“Pandora’s box” opened as COVID-19 cases surge

As cases of COVID-19 surge across India, some doctors have claimed “Pandora’s box” has opened. India’s second wave is underway, and figures now dwarf the peaks in September that saw speculation that India would rise to the most-affected nation.

pandemic preparation waving colorful national flag of india on a gray background with text coronavirus covid-19 . concept.. COVID-19 cases in India illustration. Indian COVID-19 cases concept. Cases of COVID-19 crisis in India concept. Image credit: luzitanija / 123rf. Used to illustrate one million deaths due to the pandemic. covid-19 vaccine supplies in india
Image credit: luzitanija / 123rf

Such a severe second-wave is a shock considering that in early March, India’s Health Minister Dr Harsh Vardhan declared the country was “in the endgame” of the COVID-19 pandemic. Indeed, India was heralded as an example the world over in negating a potential disastrous scenario.

Figures in mid-September last year saw a pinnacle of around 100,000 new cases of COVID-19 per day. This rise was far more gradual than in other nations. As previously reported by Health Issues India, “unlike many countries that witnessed a sudden surge followed by either a plateau or an equally sudden decline, India’s increase occurred over a period of months. Cases began to notably increase in April 2020. This initial wave would not reach its peak until mid-September”.

This peak was expected by many at the time to continue to rise — a fear sparked by India’s vast population. This, however, was not the case as, after the first peak in September, cases began to gradually fall. This gradual decline was observed to continue until February 2021, after which the reductions flatlined, followed by a marginal increase. Since mid-March cases have begun to rise rapidly, with figures now far exceeding the initial peak.

On Sunday, India recorded more than 270,000 cases and over 1,600 deaths due to COVID-19. Both these figures are single-day records, with the 270,000 figure nearly triple that of the highest point of the peak in September of last year. This peak has shown a far more rapid increase than the first, and currently shows no signs of abating.

Opinion on the matter is as of yet divided. This is likely to be the case due to the rapid pace at which the second wave has occurred, limiting the amount of data available. Dr Balram Bhargava, Director-General (DG) of the Indian Council of Medical Research (ICMR) has claimed that this second wave is ‘less severe’ than the previous one.

“Very clearly, we find that the symptoms are much less. As I mentioned that the symptoms of joint ache, fatigue, muscle ache, loss of smell or sore throat are much less compared to the first wave. However, shortness of breath is higher in this wave,” said Dr Bhargava. “From zero to nineteen years – the difference was 5.8 percent versus 4.2 percent, and in twenty-forty years, the difference was 25 percent versus 23 percent. There is a marginal difference in this. More than seventy percent were above or equal to forty years of age. A higher number of asymptomatic individuals got admitted this year, than a higher proportion of patients admitted with breathlessness.”

Doctors on the ground have opinions that contrast with this message. “I believe we are seeing a stronger mutation, many patients are testing negative for the virus but clinically they are COVID-19 positive. The pandora’s box of this disaster is open now,” said Dr Pankaj Solanki, Medical Director at the Dharamveer Solanki Hospital in New Delhi.

“People’s condition is deteriorating much quicker, we’re seeing many more patients with a cytokine storm and a lot of younger patients – their symptoms are a lot more difficult to manage this time.”

It has been found that 61 percent of cases between January and March were of the B.1.617 strain – described as the “double mutant”. Seventy of these cases have now been diagnosed within the UK, indicating that the double mutant strain is now spreading internationally. It has been feared since the start of the pandemic that mutations could lead to strains of the COVID-19 emerging that are either far more difficult to detect, or are resistant to vaccines and treatment.

The double mutant  in which two base pairs of DNA are altered from the base strain — E484Q and L452R — has been suggested by virologists to be both more contagious and capable of causing reinfection.

India has ramped up vaccine coverage in the previous weeks. The gargantuan campaign is reported to have covered more than 100 million people — a figure larger than the population of most countries. However, in the context of India, this is still less than ten percent of the population, far short of a figure needed to achieve herd immunity. With fears now present that the double mutant strain could cause reinfection, even those who have been infected once are potentially again at risk. 

The first wave was rightly deemed a public health crisis. The second wave is already beginning to dwarf previous figures with no signs of slowing. Extensive measures may be a necessity in order to curb the surge in COVID-19 cases across the country, large-scale quarantines are likely to be invoked again — a measure unlikely to prove popular among the population. However, given the spread of mutant strains out of India, such measures could be vital to preventing resurgences on a global level.

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