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Although  the COVID-19 cases in the country sees a dip, India is bracing for the third wave of COVID-19. Experts have suggested proper protection of children as they might be the most vulnerable category in the third-wave. Answering the questions regarding the impact of the third wave and the preparations that the country needs to take, a panel of experts answered FAQ's. The panel comprised of Dr. Yatharth Tyagi, Director of the Yatharth Group of Hospitals, Dr. Shashank Joshi, Member of the Maharashtra COVID Task Force, Dr. Ajay Handa, Senior Consultant Pulmonary Medicine and Intervention Pulmonologist from Sakra World Hospital, and Dr. Surabhi Madan, Infectious Disease Consultant at CIMS Ahmedabad. 

Now that cases are declining, should we let our guard down?

Dr. Yatharth Tyagi answering the question said, "Even if we let our guards down, things like wearing masks, maintaining social distance, and avoiding public gatherings should be followed. The reason is that we saw what happened in the last wave when people let their guard down and violated COVID protocols. However, I feel the chances of such havoc impact in the third wave is very less but then again we need to be cautious about it."

The second wave led to oxygen crunch. What could be the challenges in the Third Wave?

According to Dr. Shashank Joshi, "In the third wave, the country needs to be better prepared on pandemic preparedness whether it is oxygen or healthcare supplies. Right now we are ready, and I don't think the shortage we witnessed during the second wave would be the same in the third wave. By the time the third wave will hit, a large part of people will be exposed to vaccination and it will occur in another three to six months. So I don't feel we will see a shortage since most of the hospitals have procured oxygen generating units."

Will possible third wave impact children more?

Dr. Surabhi Madan answered the question and stated, "Till now we have seen that children are the most protective population. The severity of acute COVID in them has not been as much as in adults. But in the children what we are observing a syndrome called Multi-System Inflammatory Syndrome. That is a syndrome that happens long after the patient has recovered from COVID, and we are really worried about it. The Indian Academy of Pediatrics has actually said that the population of children is the one that has not been immune, and vaccination has not yet been started for children. We are looking forward to vaccinating our children as early as possible"
 

How can we better prepare for the third wave?

Answering the question, Dr. Ajay Handa said, "The initial focus of vaccination was put on healthcare workers, frontline workers, and aged people. Till this particular wave, we learned that those who were not vaccinated, the population under 50 they reported severe cases. So we can say that vaccination develops immunity and makes the disease milder and the need for hospitalization is reduced along with the chances of going under ventilator and dying is almost nil. So we need to broaden the vaccination drive as much as possible. Both the vaccines Covaxin and Covishield cover the mutant spread including the new mutant and in the coming time it will be modified."

What are the lessons from the second wave for the possible third wave?

Pointing out the major lessons taught by the second wave, Dr. Yatharth Tyagi said, "The private and government hospitals have learned major lessons like oxygen management. The amount of storage each hospital has is very important. There were a lot of hospitals that were given permission to treat COVID without them having a liquid oxygen tanker. The hospital with proper oxygen storage management should only be allowed to treat COVID because, in cylinder-based oxygen supply, the hospital tends to run out very fast. The amount of consumption is a lot and it is very difficult to keep on changing the cylinders the whole day."

How can we ensure mitigation of third-wave impact?

Dr. Shashank, Joshi mentioned the success of the Mumbai Model being decentralization, empowering each ward, it was all about coordinated effort and not forgetting basics. He added, " We still need to continue the high level of testing.  We still need to test, isolate and treat continuously so that we can face the third wave with better preparedness. We have three challenges- firstly we need the test positive rate persistently below 5% for more than two weeks, second, we need to ensure that 70% of the geography of a given district is done vaccinating, and lastly we should have zero tolerance for people who do not follow COVID appropriate behavior. If we follow these for three to six months we are certain that even if the third wave comes we would be able to take the sting out of it.

Will post-COVID complications further burden health infrastructure?

Weighing to the current scenario in the hospitals, Dr. Surabhi Madan stated, "Starting from post covid inflammatory fever to multi system inflammatory syndrome to infections like common bacterial infection and severe infection like mucormycosis even tuberculosis has increased significantly after COVID in those patients on which steroids are used. Even post- COVID lung injury that leads to lung fibrosis is seen and there are many patients who become oxygen dependent. Right now the main chunk of patients in the hospital is of Post COVID complications than actual COVID patients. 

With speedy vaccination can we evade the third wave?

Answering the question, Dr. Ajay Handa said, "At least 60 to 70% vaccination coverage is required to prevent the third wave, but as of now we have 13% of our population who have received the first dose and around 3-4% of the population who have received both the doses. Our country's population is so huge that vaccination coverage will take time. Even though it is expected that by August the vaccination procurement will be enough, but complete vaccine coverage will not be possible. We might be able to face the third wave strongly but evading it completely out can not be guaranteed."

Will vaccinating children ensure that impact on kids is mitigated?

Emphasizing the efficacy of vaccines, Dr. Yatharth Tyagi said, "Any covid vaccines when administered has mitigated the impact especially seen in the cases of adults. In the case of children, I hope the Covaxin trial passes soon. The number of severe cases post to vaccination was very limited with no mortality."
 

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