Covid rising: Lessons from the dreaded Delta wave
On April 6, India's R number was 1.3, having risen from 1.18 in just two weeks. The arrival of the second wave was swift, assisted by the slow clampdown on the rising infection rates at the local level. Individual states have it worse, Uttar Pradesh and Chhattisgarh have an R value of 1.6, while in Delhi, which is witnessing its fourth wave of infections, it is 1.5. The figures for all these states are the highest since the pandemic began. Maharashtra has an R value of 1.2 this week.The higher R value is what alarms virologists and doctors more than the number of active cases. 'Covid has a gestation period of a few days. So, those who got infected yesterday will come out in numbers in a few days' time,' says Dr Naresh Trehan, chairman of Medanta hospital in Gurugram. In other words, those who got infected before the state machinery sprang into action in early April have yet to be counted among Covid cases.'We are going from bad to worse,' says Dr V.K. Paul, member, NITI Aayog. 'Covid is still active and will strike back just when we feel we have it under control. No state should have been complacent when the numbers began falling, as the pandemic was not over.' He believes the whole country is now at risk even though 84 per cent of the cases are from eight states alone: Maharashtra, Chhattisgarh, Karnataka, Kerala, Punjab, Tamil Nadu, UP and Madhya Pradesh. 'If cases continue to rise like this, it will overwhelm the system. If we don't keep our guard up, we will never break the chain of viral transmission permanently. Masks, social distancing and hand hygiene must continue,' he says.advertisementHYDRA-HEADED VIRUSAs India enters a second Covid wave, what is different this time is that it is battling not one but four variants of the original early China virus (D614G). 'With every new person it infects, the virus has a chance to mutate,' says Dr Rakesh Mishra, director of the Centre for Cellular and Molecular Biology in Hyderabad. 'These changes occur almost as tiny errors as the virus starts to take over a cell to copy itself. The natural selection compels it to pick those bits of its genetic code that help it survive. In most cases, mutations have very little effect. But, sometimes, they help the virus become more contagious, escape immune responses, even cause more severe disease. They then become an entirely new variant.'advertisementIndia has recorded 7,000 variants so far. However, one strain, first recorded in December last year, has been especially successful in replicating itself. It was found in around 20 per cent of 1,600 samples (around 206 cases) in Maharasthra. While this may seem low in absolute terms, the fact remains that the strain is spreading faster than its predecessors. This is because it has two mutations in its spike protein that ease its access to human cells and increase its infectivity. Its 'escape' or E484Q mutation is similar to the South African and Brazilian strains and helps the virus slip past earlier antibodies. The L452R mutation, on the other hand, shares its characteristics with the Californian variant that make it more infectious. This mutated strain has become the dominant virus since November 2020.Although the relevant authorities are monitoring the strain, it has yet to be labelled a 'variant of concern' by global health bodies such as the WHO (World Health Organization) or the CDC (Centers of Disease Control and Prevention, US). This is partly because the two mutations have also been found in 43 other variants of Covid-19. But it is certainly a 'variant of interest' as its mutation can potentially overcome antibodies previously generated against the early China variant either due to infection or vaccination.advertisementThis poses some concerns for the vaccination programme in India, where over 75 million have already been inoculated with a first dose and over 10 million have taken both doses of either Covishield or Covaxin. 'The E484Q mutation is very worrying because it not only helps the virus enter cells easily but also helps it evade immune responses. If this variant spreads, it basically means we are back to square one in terms of all the immunity gained last year,' says Dr K.K. Aggarwal, noted cardiologist and former director of the IMA (Indian Medical Association). Indeed, the Brazilian variant, which has a similar mutation, reinfected thousands in the Amazon city of Manaus despite close to 75 per cent of its citizens having been infected by the early China variant.Of equal concern is the fact that the foreign variants, from the UK, South Africa and Brazil, have also been found in India. There are 737 recorded cases of the UK variant (most of them in Punjab), 34 cases of the South African and one case of the Brazilian variant.advertisementYet, experts do not hold these variants alone as responsible for India's second wave. Dr Sujeet Kumar Singh, the director of the National Centre for Disease Control, says that while these variants have been spotted, 'data does not allow for us to make a direct correlation yet for the rise in cases'. Dr Mishra adds that since the Indian variant has been spotted for months now, it is certainly not the primary reason for the fresh wave. In fact, that it has taken this long to make its presence felt could also mean it is not more infectious than the early China variant either. 'Gyms, pools, travel, schools, everything opened up this year and Covid precautions were discarded. Such complacency allows infectious diseases to thrive,' he says.IS THE SECOND WAVE DEADLIER?On April 2, India recorded 713 fatalities, the highest number of daily deaths this year. If Covid caused around 100 daily deaths in March, the figure reached 400 in the first few days of April. Experts say the increased deaths are natural given the rise in infections but the percentage of deaths against total cases, or the case fatality ratio (CFR), remains the same. In fact, our CFR at 1.3 per cent this month is lower than the 1.5 per cent last month. However, the CFR in Maharashtra (1.5) and Punjab (1.8), the two states with the highest number of rising cases, is higher than the national average. There has been no conclusive proof to link it to the new variants yet.Dr Srinath Reddy, chairman of the Public Health Foundation of India (PHFI), says the virus may be changing its behaviour and becoming more infectious but it is not becoming deadlier. 'It is still the same virus and still the same symptoms,' confirms Dr Vivek Nangia, the pulmonologist at the Covid ward of Max Hospital in Saket, New Delhi. 'The infection has spread, we are getting more cases now, but the virus isn't milder or deadlier. The disease's progression and clinical management remain the same.' But doctors do say that just because hospitals aren't overflowing and more people are recovering does not mean the viral transmission is less lethal. 'Covid cannot be taken lightly. Even a moderate infection can lead to severe complications. The personal and human cost, too, is immense,' says Dr Farah Ingale, internal medicine specialist at the Covid ward in Fortis Vashi, Navi Mumbai.HOW GOOD IS OUR FIVE-FOLD STRATEGY?To combat the second wave, the Centre has devised a new strategy, test, trace, treat, public compliance and vaccinate. The first three elements of the strategy have already been in place for over a year now. Yet, the current surge is already overwhelming health infrastructure. Delhi, for instance, has asked private hospitals to reserve 30 per cent of their beds for Covid patients. Bihar, which has never faced shortages before, had 90 patients in the 80-bed ward at AIIMS Patna on April 4, while other city hospitals reported their beds were also fast filling up. Maharashtra, particularly Mumbai, remains the worst hit. The Brihanmumbai Municipal Corporation (BMC) has had to take the extreme step of discharging asymptomatic patients at the earliest to vacate beds for patients with more serious symptoms.Meanwhile, there are also concerns over the city running out of crucial drugs such as remdesivir and steroids. Healthcare workers are back to working the kind of hours they did a year ago. 'The situation has gone back to what it was last year. It isn't just beds but manpower and medicine constraints too that one has to think of if these numbers continue to increase exponentially,' says Dr Ingale. Dr Paul adds that states must prepare for the coming wave. 'Dedicated hospitals that were set up for Covid must be re-energised, re-tested and rehearsed so that when there is an increase in patients, we are able to manage it effectively.'In addition to 'test, trace, treat', the 2021 Covid war plan has two additional elements, public compliance and vaccination. 'If we stick to our current vaccination targets, we can aim for herd immunity in six months' time. With the onslaught of cases, it is important to battle vaccine hesitancy and get as many people inoculated as possible. We can't afford an out-of-control second wave,' says Dr Trehan.VACCINATION FOR THE SECOND WAVEEven though India has vaccinated close to 70 million people with at least one dose, the five states with the highest active case load have yet to vaccinate even 15 per cent of their population. Nationally, the figure is even lower, at 6 per cent. In contrast, Israel has given at least one dose to 59 per cent of its population, Bhutan 62 per cent, the UK 47 per cent and the US 32 per cent. The vaccination strategies of these countries have a few things in common that India has failed to adopt.Vaccine supply, for one. Israel partnered with Pfizer for enough doses, the US entered into a $14 billion public-private partnership for enough vaccines and Bhutan waited till enough doses had arrived for it to begin its programme (see Vaccination in Other Countries). In India, despite two months of vaccination, states such as Chhattisgarh had run out of Covaxin doses and had Covishield for just four more days on April 5. Telangana, Rajasthan, Haryana and Odisha also claim to be facing low stocks.Secondly, like in India, the vaccine programme in these countries too began with priority groups, but was opened to all those above 16 within a few weeks. The UK is the only country where vaccination is still not open to all but its first phase includes 15 groups and has more people than its second. This has ensured that vials don't go waste and all those who want the vaccine can take it. In India, it took about a month to go from healthcare and frontline workers to those above 65 and with comorbid conditions. Given the fact that interest was low in the first group, experts say vaccination for the general public should have begun much earlier. 'We should saturate a particular high-risk zone with vaccines first and then move on,' says vaccine expert Dr Gagandeep Kang.Thirdly, these countries first prioritised their own population before exporting any vaccine. The US, in particular, has halted even the export of material other nations may need to make vaccines so that more is available for domestic use. Its current vaccine procurement deals are enough to vaccinate its entire population twice over. India, on the other hand, had by April 1 supplied 60 million doses to the global community as part of its Vaccine Maitri initiative. Of these, 10.4 million were supplied as a grant, 35.7 million on a commercial basis and 18.2 million through the COVAX initiative.Even though the Serum Institute of India says it has the capacity to make 60-70 million doses a month, its agreement is to supply 100 million to the Indian government. Bharat Biotech is currently supplying around 10 million. Experts say given the size of India's population, domestic needs should have been the first priority. So far, there has been no official statement on whether either of the two companies have committed more doses to India. The Centre, though, did issue a statement on April 4 reassuring the public that there are enough vaccine stocks for all future phases.The fourth strategy that nations whose vaccination programmes are gaining in numbers adopted is of extensive public outreach at the local level. This has helped build confidence and enabled a greater turnout. 'There are a lot of false rumours and doubts about the vaccines in India. They are entirely safe. People are hesitant due to missing information,' says Dr Trehan.The US also invested heavily in a partnership with the private sector, both for vaccine supply and distribution. In India, the private sector is still only partially involved in the programme, private hospitals can only keep Covishield and smaller clinics have yet to be incorporated. According to a source in the health ministry, private companies have made many requests to be allowed to vaccinate their employees. But the fear of improper administration, fake vaccines, hoarding and decentralisation of vaccine data is keeping the Centre from significantly expanding the programme.Experts say the strategy needs to focus on increasing both vaccine supply as well as eligibility for the vaccine. 'Currently all our priority groups are still not covered. Those under 45 with comorbidities have been waiting for the vaccine and they still can't take it. The vaccine should be opened to all now,' says Mumbai-based infectious disease expert Dr Om Shrivastava.But India isn't the only country struggling to inoculate a majority of its people. Far more developed nations have also hit stumbling blocks, France has vaccinated only 14 per cent of its people, Germany 12 per cent, South Korea 1.9 per cent and Japan 0.8 per cent with one dose of the vaccine. China, where five vaccines have been approved, has hit a slowdown and has been administering only 10 doses per 100 people so far. The UK is doing 56, and the US 50. India, unfortunately, is even lower at 6.1 doses per 100 people.However, China's new plan is to inoculate 560 million or 40 per cent of its people by June 2021. It plans to use volunteers and creative freebies such as ice cream to convince people to take the shot. Some nations are also planning to increase their numbers by offering vaccine passports to people, which would save them the inconvenience of repeated RT-PCR tests whenever they travel. Experts say incentive-heavy strategies could work in India as well.NEED FOR STRAIN SURVEILLANCEWith new variants on the rise, what India needs the most right now is an effective strain surveillance system and data analysis. Currently, we have only limited information on the number of variant infections, reinfections or infections post-vaccination. This data is absolutely essential to strengthen our Covid combat strategy. 'To really understand how the virus is evolving and to what extent the new variants have spread, you need to sequence more samples,' says Dr Shahid Jameel, director, Trivedi School of Biosciences at Ashoka University.Indeed, the prevalence of the UK, Brazilian and South African variants is based only on 10,787 samples from 18 states. Similarly, the presence of the UK strain in Punjab is based on only 401 samples from the state. The Indian variant in Maharashtra was found in only 1,600 samples. 'It will be difficult to ascertain if any one variant has become more dominant if we do not do more sequencing,' says Dr Aggarwal.In December 2020, the Union health ministry had announced that the Indian SARS-COV-2 Genomics Consortium, or INSACOG, would ramp up its sequencing efforts. The country had planned to do the genome sequencing of 5 per cent Covid-positive samples from every state, and all positive samples of international travellers. However, less than 1 per cent, or 7,664, of the total Covid positive samples between January and March 18 were genome sequenced. Since India saw 1,022,335 new cases in this period, 51,117 samples should have been sequenced.It is not as though we lack the capacity to sequence more samples. According to the INSACOG's guidance document released in December, the 10 institutes in the consortium have the capacity to sequence more than 30,000 samples a month. The Institute of Genomics and Integrative Biology alone has the capacity to sequence more than 10,000 samples a month. But it had received only 3,186 samples till March 18, of which 1,586 had been sequenced and the rest were under the process of being sequenced.For the most part, logistical hurdles seem to be the reason. According to health ministry guidelines, samples from only RT-PCR tests and not rapid antigen tests are eligible for sequencing. They also have to be sent 3-4 days after testing positive and stored at -80 degree celsius. Finding transport to ferry Covid-positive samples has also been difficult in some states. Financial constraints have also contributed to the slowdown in sequencing, even three months after its launch in December, the consortium had reportedly not received funds of more than Rs 90 crore from the Union government.Dr Mishra, whose institute is part of the consortium, says more sequencing has been done in the past few weeks as both logistical and financial issues have been sorted out. 'It doesn't matter whether you sequence a few hundred or a few thousand samples, the time taken remains 2-3 days. Since we have the capacity to monitor more, we must use it to gain more insight on various variants and their nature in India,' he says.According to the CDC, variants are worrying about five main reasons, they help the virus infect more people; manifest in a more severe form; evade diagnostic tests; fight off antibodies in the human immune system; escape natural or vaccine-induced immunity. The last has already been seen in the South African, Brazilian and even the newly emerging Indian mutation. Experts say even if the vaccines fail against any of the variants, control and protection is mostly in our own hands. Covid vigilance is a must for the next one year. Simultaneously, the government needs to expand its vaccination drive, and involve private players. After all, complacency could be more deadly than Covid.Subscribe to India Today Magazine
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News18
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- News18
Contagion scale: which diseases spread fastest?
Agency: Bristol (UK), Aug 3 (The Conversation) When the COVID pandemic hit, many people turned to the eerily prescient film Contagion (2011) for answers – or at least for catharsis. Suddenly, its hypothetical plot felt all too real. Applauded for its scientific accuracy, the film offered more than suspense – it offered lessons. One scene in particular stands out. Kate Winslet's character delivers a concise lesson on the infectious power of various pathogens – explaining how they can be spread from our hands to the many objects we encounter each day – 'door knobs, water fountains, elevator buttons and each other". These everyday objects, known as fomites, can become silent vehicles for infection. She also considered how each infection is given a value called R0 (or R-nought) based on how many other people are likely to become infected from another. So, for an R0 of two, each infected patient will spread the disease to two others. Who will collectively then give it to four more. And so a breakout unfolds. The R0 measure indicates how an infection will spread in a population. If it's greater than one (as seen above), the outcome is disease spread. An R0 of one means the level of people being infected will remain stable, and if it's less than one, the disease will often die out with time. Circulating infections spread through a variety of routes and differ widely in how contagious they are. Some are transmitted via droplets or aerosols – such as those released through coughing or sneezing – while others spread through blood, insects (like ticks and mosquitoes), or contaminated food and water. But if we step back to think about how we can protect ourselves from developing an infectious disease, one important lesson is in understanding how they spread. And as we'll see, it's also a lesson in protecting others, not just ourselves. Here is a rundown of some of the most and least infectious diseases on the planet. In first place for most contagious is measles. Measles has made a resurgence globally in recent years, including in high-income countries like the UK and US. While several factors contribute to this trend, the primary cause is a decline in childhood vaccination rates. This drop has been driven by disruptions such as the COVID pandemic and global conflict, as well as the spread of misinformation about vaccine safety. The R0 number for measles is between 12 and 18. If you do the maths, two cycles of transmission from that first infected person could lead to 342 people catching the illness. That's a staggering number from just one patient – but luckily, the protective power of vaccination helps reduce the actual spread by lowering the number of people susceptible to infection. Measles is extraordinarily virulent, spreading through tiny airborne particles released during coughing or sneezing. It doesn't even require direct contact. It's so infectious that an unvaccinated person can catch the virus just by entering a room where an infected person was present two hours earlier. People can also be infectious and spread the virus before they develop symptoms or have any reason to isolate. Other infectious diseases with high R0 values include pertussis, or whooping cough (12 to 17), chickenpox (ten to 12), and COVID, which varies by subtype but generally falls between eight and 12. While many patients recover fully from these conditions, they can still lead to serious complications, including pneumonia, seizures, meningitis, blindness, and, in some cases, death. Low spread, high stakes At the other end of the spectrum, a lower infectivity rate doesn't mean a disease is any less dangerous. Take tuberculosis (TB), for example, which has an R0 ranging from less than one up to four. This range varies depending on local factors like living conditions and the quality of available healthcare. Caused by the bacterium] Mycobacterium tuberculosis, TB is also airborne but spreads more slowly, usually requiring prolonged close contact with someone with the active disease. Outbreaks tend to occur among people who share living spaces – such as families, households, and in shelters or prisons. The real danger with TB lies in how difficult it is to treat. Once established, it requires a combination of four antibiotics taken over a minimum of six months. Standard antibiotics like penicillin are ineffective, and the infection can spread beyond the lungs to other parts of the body, including the brain, bones, liver and joints. What's more, cases of drug-resistant TB are on the rise, where the bacteria no longer respond to one or more of the antibiotics used in treatment. Other diseases with lower infectivity include Ebola – which is highly fatal but spreads through close physical contact with bodily fluids. Its R0 ranges from 1.5 to 2.5. Diseases with the lowest R0 values – below one – include Middle East respiratory syndrome (Mers), bird flu and leprosy. While these infections are less contagious, their severity and potential complications should not be underestimated. The threat posed by any infectious disease depends not only on how it affects the body, but also on how easily it spreads. Preventative measures like immunisation play a vital role – not just in protecting people, but also in limiting transmission to those who cannot receive some vaccinations – such as infants, pregnant women and people with severe allergies or weakened immune systems. These individuals are also more vulnerable to infection in general. This is where herd immunity becomes essential. By achieving widespread immunity within the population, we help protect people who are most susceptible. (The Conversation) NSA NSA (This story has not been edited by News18 staff and is published from a syndicated news agency feed - PTI) view comments First Published: August 03, 2025, 09:45 IST News agency-feeds Contagion scale: which diseases spread fastest? Disclaimer: Comments reflect users' views, not News18's. Please keep discussions respectful and constructive. Abusive, defamatory, or illegal comments will be removed. News18 may disable any comment at its discretion. By posting, you agree to our Terms of Use and Privacy Policy.
Hindustan Times
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Mohali Fortis told to pay ₹50 lakh for patient's death due to negligence
Finding Fortis hospital in Mohali guilty of gross medical negligence, the district consumer disputes redressal commission has directed it to pay ₹50 lakh compensation to the family of a patient who died at the hospital in 2021. The consumer commission held that the hospital is liable not only for medical negligence but also for deficiency in services and unfair trade practices. (Getty Images/iStockphoto) The deceased, Harit Sharma, was a practising advocate at the Punjab and Haryana high court. His dying declaration from the hospital bed, a note in which he had written that he overheard doctors discussing that his case was mishandled, served as a crucial piece of evidence. The consumer commission held that the hospital is liable not only for medical negligence but also for deficiency in services and unfair trade practices. 'The ends of justice would meet if a lump sum compensation of ₹50 lakh is awarded to the complainants in lieu of the medical negligence committed by the hospital,' said the commission. The complainants included the deceased's wife Priyanka Sharma and her two minor sons. They stated before the commission that Sharma had been admitted at the Fortis Hospital, Mohali, on the morning of July 28, 2021, as he suffered from acute gastric problem. He was treated by Mohnish Chabra and other attending doctors. Before admitting him, Fortis conducted a Covid test which was found negative. It is further pleaded that as the visiting hours were restricted, the victim's wife only went to meet him between 12.30pm to 1pm on July 29, 2021. She was told that her husband had recovered from the gastric problem and due to improvement, the patient desired to be shifted to a private ward from ICU. However, he was kept in ICU on the pretext that ascites – a medical condition characterised by the excessive accumulation of fluid in the abdominal cavity – was to be removed from his stomach. It was further stated that due to negligent tapping, his oxygen levels came down drastically and he had to be put on oxygen support. The victim's wife stated that Sharma was fully conscious despite being on oxygen support and he overheard the hospital director saying that the tapping was done wrongly and that it had to be re-done. The victim revealed this to the complainant through a written note – he was unable to speak due to the oxygen mask – when she went to meet him the next day. The note read: 'Subah director had come. Director said Chabra has done wrong tapping. It will be done again.' She attached the dying declaration as evidence in her case before the consumer forum. A spokesperson of the Fortis hospital said they are aware of a consumer case concerning their hospital. 'As we are yet to receive the official court order, we are unable to comment on the specifics at this stage. Once the order is in hand, we will conduct a thorough review and, guided by expert legal advice, take appropriate action as deemed necessary.'
Hindustan Times
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State Government approves BSc Nursing College at YCM Hospital with 60 seats
In a boost to medical education and public healthcare in Pimpri-Chinchwad, the State government has granted final approval to establish a BSc Nursing College at the Yashwantrao Chavan Memorial (YCM) Hospital, run by the Pimpri-Chinchwad Municipal Corporation (PCMC). The new college, named the 'Institute of Nursing Sciences', will commence its operations with an intake of 60 students from the academic year 2025–26, officials announced on Saturday. (HT) According to officials, the nursing college will be housed in the newly constructed 11-storey building on the YCM Hospital campus. Additionally, the classes and training sessions will be conducted on the third, fourth, and sixth floors of the said building. According to officials, the idea to establish a nursing college was first proposed in January 2022. Administrative and elected body approvals were granted through the Standing Committee on March 10, 2022, and the General Body on April 6, 2022. This Nursing college marks a significant addition to PCMC's medical education infrastructure. Since the inception of the Postgraduate Institute at YCM Hospital in 2018, over 240 postgraduate students have supported the hospital's critical operations — especially during the COVID-19 pandemic. With the launch of the nursing college, a new generation of trained nursing professionals will emerge to strengthen the city's public healthcare system, said the YCM Hospital officials. This initiative is a strategic investment in both public health and women's empowerment. The Institute of Nursing Sciences will further enhance Pimpri Chinchwad's growing stature as a hub for quality medical education and services, the officials said. Dr Rajendra Wabale, dean, postgraduate institute, YCM Hospital, said, 'The admissions for the BSc Nursing course will be carried out by the Maharashtra State CET cell and Directorate of Medical Education and Research (DMER), Mumbai. The move not only addresses the rising demand for qualified nursing professionals but also ensures affordable and accessible nursing education for eligible candidates from the PCMC region.'
