Conjunctivitis, Upset Stomach: What's New In India's Second Wave Of Mutated Covid-19

It has been more than a year since the deadly Covid-19 wreaked havoc in India, and even after several efforts to contain its spread, the second wave of the virus is currently spreading like wildfire in the nation.

India overtook Brazil to become the second-most affected country globally by the coronavirus.

Like all other pandemics in the past, a second wave with the Covid-19 was an expected occurrence. But the first wave did give us very important lessons of preventing a second one. Since we did not learn from history, we are doomed to repeat it. 

During the second Covid wave, the most common symptoms remain dry cough, fever, loss of taste, and smell, however, there has been evidence of the mutated forms of the virus producing different symptoms and reportedly being more transmissible.

Here are all your questions answered by Dr Trupti Gilada, Consultant Physician in Infectious Disease, Masina Hospital.

What is different in the clinical presentation of the second wave?

Given the extremely high transmissibility with the new variant, we are seeing entire families getting infected. Even just one meal together with a friend or relative means a few other households falling target to the virus.

In the previous wave, we saw that a majority of individuals remained asymptomatic. This time around it seems that the percentage of symptomatic cases is much more albeit most of these continue to be mild. 

In the previous wave, children almost escaped unscathed. Increasing numbers of symptomatic infections in children is another concern in the current wave. This change in the age group of symptomatic infection is also evident because a higher number of younger people are getting infected this time around. This may be attributed to the fact that this is the age group that steps out to work and socialize but at the same time show very poor compliance to Covid-appropriate behaviour. 

Runny nose, vomiting, loose motions and coughs that begin early but continue for over 2 weeks is being seen much more commonly with the current variant. In some individuals, there is no fever at all and in others fever sometimes begins only a day or two after the other symptoms. Since patients do not attribute their colds and abdominal discomfort to Covid, they continue interacting with people until the fever strikes. By then, they have transmitted the virus to a few households. 

It is therefore extremely crucial to inform the masses that they should isolate at the very onset of anything uncomfortable they experience, be it even a headache or even a slight sore throat. 

Reasons for the recent spike in Covid cases: 

New variant: Although we all know that the cause of the second wave is multifactorial, the main reason is the emergence of a new variant. 

We need to acknowledge that the public behaviour or the unlocking norms did not change drastically in February to be solely responsible for the surge we are seeing since March. Although the Centre is yet to flag the double mutation variant of the virus as a matter of serious concern, the increased infectiousness of the current strain as also the re-infections in those who had recovered from Covid in the past points towards a new strain being potentially responsible. The double mutation has the E484Q mutation (making it highly transmissible) and the L452R mutation (that helps the virus evade the body’s previous immune response). This double mutant strain has been named B.1.617. Importantly, the degree of efficacy of the vaccines in preventing infection, both preventing mild infection and preventing hospitalization/ death from such mutant strains remains unknown. It is more important than ever that we need to do more genetic testing of the current strains and put together all the data to understand how this wave will shape out and how it will affect people.   

The irresponsible human and societal behaviour indeed gave momentum to this new strain to push the country into a second wave. As society slowly unlocked, festivities started and the onset of the wedding season meant people gathering indoors to eat, drink and celebrate. All of these meant unmasked interactions over prolonged periods. 

Countries in the east are great examples to learn from. For example, in Japan where their population continues to behave very responsibly from the very beginning in terms of masking and social distancing succeeded in both, keeping the first wave small as well as preventing future waves. And this when Japan did not impose even a single day of lockdown. 

Covid Fatigue: 

After many months of economic slow-down, cancelled activities and social isolation, people claimed that they were frustrated and tired of Covid precautions. From the period from October 2020 to February 2021, people in India also started believing that the worst was behind them and the Covid saga was almost over. Reopening restaurants, businesses and relaxing occupancy limits in the community encouraged people to lower their guards and this drove the wave that we are seeing. 

Sluggish Covid Vaccination Roll-out: 

Despite having the vaccines ready in 2020, the vaccination drive only started in January 2021. Even then, the initial efforts by the government and enthusiasm of the people were surprisingly underwhelming. Almost 3 months into our national vaccination drive and ramping it up, we have only vaccinated about 7 per cent of our population before entering the current slowdown because of a vaccine shortage. A substantial population being vaccinated works in two ways. At an individual level, it prevents hospitalization and death in those vaccinated even if they do get infected. On the other hand, the decreasing transmission in the population means lesser chances of mutation and thus prevents the emergence of newer strains. Having lost the opportunity to mass vaccinate our population during the Covid lull, we are now paying a heavy price. 

While country leaders need to start leading by example, we need to put into full play a very responsible attitude from individuals and society as also a rapid ramp-up of both healthcare facilities and the vaccination drive. And while there is no easy sailing through this wave, let us minimize the damage and at least this time learn from the science and the history that we are witnessing unfold.