'Second Wave is Not Over'

'We keep worrying about this variant or that variant. Forget about that.'
'Every variant can be stopped with a mask.'
'We don't want to do the simple thing of wearing a mask, but we worry ourselves to death about different variants.'

"I don't think anybody can say with certainty that there will be a third wave and when it will come. Two measures to take to avert a third wave are, follow covid appropriate protocol and vaccinate as many people as possible," Dr Shahid Jameel, the well known virologist, tells Rediff.com's Shobha Warrier in the concluding segment of a two-part interview.

• Part I: 'When you engineer a virus, you leave behind...'

The second wave exploded in India to dangerous proportions. Did it happen because of the highly infectious Delta variant or lack of preparedness or denial on the part of the government or poor health infrastructure?

I would say it was possibly a combination of all the factors you mentioned.

The mutant arose at a time when people were complacent. We went through five months of cases going down continuously and everyone thought that India had overcome the pandemic. So, we all let our guard down.

When the second wave happened all over the world, should India also have expected such a possibility?

Exactly. We really took eyes off the ball.

If you look back, the second wave came around 32-38 weeks after the first wave in the UK, Italy, Brazil, and the US. In India also, the second wave came after 32 weeks.

I think partly it was complacency, and partly it was because of the poor public health infrastructure in the country. At the same time, this very infectious variant called Delta was developing and circulating among people.

Is it because the population density in India is high, and also because people were not following covid appropriate behaviour that such a highly infectious mutant came into existence?

Viruses mutate at random. The more you allow a virus to spread, the more you give the chance for it to multiply. So, it will mutate.

Does that mean we also contributed a part in this mutation?

Of course, we did.

That's why I said, all of us became complacent even though the government was telling people to follow covid appropriate behaviour.

Then the government was also telling on all platforms that India had conquered the pandemic. So, it also became complacent.

I would say it is not one thing which is responsible for the second wave but multiple reasons played a part.

What made the second wave really bad was because the hospital capacity got completely overwhelmed. On a daily basis, we had four times more people getting sick than the first wave.

I think it is a wakeup call for the country to realise that we have a public health system that does not function properly, and does not have the surge capacity needed during an epidemic or pandemic.

What are the lessons to be learnt from the devastation caused by the second wave?

The first lesson to be learned is, it is not over till it is over.

Now that many places are opening up, we see crowded markets with many people without masks.

I think the policymakers and the governments are very alert right now. It is a case of once bitten twice shy.

But individuals are not alert. In fact, I would say, people were more scared in the first wave than they were in the second wave.

Do you think it's because life has become difficult for everybody?

It could be.

In the first wave, it was like, you knew someone who knew someone who had covid. But in the second wave, people within one's family and friends' circle got covid.

In my case also, I lost at least 25 people who I knew very well in the second wave, including two close relatives and two very dear friends. And each one of us is in such a situation.

It means the magnitude of the second wave was huge and the virus was extremely infectious.

The first lesson to learn from the second wave is, it is not over yet.

The second lesson is, for which we have evidence also coming through, vaccines give us protection.

During the first wave, there was no vaccine. By the time the second wave started, there was vaccine available but many people who were supposed to take the vaccine in January and February did not take it, including many health workers.

There was vaccine hesitancy. That stems from the fact that people thought it was over.

The new mutants of the virus are more and more infectious, like the latest Delta Plus. Is it a question of survival for the virus?

This is just a way for the virus to escape immunity to spread better.

If you look at this philosophically, what is the goal of the virus? The goal of a virus is no different from the goal of the human species. What does the human species want to do? Survive and propagate.

We reproduce two or three times in our lifetime while the viruses reproduce millions of times.

Just like we are adapted for survival, just like we are adapted to propagating our species, so is the virus.

So, what we are seeing is simply an adaptation going on between the human species and the virus; for the virus to survive and transmit from one individual to another. Humans are adapting by developing individual and population based immunity.

A highly lethal virus is not a very good virus because a dead host is also a dead end for the virus. A severely ill host also has restricted mobility and cannot transmit very efficiently. From a virus perspective, asymptomatic infection is the most useful.

What is happening now is, the mutations are allowing the virus to transmit better. This is a way for the virus to become endemic in the population. It will slowly become a virus that will transmit very well but it will not make people sick very much.

The US is talking about vaccinating 70% of the population so that there is herd immunity. When do you think India can reach that stage?

I am not sure whether 70% will give herd immunity especially with the Delta virus spreading there. Nevertheless, 70% is a big number. It should make them very comfortable.

I think probably by the end of this year, we will be able to reach the 50%-70% mark.

But the figures the government puts out that India will have 2.1 billion doses available by then is a bit of an overestimate. We will possibly have somewhere around 1.6 billion doses. And that is not a mean achievement.

I think we should keep our focus on vaccination. And the need of the hour is to take the vaccine to rural India. Fortunately, our country has a lot of experience doing that because of a very successful polio eradication programme.

The Delta Plus is said to be more infectious than the Delta variant and is already present in three states in India. Do you think this will lead to a third wave sooner than later?

I don't know whether it can create a third wave. There is so far no evidence that Delta Plus is more infectious.

Out of 45,000 sequences available in India, we have about 40 sequences of Delta Plus. So, it is very low right now. But we should keep an eye on it because even Delta's presence was very low in December 2020. This can increase very quickly.

We keep worrying about this variant or that variant. Forget about that. Every variant can be stopped with a mask. We don't want to do the simple thing of wearing a mask, but we worry ourselves to death about different variants.

Yes, this is a variant we must be concerned about because it has brought a key mutation from the Beta variant which was found in South Africa into the Delta variant. So, it has made the Delta variant possibly more potent.

I am not sure whether it is more infectious, but it may evade antibodies a little better than Delta. It may pose a problem if it starts spreading widely. It may pose a challenge to people who are vaccinated or have been infected with an early version of the virus. But, it is too early to say that for sure.

How should we prepare ourselves for the eventuality of a third wave? Some people are talking about it striking in October...

I don't think anybody can say with certainty that there will be a third wave and when it will come.

Two measures to take to avert a third wave are, follow covid appropriate protocol and vaccinate as many people as possible.

This way, you can convert the infection from a wave across the country into localised outbreaks so that it can be controlled properly.

Of course, a lot of it depends on whether another mutant more infectious than Delta starts spreading soon!

• The War Against Coronavirus

Feature Presentation: Aslam Hunani/Rediff.com