Dr. Shyam P Lohani

A decline of new COVID-19 cases and the beginning of mass immunisation drives across several countries over the last few months of 2020 have driven the world with enthusiasm about a long-term solution to the pandemic. But the euphoria turned to be ephemeral. We are now in the midst of the second wave which is infecting more people than expected.
Many countries are already in their third wave and few in subsequent waves. Several mitigating strategies are being implemented around the world. Those include the re-imposition of strict social distancing measures such as quarantines, isolation, curfews, and lockdowns. The principal objective behind those measures is to lengthen the time through which the virus spreads and to flatten the curve of infections before hospitals get overwhelmed with severe cases. Those measures are intended to save lives, increase treatment success and avoid unintended consequences associated with already overstretched healthcare systems.
Evidence
The high levels of the virus circulating in the population meant a “phase three of the pandemic” is inevitable but the exact timeline and its impact is still not known. When the virus circulates in a large segment of the population, there is an increased chance of it mutating. There is also the chance of the new variant becoming more infectious as well as deadly. It is, therefore, important to have a resilient surveillance system in place and continuous adherence to the preventive measures. In the time of the third wave as more people are destined to be vaccinated, the virus will definitely have adaptive pressure to mutate according to scientific studies.
The increased number of people infected in the second wave are in the age group of 15 -49 as against the first wave. It has been speculated that the children could be at a higher risk of getting infected in the third wave of COVID-19. It is probable; since most adults will have received at least one vaccine shot by the time we see the third wave hit Nepal. We still don't have a COVID-19 vaccine for children.
The needs for supplemental oxygen for the admitted people in the second wave are more than the first wave and the supply of oxygen to the hospital seems exhausted. Oxygen is a crucial treatment for many patients with severe COVID-19 since the disease affects lung function and causes pneumonia. It is, here, important to install an oxygen generator in hospitals which helps them cater to the increased need uninterrupted.
Available evidences suggest that all approved vaccines are working against currently circulating B1.1.7 (UK strain) and B1.617 (the double mutant) variants. But it is not known that the new variants in the third wave and subsequent waves respond to the available vaccines. But, as the experience of third waves in Europe, even the new variants can easily be countered with masks and distance along with other preventive measures.
The current surge is mainly due to laxity at different levels. With the news of approval of vaccines against coronavirus and fatigue due to long lockdown, social distancing measures became more relaxed. A perception of safety among the non-immunised population, which affected their behaviour and increased their exposure to the virus also increased with the approval of vaccines against the virus. At the individual people level, when the number of cases declined in the first wave and lockdown was eased, COVID-19 precautions were abandoned. People started avoiding masks, social distancing measures disobeyed, moving around, celebrating whether in outdoor places or, particularly problematically, in enclosed places.
Once there was a decline in the number of cases, the resumption of economic activity brought a large number of people together for a long period of time, in offices and factories and on public transport. But even enforcement by authorities has slackened if not abandoned. We have seen an increase in the number of political meetings and rallies being organised. Large political, religious, and cultural gatherings have been permitted even despite warnings from health professionals. Another reason being slow vaccination campaigns and supply constraints as well as bureaucratic hurdles have caused a halt to mass vaccination programmes.
The third wave is destined to come as our vaccination drive is currently stopped owing to vaccine unavailability. The mutations of a virus are natural, therefore, the existing variants will make way for new variants which may or may not be more virulent, but variants should not make any difference in our primary attitude to combat COVID-19 that is maintaining social distancing.

Preparedness
We need sustainable solutions while emerging out of the second wave. Similarly, we should carry out an effective and aggressive containment strategy to reduce the number of cases and deaths. While doing this, it is imperative to scale up testing to isolate people as soon as possible. Laboratories should be strengthened through enhanced infrastructure, a permanent workforce, and sustained funding.
The mass vaccination is the only solution to the subsequent waves. Nepal’s already sluggish vaccination campaign is likely to take a further hit following a delay in the supply of vaccines from the manufacturers. The government should focus its endeavor in obtaining vaccines through formal as well as informal means.
Until eligible people are vaccinated in the country and herd immunity is achieved, the only option left is to observe public health measures along with continuously strengthening the health infrastructure of the country. We may have to tolerate occasional clustered restriction or even clustered lockdown in the pocket areas in case of a surge in the cases. It is called upon the government to take this opportunity to develop a resilient healthcare system by permanently hiring and training health manpower for handling future waves.

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