Noting that COVID-19 may be heading towards endemicity in India, vaccinologist Dr Gangandeep Kang on Monday said local flare-ups that will be smaller and spread wider across the country may add up to form a third wave of the pandemic, but the scale will not be like before.
The endemic stage is when a population learns to live with a virus. It is very different from the epidemic stage when the virus overwhelms a population.
In an interview with PTI over the COVID-19 situation in India, Kang said after the second wave, maybe a quarter of the country's population continues to be susceptible to the virus.
"So will we be able to achieve within that quarter the same numbers and the same patterns that we saw in the second wave? That I think is unlikely. What we will see is local flare-ups that will be smaller and spread wider across the country. Now if that will collect to form a third wave, that may happen if we have a lot of behaviour change around festivals, but the scale is not going to be anything like what we saw before," she said.
Asked if Covid may be heading towards an endemic stage in India, Kang said, "Yes."
"When you have something that is not going to go away in the near future, it is heading towards endemicity. Right now, we are not looking at eradicating or eliminating SARS-CoV2, which means it has to become endemic," Kang, who is a professor in the Christian Medical College, Vellore, said.
"We have a lot of endemic diseases like influenza, but you can have a pandemic layered on top of an endemic disease. So for example, if you get a new variant that completely escapes the immune response, you could have a pandemic again but that would not mean that SARS-CoV2 is only a pandemic and has stopped being endemic.
"There is both, because one set of variant will be doing something while another would be doing something else," she explained.
Kang stressed on the need for developing better vaccines that can deal with new variants of Covid.
"We designed vaccines based on the ancestral variant of SARS-CoV-2. Is that the best possible vaccine we could have in terms of the quantity, quality and longevity of immune response? So will it be better for us to have a vaccine based on a newer variant, should we be thinking about combining the two -- like one dose with the older variant and one with the new -- what will that mean in terms of immune response?
"I think these are things for us to think about and we should focus on making the product -- new variant-based vaccines, new platform vaccines -- and test those very carefully in clinical trials, so we can maximise the value that vaccines bring. And we can only do that if we experiment enough of what we have and what we can potentially make," she said.
Speaking about how the pandemic overwhelmed the medical system and affected other diseases, she said what needs to be done is rationalising the approach.
"What we need to do is rationalise our approach. What we did during the height of the pandemic is that we took people, laboratories, testing away from the regular medical system and devoted all these resources to COVID-19...we cannot be doing the same thing we did 18 months ago...we need to think that in the future, if we need to ramp up SARS-CoV2 activity, what will we do so that we will not lose what we lost this time around," she said.
Kang said in many states, the maternal mortality rate went up because women did not get care, the immunisation programmes were affected, people with cancer did not get chemotherapy, those diabetic could not get medicines, the TB programme, which needs high compliance with therapy, struggled.
"What we need to do is build resilience in the healthcare system so we do not lurch from damage to damage," she said.
She said the time has come to rethink about the attitude towards testing.
"I think we also need to change what we are measuring about COVID-19 and should measure what matters -- what puts people in hospitals, what puts people in the risk of dying, not just the fact that the test is positive. And then, another thing to remember is that with any test, you can potentially have false positives...so the imperative to understand what testing is really showing us matters more and more now," she added.