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EDITORIAL
Year : 2021  |  Volume : 19  |  Issue : 3  |  Page : 129-131

Second wave of COVID-19: Unrelenting rampage of the SARS CoV-2 variants


Department of Emergency Medicine, Christian Medical College, Vellore, Tamil Nadu, India

Date of Submission29-Apr-2021
Date of Decision07-May-2021
Date of Acceptance12-May-2021
Date of Web Publication05-Jul-2021

Correspondence Address:
Dr. Kundavaram Paul Prabhakar Abhilash
Department of Emergency Medicine, Christian Medical College, Vellore, Tamil Nadu
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/cmi.cmi_44_21

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How to cite this article:
Abhilash KP. Second wave of COVID-19: Unrelenting rampage of the SARS CoV-2 variants. Curr Med Issues 2021;19:129-31

How to cite this URL:
Abhilash KP. Second wave of COVID-19: Unrelenting rampage of the SARS CoV-2 variants. Curr Med Issues [serial online] 2021 [cited 2021 Dec 4];19:129-31. Available from: https://www.cmijournal.org/text.asp?2021/19/3/129/320655



Over 100 years ago, a new strain of influenza (H1N1 influenza A virus), also called Spanish flu, infected a third of the world's population. Within 3 years, the threat of this deadly pandemic had all but passed out and it metamorphosed to the regular seasonal flu. However, the 1918 H1N1 strain remained the seasonal flu strain until 1958, when it was replaced by the H2N2 strain, the Asian flu pandemic.[1],[2] Those were the days of modern medicine in its nascent stage and without a vaccine.

When the novel coronavirus disease (COVID-19) pandemic started in December 2019, there were hopes of early containment through quarantine and lockdown measures. In the early days, many hoped the coronavirus would simply fade away. Some speculated that it would disappear on its own with the summer heat. Others hoped that herd immunity would kick in once enough people had been infected. However, none of that has happened. And alas, every country in the World failed to prevent the entry of the virus into their land. The only exceptions are Tuvalu, Turkmenistan, Tonga, Tokelau, Saint Helena, The Pitcairn Islands, Palau, North Korea, Niue, Nauru, Kiribati, Cook Islands, and American Samoa.

After the first wave in India in 2020, one may have thought that the contagion had almost left its shores and that the “curve” had been flattened enough. Politicians, policymakers, and social media believed that India was truly out of the woods, but severe acute respiratory syndrome coronavirus 2 (SARS CoV2), with all its variants, continued its unrelenting rampage of killing with reckless abandon.[3],[4] The weekly number of patients presenting to the emergency department of Christian Medical College, Vellore during the two waves of the pandemic in India, where the first wave of 2020 dwarfs in comparison to the second wave of 2021, is shown in [Figure 1].
Figure 1: Weekly cases in the SARIZONE of the Emergency Department of Christian Medical College, Vellore during 2020 and 2021.

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  Severe Acute Respiratory Syndrome Coronavirus-2 Variants Top


The SARS COV2 variants emerged within 3 months of detection of the original virus and perhaps been its Frankenstein monster during the second wave. The first variant with a D614G substitution in the gene encoding the spike protein was first detected in February 2020 in Europe and by June 2020, became the dominant strain circulating globally. Since then, many other variations have been detected from many countries, thus compounding and complicating the pandemic [Table 1]. The second wave of 2021 in India, is thought to be due to a coalition of the British (B.1.1.7), South African (B.1.351), the Indian (B.1.617) and perhaps the newly detected delta plus variant in Maharashtra. While most mutations are deleterious to the virus, some make it easier for the virus to survive. Hence, not all variants have increased transmission rate or virulence. The emerging variants have been classified by the Centres for Disease Control and prevention as follows: [8]
Table 1: Significant severe acute respiratory syndrome coronavirus 2 variants

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  • Variant of interest (VOI): A VOI is a new strain with a mutation that is predicted to affect the transmission, diagnostics, therapeutics, and vaccine effectiveness. A VOI would have caused discrete clusters of infections in some countries, but is not associated with definite evidence of change in disease transmission or severity, however may still warrant appropriate public health measures, increased surveillance, and epidemiological survey. All VOI s are under constant surveillance.
  • Variant of concern (VOC): A VOC is one that has been proven to be more contagious or cause more severe disease. It may also cause decreased effectiveness of therapeutics and vaccines. People with prior COVID-19 infection would be susceptible to these new variants. Many VOC s are currently being monitoring across the World.
  • Variance of high consequence (VOHC): Strains with VOHC are associated with failure of diagnostics, reduced effectiveness to approved therapeutics, decreased vaccine effectiveness, and more severe clinical diseases leading to increased hospitalization. Currently, none of the SARS CoV2 variants have risen to the level of VOHC.


However, the circulating variant strains are probably only part of the conundrum of the second wave in India. The public health efforts that reasonably contained and mitigated the first wave of the pandemic; rigorous testing, contact tracing, social distancing, and wearing masks have become lax in most places. After enduring weeks-months of stringent lockdown through most of 2020, the general public started developing “lockdown fatigue” with consequent “covid inappropriate behaviour.” Multiple therapeutic options, all dubbed the “silver bullet” before clinical trials, were tried out, but most of them turned out to be damp squibs. Finally, the beginning of the year 2021 brought a ray of hope in India in the form of two indigenously developed or produced vaccines, Covishield and Covaxin. The relatively calm period of January-March was a golden opportunity for mass vaccination but was squandered by “vaccine hesitancy” and restrictions to age limits for vaccination. Compounding this were election rallies, religious congregations in the thousands and political protests across the country with utter disregard for social distancing and safety measures. The Indian health system inevitably cracked under the weight of the second wave of COVID-19 with grossly inadequate hospital beds and oxygen supply. Even the crematoria across the country are overwhelmed, though the actual number of COVID-related deaths certainly far exceed the official daily figures declared. Drugs like remdesevir, indicated only for moderate-to-severe diseases with a proven decrease in hospitalization and no mortality benefit were never the “magic bullet.” However, social media misinformation and panic led to it being grossly misused for mild cases and stockpiles were hoarded during the second wave, causing a severe drug crisis, setting off more panic among physicians and the general public. Despite numerous health advisories against the use of steroids, numerous hospitals, dispensaries and unqualified quacks from the national capital to remote villages have been indiscriminately prescribing steroids like dexamethasone and methyl-prednisolone, often in monstrous doses with disastrous consequences like the 'black fungus' (mucormycosis) storm.

At this point, the saga of the COVID-19 pandemic seems to be endless. COVID-19 and lockdown fatigue have set in and everyone is desperate to get back to the blissful life of the “pre-Covid” era. Miserable situations are usually supposed to end with hope but I imagine no healthcare worker in India has any capacity for whimsy and hope right now, only dogged determination to do the task in front of them and keep putting one foot in front of the other. The destructive second wave will burn out at some point. It has to. That is what pandemics do. That is their natural history. They end. The only question in the infinity war against the COVID-19 pandemic is; when are we going to reach the “end game”?



 
  References Top

1.
Huremović D. Brief History of Pandemics (Pandemics Throughout History). Psychiatry of Pandemics. 2019;7-35. Published 2019 May 16. doi:10.1007/978-3-030-15346-5_2.  Back to cited text no. 1
    
2.
Sreekumar G, Lohanathan A, Hazra D. COVID-19 – A replay of the 1918 pandemic? Curr Med Issues 2020;18:83-6.  Back to cited text no. 2
  [Full text]  
3.
Abhilash KP. COVID-19 vaccines: Hope on the horizon with doubts. Curr Med Issues 2021;19:67-9.  Back to cited text no. 3
  [Full text]  
4.
Abhilash KP. COVID-19 pandemic: Quo vadimus? Curr Med Issues 2021;19:1-2.  Back to cited text no. 4
  [Full text]  
5.
Galloway SE, Paul P, MacCannell DR, Johansson MA, Brooks JT, MacNeil A, et al. Emergence of SARS-CoV-2 B.1.1.7 lineage – United States, December 29, 2020-January 12, 2021. MMWR Morb Mortal Wkly Rep 2021;70:95-9.  Back to cited text no. 5
    
6.
Novazzi F, Genoni A, Spezia PG, Focosi D, Zago C, Colombo A, et al. Introduction of SARS-CoV-2 variant of concern 20h/501Y.V2 (B.1.351) from Malawi to Italy. Emerg Microbes Infect 2021;10:710-2.  Back to cited text no. 6
    
7.
Raghav S, Ghosh A, Turuk J, Kumar S, Jha A, Madhulika S, et al. Analysis of Indian SARS-CoV-2 genomes reveals prevalence of D614G mutation in spike protein predicting an increase in interaction with TMPRSS2 and virus infectivity. Front Microbiol 2020;11:594928.  Back to cited text no. 7
    
8.
Centers for Disease Control and Prevention: COVID-19. Doi: Available from: https://www.cdc.gov/coronavirus/2019-ncov/cases-updates/variant-surveillance/variant-info.html. [Last accessed on 2021 May 20].  Back to cited text no. 8
    


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