"[T]he need of the hour is to prepare for the third wave if and when it hits the nation," a report titled 'Third Wave Preparedness' prepared by the National Institute of Disaster Management (NIDM), which comes under the Ministry of Home Ministry, has said.
"India’s second wave of COVID-19 has been catastrophic, with a surging increase in new cases in the past months. According to experts and media reports, the number has been much higher as most of the cases and deaths are unreported."NIDM report
"India’s second wave of COVID-19 and the challenges posed have been alarming and need strong policy interventions at all levels with immediate, short, and medium to long term priorities, in order to be best prepared for the third wave," the NIDM report said.
The report, which analyses various aspects of the third wave preparedness in India, quoted a study conducted by the Indian Institute of Technology Kanpur that suggests that a third outbreak will hit the country some time between September and October.
The NIDM Report
The NIDM reports lists two indicators that predict the onset of a third COVID-19 wave in India.
There has been a slowdown in the downward trend of daily COVID-19 infections and a slight increase in the positivity rate as per the Ministry of Health and Family Welfare.
The R-value, which is the reproduction rate of COVID-19, increased from 0.96 to 1 in the last few days of July and has been flagged as a matter of concern by the All India Institute of Medical Sciences.
Taking view of the imminent third wave of the pandemic, the NIDM organised two consultative working group meetings to cover issues related to the preparedness of the third wave, and make recommendations to the government.
The first online consultative meeting titled 'COVID-19 Third Wave in India: Children’s Vulnerability and Preparedness' was organised on 2 June, and the second working group meeting on 'COVID- 19 Third Wave in India: Differential Impact on Women-Children (Women and Children Complementarity)' was held on 10 June.
What the NIDM Report Says About 'Children's Vulnerability and Preparedness'
Many health experts had initially raised concerns about the possibility of a third wave affecting children more adversely than adults, while recent reports suggest otherwise.
However, the NIDM states that "there is a cause for worry if not panic according to public health experts, since the children below 18 years remain unvaccinated in India. Also, the existing pediatric health care facilities are not robust enough to treat children on a large scale."
The NIDM further indicated that paediatric facilities such as doctors, staff, ventilators, and ambulances are nowhere close to what may be required in case a large number of children become infected.
Here are some of the recommendations that were made by the NIDM following the consultative meeting held by the expert body on “COVID-19 Third Wave in India: Children’s Vulnerability and Preparedness”:
Awareness programmes which make people understand that children are different from adults and their needs are different. Teachers and guardians should be trained as to what to do if a child is infected.
Vaccination among young children and children with comorbidities should be an immediate future priority.
Identification of need for rehabilitation of COVID-19 affected children- both short as well as long term. Hospitals should be well equipped with a comprehensive child care model.
Protocols for children with comorbidities, malnutrition, disabilities and special needs to be developed and publicised widely.
Special provisions for parent-child hospital accommodation facilities should be in place. The hospitals and care centres should have provisions for the stay of parents with COVID-19 infected children.
"Vaccinating children would be a milestone in our fight against this pandemic and children can resume learning and can be expected to go back to school," the NIDM stated in its report.
What the NIDM Report Says About the Third Wave's 'Differential Impact on Women-Children'
According to data from the CoWin portal, out of the total 30.9 crore doses administered since January 2021 till 25 June 2021, 14.3 crore went to women while 16.7 crore doses were given to men.
This data shows that 856 doses were given to women for every 1,000 doses for men, and is not consonant with India’s current sex ratio of 924 women per 1,000 men, the NIDM report notes.
Here are some of the recommendations made by the NIDM to deal with the differential impact of the COVID-19 third wave on women and children:
Pregnant women to be treated as a priority group and antenatal as well as postnatal, including mental health care to be ensured to all women through Accredited Social Health Activists (ASHAs), auxiliary nurse midwives, and tertiary and referral services.
Vaccination for pregnant women should also be a priority as these women are more vulnerable once they test positive for COVID-19.
Special medical equipment for reproductive, maternal, newborn and child health such as paediatric ventilators.
Prevention of neonatal mortality due to separation from the mother who is a COVID-19 suspect/patient.
Special support system to be created for economic, food, nutrition, health and social security coverage for COVID-19 widows and orphans, abandoned women, children, and female-headed households who are at the additional risk of poverty and exploitation due to loss of livelihoods, informal nature of work, trafficking, and abuse.
Other Recommendations Made by the NIDM
The NIDM has also raised the following concerns regarding third wave management:
Lack of mental health professionals – Psychiatrists, clinical psychologists, and psychotherapists for addressing the mental health crisis that has engulfed India needs an urgent plan for completing the Mental Health Pyramid.
Public health messaging and communication with respect to COVID Appropriate Behaviour (CAB) and vaccination should be based on community engagement and must address specific concerns of the community members, especially in rural areas.
Transportation has been one of the major concerns during the second wave. There was a dearth of ambulances so this has to be taken care of in order to prepare for the possible third wave.
Scientific collection, organisation, analysis, and presentation of quality data pertaining to serological surveillance, case fatality, and immunisation. The data should be used to forecast requirements like beds, oxygen, and drugs, and plan effective preparedness strategies.
Training for COVID-19 case management (to all healthcare workers) should become a priority while cases are low so as to be ready for the next wave.
Coordination among agencies – Government (central, state, district and local level), private sectors, NGOs, faith-based organisations, resident welfare associations, and other civil society organisations.
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