Chairman, Apex Level Advisory Committee of Government of Jammu and Kashmir for COVID19, Prof. M. S Khuroo said that J&K should prepare to receive close to 10,000 COVID positive cases with around 100 deaths per day. The pandemic is likely to peak within 3 to 4 weeks and stay at a plateau for several weeks before showing regression.
Prof Khuroo, former Director SKIMS, in an exclusive interview said that the next 6 to 8 weeks are crucial as J&K is likely to witness 6000 to 10000 COVID cases, 60 to 100 deaths per day and all efforts need to be done to control the spread, save human lives and give comfort and care to the needy.
“To face such a huge challenge, a heightened state of emergency has been called for and all state machinery is geared to act and face the pandemic as J&K has shown significant mutations and several variants circulating in the population.”
“Apart from the wild virus strains of SARS-CoV-2, several variants of the virus are circulating in the community in J&K which include: mutation B.1.1.7 (UK variant): This mutation was first described in Kent, UK, and has the potential for increased infectivity and spread in the community. This mutation is fast spreading in the USA and many other countries. In India, B.1.1.7 (UK mutant) is highly prevalent in Punjab and is also seen in a high proportion of cases from Delhi and Haryana. Mutation similar but not exactly like the UK variant. These mutations are similar to UK mutations with the same signature and have the potential to be more infectious as mutation B.1.1.7. iii. B.1.617 (Indian double mutation): This is the variant to have 2 mutations that enable the virus to evade antibodies and increase infectivity.”
“Because of these many mutant strains of the virus in addition to the wild strain, the disease COVID-19 2021 has some distinctive features which include: massive surge of cases due to increased infectivity, super-spreader phenomenon is shown by the fact that infection in one member in a family/office/establishment spreads to all and spares none. This phenomenon has a major implication on the ‘stay home policy’ as elderly people who stay home can yet get infected. The advice on ‘mask and social distances indoors’ (reverse quarantine) needed to be practiced to save the elderly from getting infected, aerial mode of spread especially in congregations in ill-ventilated areas.”
“In such a situation masks may become less protective and viruses circulating in the air spreads for extended distances. The basic mode of spread by droplet continues to be a major factor, as of today, disease occurs more often in young people than seen in 2020 and a significant percentage developed moderate to serious disease and even die, higher percentage of infected patients developed lung disease and get hospitalized and cause pressure on resources including space, manpower, drugs, oxygen, and ventilators.”
“There is a suspicion that COVID-19 as of today in J&K has higher mortality and morbidity. Immune evasion phenomenon: Unfortunately, people who are vaccinated, partially or fully or those who have suffered COVID in the past can get breakthrough infections due to variants in the community. The breakthrough infections may be mild or asymptomatic in a large majority of cases. However, some patients may get lung disease, and need hospital admission.”
“Diagnostic test evasion, due to major mutations in the spike proteins, otherwise sensitive test ‘rt RT-PCR may show false negative results delaying therapeutic interventions at crucial times. Because of the above variants and distinctive disease features, I would prefer to call it a new-COVID-virus with a new-COVID-disease of 2021,” said Prof. Khuroo.
Explaining the recent massive surge, Prof. Khuroo said that apart from mutation, the inability of society to follow COVID appropriate behaviour has been instrumental to bring us to this stage. For several reasons, the COVID appropriate behaviour had gone for a toss. The dictum of “mandatory-masking, social-distancing, avoid-crowding, and hand-sanitation” were forgotten. Masks became a liability or an ornament to hang from the chin and the value of social distancing inside the house and in places of work was laughed out as a stigma. Congregations of diverse nature may be political, religious, social, recreational, academic, and cultural all were supported and upgraded. Markets became as busy and as crowded as one could imagine. In fact, COVID was forgotten and conceived to be conquered.”
“Unfortunately, while as this show in the society was on, little we knew how a virus of 200 nm of 30kb with around 30,000 nucleotides would behave, mutate and evade all human endeavours,” he said.
How can we tame the beast? Prof. Khuroo said that looking at the epidemiology of COVID-19, the incubation period, and modes of transmission, any effective measures to stop transmission at an early stage of the surge of pandemic make gains in a matter of days to few weeks.
“However, as of today, we have missed the bus and not acted effectively for so long and let the community spread of infection through society. Even highly effective measures to block the transmission at this stage namely ‘Mandatory-masking, Social distancing, Avoid-crowds/gatherings, and hand-washing policies ‘shall take from 6 to 8 weeks to initiate benefits. In such a situation, there is only one crash major to tame the beast: the so-called Lockdown. Lockdown is no permanent solution but shows effects to dampen the impact of the pandemic within 10 days to 2 weeks. “
“If done, one has to evaluate the economic effects of the lockdown, give massive support to those who get badly affected, in the form of cash and free rations. Thus, an effective economic package needs to be implemented to mitigate the economic suffering of lockdown.”
How do make a sense of fight to the finish to conquer the pandemic? Prof Khuroo said to fight the pandemic, highly coordinated and effective measures need to be implemented in society. “These have been practiced by all countries including India while fighting the 2020 surge. However, additional measures need to be done to block the altered behaviour of the variants and their additional mode/mechanism of transmission. The virus/variants often show super spreader phenomenon and are transmitted rapidly in households, offices, and establishments. This is a major threat to the elderly population who are otherwise housebound and would call for reverse quarantine policies in such households.”
“Secondly, airborne transmission may play a significant role in the transmission and can spread in close spaces beyond 6 feet distances and for a longer period. Mask wearing in such a situation may not be as effective as otherwise in such a setting. “
Finally, on vaccines, Prof. Khuroo said that with variants that are more infectious and have immune evading properties, and can infect those who are partially or fully immunized, the role of the COVID-19 vaccination program in society needs to be redefined. He believed that vaccination programs should continue with full strength and force even with such variants are circulating in the community. The fact is that vaccines may not give sterilizing immunity but can safeguard you from getting infections that need hospitalization and/or serious lung disease and death. Also, the doctrine to fight RNA-virus-variants as of the SARS-CoV-2 virus is to stop or reduce viral replication in the community. So, implementation of COVID appropriate behaviour and vaccination shall reduce the occurrence of infections. Once the virus replication is reduced occurrence of variants is also inhibited.