<p>With just a fortnight for the start of the Dasara-Diwali festival season, worries about a possible third wave of Covid-19 are on everyone’s mind.</p>.<p>In an interview with <em><span class="italic">DH</span></em>’s <span class="bold">Kalyan Ray, </span>one of India’s foremost virologists, <span class="bold">T Jacob John, </span>a former professor at Christian Medical College, Vellore, shared his views on the third wave, whether booster shots of Covid-19 vaccines are needed, and should the gap between the two doses be shortened.</p>.<p>Excerpts:</p>.<p><strong>Do you foresee a third wave after the festival season? Is there a way to figure out what the scale of such a wave would be?</strong></p>.<p>Prediction of the future is an Indian pastime. We do not know how to predict future virus-human interactions because the past did not give us clear metrics. Between the first and second waves, the virus behaviour changed drastically and that could not be predicted. While other countries did not predict the "end of the problem" by January 2021, Indian oracles predicted the end of the problem, reflected by the assertion in the Davos Economic Forum in February 2021.</p>.<p>After the second wave, the same oracles swung the pendulum to the other extreme and predicted “greater problem awaits India" by way of a third wave. Both predictions were unfounded and that illustrates that we in India do not have real oracles who collect all data with an eye on accuracy and then project forward, mainly to prepare for the next phase of the battle.</p>.<p>Real (professional) oracles are missing in India. The UK and USA and all democracies in the western world have them as "epidemiologists, professional and government-employed" who are the real prophets of "public health". China has them in large numbers but not being a democracy, they are controlled by the State. India just does not "believe" in their profession and does not employ them. All well-trained ones work overseas or in Indian universities and institutes.</p>.<p><strong>Is Covid-19 becoming endemic in India? Will there be a requirement for annual shots like the influenza jabs in the USA?</strong></p>.<p>Whether oracles agree or not, nationally (except Kerala) our epidemic has settled down as "endemic" meaning low and relatively steady numbers not showing trend of going up but trend of coming down is compatible. Such a trend has been consistent over 11 consecutive weeks. A third wave is quite unlikely unless a super-transmissible variant, far more transmissible than Delta turns up. That is where all attention must be focused to keep all variants under watch. Regarding annual shots, I am no oracle but my hunch is that we will need a "booster dose" once for sure. Whether we will need any more will depend on study data -- longevity of robust immunity post-one booster. Sars-CoV-2 is quite unlike influenza in more than one way and my scientific knowledge tells me that annual boosters will not be needed.</p>.<p><strong>With multiple studies recommending double doses of the Covid-19 vaccines due to limited utility of the single-shot particularly when the epidemic is being driven by the Delta variant, is there a need to have a relook at India’s current vaccination strategy and shorten the gap between the two doses of Covishiled to maximise the number of people fully vaccinated (currently it is 60% vs 20%)?</strong></p>.<p>You are absolutely correct; we do not need an oracle to say that. Science calls for two doses as early as possible and for both Covishield and Covaxin it is four weeks. A High Court Judge in Kerala had no problem in figuring that out. Not only that -- if officials analyse severe Covid-19 cases with mortality, they will find that almost all are in persons not given two doses. Like Kerala, the officials must put an emphasis on reducing deaths and not just doing vaccination as a modern ritual. Men above 65 and persons with immune-suppressing diseases or treatments actually deserve the third dose.</p>.<p><strong>Will the number of breakthrough infections (Covid-19 cases two weeks after the second dose) increase among the general population as time passes and will a booster shot help?</strong></p>.<p>Everyone will gradually learn the new game, never played before -- universal adult vaccination. The Covid-19 experts in any country are not paediatricians well versed in the game. There are rules to go by. We know that all "non-replicating" vaccines given to children are by schedule of "primary series" and "boosters". Primary (actually priming) series are usually 3 doses. Even then immunity wanes over about one year or a bit more, and a booster is necessary in the second year of life. Covid-19 vaccines cannot be any different.</p>.<p><strong>Is it alright to reopen the school at all levels once the teachers and staff are vaccinated? In states like Delhi where schools have reopened (Std: IX to XII), the majority of the parents are still not sending their wards to the school. Are their fears justified?</strong></p>.<p>If all teaching and non-teaching staff are vaccinated (two doses) and also all grandparents and parents, then the schools must reopen as soon as possible, but not all at once but slowly and by testing the waters. If parents are not willing to send children then either the conditions have not been fulfilled or parents have not been informed. The order of reopening should be Anganwadis and primary schools first, with piloting a few and monitoring for two incubation periods -- two weeks -- and if the coast is clear, open all others.</p>.<p>Next, reopen middle schools on a pilot basis and observe for two weeks. If everyone is convinced of the sky not falling, open all middle schools. Then all higher secondary can be opened as the skills and drills of infection prevention and monitoring are by now fully practised.</p>.<p><strong>What's the way out for Kerala to reduce its caseload and daily new infection count?</strong></p>.<p>Kerala has been doing a balancing act when festivals come. Eid was on July 20 -- the trend of daily numbers was unaltered post-Eid. Onam (August 20) is an "all religion" festival and lasts 10 days. It was followed by a spurt in infections (from August 25) that has now begun declining since September 10 and the trend I hope will sustain. The two-dose vaccination coverage as of now is 27% and as it increases, the decline in numbers will sustain. All hospitalizations are in persons not given two doses.</p>
<p>With just a fortnight for the start of the Dasara-Diwali festival season, worries about a possible third wave of Covid-19 are on everyone’s mind.</p>.<p>In an interview with <em><span class="italic">DH</span></em>’s <span class="bold">Kalyan Ray, </span>one of India’s foremost virologists, <span class="bold">T Jacob John, </span>a former professor at Christian Medical College, Vellore, shared his views on the third wave, whether booster shots of Covid-19 vaccines are needed, and should the gap between the two doses be shortened.</p>.<p>Excerpts:</p>.<p><strong>Do you foresee a third wave after the festival season? Is there a way to figure out what the scale of such a wave would be?</strong></p>.<p>Prediction of the future is an Indian pastime. We do not know how to predict future virus-human interactions because the past did not give us clear metrics. Between the first and second waves, the virus behaviour changed drastically and that could not be predicted. While other countries did not predict the "end of the problem" by January 2021, Indian oracles predicted the end of the problem, reflected by the assertion in the Davos Economic Forum in February 2021.</p>.<p>After the second wave, the same oracles swung the pendulum to the other extreme and predicted “greater problem awaits India" by way of a third wave. Both predictions were unfounded and that illustrates that we in India do not have real oracles who collect all data with an eye on accuracy and then project forward, mainly to prepare for the next phase of the battle.</p>.<p>Real (professional) oracles are missing in India. The UK and USA and all democracies in the western world have them as "epidemiologists, professional and government-employed" who are the real prophets of "public health". China has them in large numbers but not being a democracy, they are controlled by the State. India just does not "believe" in their profession and does not employ them. All well-trained ones work overseas or in Indian universities and institutes.</p>.<p><strong>Is Covid-19 becoming endemic in India? Will there be a requirement for annual shots like the influenza jabs in the USA?</strong></p>.<p>Whether oracles agree or not, nationally (except Kerala) our epidemic has settled down as "endemic" meaning low and relatively steady numbers not showing trend of going up but trend of coming down is compatible. Such a trend has been consistent over 11 consecutive weeks. A third wave is quite unlikely unless a super-transmissible variant, far more transmissible than Delta turns up. That is where all attention must be focused to keep all variants under watch. Regarding annual shots, I am no oracle but my hunch is that we will need a "booster dose" once for sure. Whether we will need any more will depend on study data -- longevity of robust immunity post-one booster. Sars-CoV-2 is quite unlike influenza in more than one way and my scientific knowledge tells me that annual boosters will not be needed.</p>.<p><strong>With multiple studies recommending double doses of the Covid-19 vaccines due to limited utility of the single-shot particularly when the epidemic is being driven by the Delta variant, is there a need to have a relook at India’s current vaccination strategy and shorten the gap between the two doses of Covishiled to maximise the number of people fully vaccinated (currently it is 60% vs 20%)?</strong></p>.<p>You are absolutely correct; we do not need an oracle to say that. Science calls for two doses as early as possible and for both Covishield and Covaxin it is four weeks. A High Court Judge in Kerala had no problem in figuring that out. Not only that -- if officials analyse severe Covid-19 cases with mortality, they will find that almost all are in persons not given two doses. Like Kerala, the officials must put an emphasis on reducing deaths and not just doing vaccination as a modern ritual. Men above 65 and persons with immune-suppressing diseases or treatments actually deserve the third dose.</p>.<p><strong>Will the number of breakthrough infections (Covid-19 cases two weeks after the second dose) increase among the general population as time passes and will a booster shot help?</strong></p>.<p>Everyone will gradually learn the new game, never played before -- universal adult vaccination. The Covid-19 experts in any country are not paediatricians well versed in the game. There are rules to go by. We know that all "non-replicating" vaccines given to children are by schedule of "primary series" and "boosters". Primary (actually priming) series are usually 3 doses. Even then immunity wanes over about one year or a bit more, and a booster is necessary in the second year of life. Covid-19 vaccines cannot be any different.</p>.<p><strong>Is it alright to reopen the school at all levels once the teachers and staff are vaccinated? In states like Delhi where schools have reopened (Std: IX to XII), the majority of the parents are still not sending their wards to the school. Are their fears justified?</strong></p>.<p>If all teaching and non-teaching staff are vaccinated (two doses) and also all grandparents and parents, then the schools must reopen as soon as possible, but not all at once but slowly and by testing the waters. If parents are not willing to send children then either the conditions have not been fulfilled or parents have not been informed. The order of reopening should be Anganwadis and primary schools first, with piloting a few and monitoring for two incubation periods -- two weeks -- and if the coast is clear, open all others.</p>.<p>Next, reopen middle schools on a pilot basis and observe for two weeks. If everyone is convinced of the sky not falling, open all middle schools. Then all higher secondary can be opened as the skills and drills of infection prevention and monitoring are by now fully practised.</p>.<p><strong>What's the way out for Kerala to reduce its caseload and daily new infection count?</strong></p>.<p>Kerala has been doing a balancing act when festivals come. Eid was on July 20 -- the trend of daily numbers was unaltered post-Eid. Onam (August 20) is an "all religion" festival and lasts 10 days. It was followed by a spurt in infections (from August 25) that has now begun declining since September 10 and the trend I hope will sustain. The two-dose vaccination coverage as of now is 27% and as it increases, the decline in numbers will sustain. All hospitalizations are in persons not given two doses.</p>
