them under stress, in case a third wave hits the country. What is expected from stakeholders? To prepare for the worst must be the mantra for the success. Replenishment of supplies and adequate fortification during peace time allows an army to fight a looming war. If we are fighting a war against COVID, with the help of “corona warriors,” it’s high time that we should use this “peace time” for developing infrastructure in the form of new hospitals, intensive care facilities, oxygen plants, and RTPCR laboratories. At the same time, vaccination drive should go unhindered. It is also time for capacity building of trained workforce.

It is speculated that Omicron may be the variant which will convert “COVID pandemic” into “COVID endemic.” Till the time that happens, let’s focus on the lessons learnt till now and observe COVID appropriate behavior, namely, regular hand sanitization, use of face masks, and observing social distancing.