Third COVID-19 wave inveitable, says AIIMS chief: What Centre, states and experts have predicted so far

Albeit India's COVID-19 caseload has witnessed a declining trend following a disastrous 'second wave' between April and mid-June, with states unlocking activities after weeks of strict lockdown restrictions, a possible 'third wave of infections has entered the scientific and public discourse.

The "inevitable" third COVID-19 wave could hit the country in the next six to eight weeks, said Dr Randeep Guleria, Director of All India Institute of Medical Sciences Director (AIIMS), to NDTV on Saturday.

Why is this relevant?

• There is a lack of COVID-appropriate behaviour after the easing of restrictions across India, Guleria said, adding the country's main challenge is vaccinating a huge population.
• "As we have started unlocking, there is again a lack of COVID-appropriate behaviour. We don't seem to have learnt from what happened between the first and the second wave. Again crowds are building up, people are gathering. It will take some time for the number of cases to start rising at the national level. The 'third wave' is inevitable and it could hit the country within the next six to eight weeks, maybe a little longer," the report quoted him as saying.

Guleria's remarks have come amidst a debate within the public as well as scientific space on the possible third wave, and how it may impact India. Several state governments have already started preparing for the possible next wave of COVID-19 infections, and are regularly warning the public to follow COVID-19 precautions and the authorities to implement them.

What did the Maharashtra COVID task force say?

Guleria's remarks have come just two days after the Maharashtra government's COVID task force warned that the third wave could hit Mumbai within the next two to four weeks.

The predictions were part of the meeting chaired by Maharashtra chief minister Uddhav Thackeray on Wednesday to review preparedness for the projected third wave. It included task force members, the state health minister and senior bureaucrats. During the meeting, the Maharashtra COVID-19 task force presented the following projections:

• Cases likely to double: According to data presented in the meeting, the total number of cases in the third wave is projected to double over those in the second wave, with active cases set to reach 8 lakh, News18 reported.
• Children likely to be 10% of total cases: Unlike the claims from a section of experts — that children will be hit worst in the third wave — 10 percent of the total cases will come from children and young adults, the task force said.
• Experts predict 100 days gap between peaks of two waves: Epidemiologists expect up to 100 days between the peaks of two waves or eight weeks from the decline of one wave to the next peak. Stressing on the need to practice COVID-appropriate behaviour, Dr Shashank Joshi, a member of the task force told The Times of India, "The UK is facing a third wave within four weeks of ebbing of the second wave. We could be in the same situation."
• Groups that skipped the first, second wave most vulnerable: The task force has also warned that the population that managed to skip the dreaded virus in the first two phases are the most vulnerable in the third phase. "It is likely to affect the paediatric category, but it's difficult to predict. The population segment that escaped COVID-19 in the first two waves seems more vulnerable. But can't say when the third wave will come. We need to be prepared," said Dr Om Srivastava, Director of Infectious Diseases Department, Jaslok Hospital, and member of Maharashtra COVID task force.

Children and third wave: Who said what

Over the last few weeks, several theories and reports have emerged on how a possible 'third wave' may affect the children disproportionately or severely. However, there remains a significant difference in opinion between authorities and medical experts. Even doctors seem to disagree among themselves. Here's what's been said so far.

Centre, experts cite lack of scientific evidence

The government officials have dismissed reports claiming that the COVID third wave will impact children more as "misinformation" and lacking any scientific evidence.

During a media briefing on COVID-19 on 9 June, Guleria had said, “It is a piece of misinformation that subsequent waves of the COVID-19 pandemic are going to cause severe illness in children."

He also said that 60 percent to 70 percent of children who got infected and needed hospitalisation in the second wave were children with either comorbidities or low immunity. Healthy children recovered with only a mild illness and they did not need to be hospitalized.

Firstpost had spoken to Dr Tushar Parikh, consultant neonatologist and paediatrician at Motherhood Hospital in Pune's Kharadi Parikh to find out what they have to say on the subject.

"There is no evidence to say that children will be affected more or badly in the third wave but there is an assumption that since they will not have been vaccinated, they will be the vulnerable population by the time of the third wave," he had said.

Possible third wave unlikely to affect children more, concludes serosurvey

According to a seroprevalence study conducted by the World Health Organisation (WHO) and the All India Institute of Medical Sciences (AIIMS), a possible third wave is unlikely to disproportionately affect children than adults

The study, which compared the COVID-19 sero-positivity rate between children and adults from five locations in four states found a seroprevalence of  55.7 percent in those aged less than 18 (two to 17 years) age group and 63.5 percent in the 18 years and above age group.

The SARS-CoV-2 sero-positivity rate among children was high and was comparable to the adult population, the study said.

Among the 700 children aged 2-17 years who were part of the serosurvey, 362 (51.7 percent) were male. The number of participants in the aged 2-4 years were 33 (4.8 percent), 5-9 years 153 (21.8 percent), and 10-17 years 512 (73.1 percent).

"The higher seropositivity rate in children aged 10-17 years may be reflective of their higher mobility and independence compared to the younger children," it said.

How states are preparing for third wave

While the jury is still out on the third wave and its impact on children, state health departments don't want to get caught unprepared and have already started preparing to augment existing healthcare facilities for children, especially ICU and High Dependency Units (HDU) that provide specialised healthcare services.

Standalone paediatric hospitals in Telangana like Niloufer Hospital and Gandhi Hospital already have dedicated paediatric COVID-19 care facilities. In the coming days, HDUs and ICU will be strengthened within all the paediatric hospitals to handle Multisystem inflammatory syndrome in children (MIS-C) cases.

Kerala chief minister Pinarayi Vijayan advised people to exercise utmost caution due to the possibility of a third wave of COVID-19. The third wave could be marked by a genetically mutated virus that could spread faster than the delta virus, the chief minister warned, and added that the government was fully prepared to face any eventuality.

Paediatric intensive care facilities are being strengthened to ensure expert treatment for children in the event of a third wave. An additional 10-bed paediatric ICU will be established in medical college hospitals, he said.

The Jharkhand government is on high alert to contain any possible third wave of the COVID-19 pandemic, following suggestions of experts that any laxity may lead to serious consequences, officials said on Friday.

The state government issued a detailed document to deal with the possibility of the third wave, which may lead to an increased number of infections among children.

"Experts suggest that the coronavirus is mutating at a fast pace and any kind of lethargy may lead to serious complications. With the inputs received from the experts, the state government of Jharkhand is on high alert regarding this matter. Efforts are being undertaken to enhance and upgrade the existing medical infrastructure," an official statement said.

With inputs from agencies

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FP Staff