How do we protect against the second wave?

The Covid-19 pandemic has shaken the lives of people around the world. The global lockdown devastated the world economy. But with the vaccine being distributed throughout the world, a new ray of hope was bestowed upon everyone. 

The world is gradually trying to return to normalcy from the 'new normal' by resuming offices, businesses, public gatherings, vacationing, academic institutions etc. Bangladesh lifted the lockdown in June last year and was planning to reopen the educational institutions. 

Bangladesh was finally experiencing a sense of relief after rolling out the vaccine distribution programme from February 2021, combined with confirmed infection cases dropping to 200 to 300 per day in the same month. Scientists, however, had predicted a second wave with new and bigger challenges several months ago, based on the history of previous pandemics. 

The sudden surge of Covid-19 cases, up to 3,737 per day on the 26th of March, probably confirms the prediction. This brings out the most concerning question for everyone: in what ways will the second wave be different from the first wave? Will the vaccine be worthless against it or will it remain protective? 

Illustration: TBS

Viral resurgence with new variant 

If we look at the history of pandemics, the Spanish flu outbreak – the largest pandemic in modern history – we can draw a probable picture of the second wave of Covid-19. The second wave of the Spanish flu pandemic was more devastating and killed more people than the first wave. 

Scientists state that the second wave of any viral outbreak returns with a change in their structure and strength and spreads more rapidly targeting a different geographical or gender group. The new wave of the pandemic is following similar traits. 

In the UK, two third of total deaths occurred during the second wave. A mutated variant of corona virus was found in the United Kingdom in September 2020 followed by another variant discovered in December of 2020 in South Africa. Both variants can spread faster (50% to 70%) than the wild type (original virus) with 30% higher virulence. 

The new variant is known as N501Y (UK) and N501Y.V2 (South Africa). Both of the variants have mutations in the gene, which encodes the spike protein of the virus, which is instrumental in initiating infection. It has been proved that those mutated variants are stronger compared to the original virus because of their altered spike protein. 

It has been clarified that the Oxford-AstraZeneca vaccine works well against the UK variant but not against the South African variant as it has acquired the ability to escape host immunity. Now where does Bangladesh stand in this chaos and what measures will it take to pull us out of it?

Necessary guideline for Bangladesh

In the current month, the ICU beds of Bangladesh are again getting filled with Covid-19 cases, but this time with younger victims. The new wave has changed the pattern of affecting older and immunosuppressed individuals. 

According to IEDCR, the UK variant was found in six patients of Bangladesh in January. With re-increasing infection rates in Dhaka, Chattogram and Sylhet, we still do not know if the variants have spread to our urban areas yet, or whether this spike in case numbers is related with the new variants. 

Emergence of an aggressive local variant cannot be ruled out either. Necessary measures have to be taken fast and precisely, in accordance with the limited resources we have right now. The first and foremost solution is to carry out surveillance programmes for the UK and South African variant at both government and private level. 

At this moment the routine RT-PCR tests carried out by government and private laboratories cannot identify any novel variant because the test kits in use were not designed for the novel variants. Therefore, an overhauling of the Covid-19 testing system is essential now to ensure the quality and also to enhance the capacity. 

The purpose should be testing these two variants through 3-gene RT PCR. So, if a patient is found with the target result, track down their last group of contact to estimate the spread they made. The difference between regular 2-gene RT-PCR and 3-gene RT-PCR is that the latter would target 3 genes in the virus and could detect whether the wild type spike protein gene is missing in the strain or not. 

This process is highly target specific and 99.99% sensitive to the UK strain, according to the public health office of England. Once a sample with the variant type is found it can then be sent for genome sequencing, if necessary. The whole process is budget friendly and not time consuming. Bangladesh can acquire this 3-gene RT PCR kit from a reputed global supplier at a cost which is the same as the 2-gene RT-PCR kit. 

To simplify, under surveillance patients with severe symptoms can be tested through 3-gene RT-PCR kit and then genome sequencing can be done if only the result came out positive. 

A routine mutation surveillance system should be in place so that we can be updated about the viral mutations circulating in our local population. It will allow us to track down the dynamics of mutation in SARS-CoV-2 virus throughout the pandemic. 

We need to accumulate these valuable lessons to face future challenges. Unfortunately we have not seen any concerted effort to track viral mutations in the country apart from some genome sequencing initiatives by different institutions in the country. 

Another addition which is needed is rapid antigen test or viral antigen test, a lateral flow immunoassay test which is being used in the UK on a routine basis on all outgoing people. It gives a quick result at low cost and should be used as the first line of screening to keep the infection under control. 

Apart from diagnostic level measures, other pivotal guidelines should be strictly followed too in order to tackle this second wave. Bangladesh should restrict all types of non-essential public gatherings (e.g. Dhaka International Book Fair, Trade Fair etc.) instantly and instead hold them online. 

All the holiday destinations should be restricted for at least the next two months. The educational institutions should remain closed for now. Working places like industries, offices and business institutions can continue their work by running a lateral flow immunoassay test to keep the infection under control. 

Most importantly, everyone must wear a mask and hand hygiene must be in practice. 

If we remember last year's scenario, we will definitely not want to go back to the same situation again. In order to avoid the path to that valley, it is the high time to intervene. 

The difference is, neither did we have the capacity nor did we have the knowledge a year ago on how to fight the pandemic. Now, we acquired some capacity and also learnt lessons to fight Covid-19. All we need to do is take pragmatic steps on time, so that we can save more lives. 

Dr Muhammad Sougatul Islam is an Executive Director at the BioTED, Bangladesh 

Shabnoor Binte Dayem is a  Research Assistant at the BioTED, Bangladesh

Disclaimer: The views and opinions expressed in this article are those of the author and do not necessarily reflect the opinions and views of The Business Standard.