Are the kids an easy kill for the Delta plus variant? Is India prepared for the third wave?

Vikas, a 8 year old boy in Thane, wakes up in his neighbour’s house, with a heart full of expectation that today his parents will return from the hospital where they have been taken a month ago. But, everyday reality weakens him a bit more and produces doubt in his innocent mind. Pratham, a 4 year old in Mumbai, waits for his parents to return from a business trip that he has been told about by his uncle. These kids are unaware of the bitter truth that their parents shall never return. Their lives have changed forever and they didn’t even know about it. There are hundreds of children not only in Maharashtra (the worst COVID-19 hit state in the country) but also in other states.

The future of these kids lie in darkness, with stringent adoption laws in the country, it seems next to impossible for them to have a secured life. The relatives of some of these unlucky kids have informed the non-governmental organisations (NGOs) which hopes that these kids will be adopted soon. However, India’s adoption rates are low: only 3,351 children were adopted in the year leading up to March 2020, despite the fact that tens of thousands of children were orphaned. In the United States, more than 66,000 children were adopted in 2019.

Covid has wreaked havoc on Indian families, leaving many children orphaned and families devastated. The second wave of the virus caused by the Delta variant has proved extremely fatal to Maharashtra and numerous has succumbed to the disease.

But, just when the cases are dropping in the state, human life is all set to struggle again and make a living, the virus is prepared to strike again. This time, it has mutated into the Delta plus variant and experts believe that this might prey upon children. Maharashtra braces itself for the third wave of Covid-19 which is expected to arrive within 1-2 months.

What is the Delta plus variant?

The Delta variant of the novel coronavirus has further mutated into the ‘Delta plus’ variant. It is said that this particular variant has been spotted in Europe since March this year and has been brought into the public domain on June 13. To add some respite, as of now, the Delta plus variant has been classified as the variant of interest (VOI) and not a variant of concern (VOC).

As per the provided data, this variant nullifies the use of a monoclonal antibody. It means the variant is resistant to monoclonal antibody cocktail treatment which has been recently authorized in India. A reason to be concerned!

What else do we know about this variant?

• B.1.617.2.1, often known as AY.1 (Delta plus variant), is identified by the acquisition of the K417N mutation.
• The mutation is in SARS-spike COV-2’s protein, which aids the virus’s entry and infection of human cells.
• The GISAID has found 63 Delta (B.1.617.2) genomes bearing the novel K417N mutation so far.
• According to Public Health England, Delta plus was found in six Indian genomes as of June 7. (PHE).
• In India, the variation frequency for K417N is now quite low. The majority of the sequences are from Europe, Asia, and America.

Is our country prepared for the third wave?

The first wave of the virus proved to be fatal for the aged population. The second wave was totally different and it brought into the spotlight the defects in our health infrastructure. It was an embarrassment for the largest democracy to be unable to provide the basic health needs for her people. The shortage of vaccines added to the shame with extremely low rates of vaccination. Ventilators were sent by other countries proved how weak our nation is when it comes to health infrastructure. The whole government and its policies were brought under questions. With such a disgraceful performance, is our nation ready to face yet another blow by the enemy? What should be India’s move to prevent the third wave? Of course, the rate of immunizations will be the most important factor in determining whether or not a widespread third wave occurs. Apart from vaccinations, there are a few things that must be done to mitigate the effects of a potential third wave of the virus. 

Increasing the number of testing facilities

The key to reducing Covid-19 infections is timely testing and isolation of affected patients. Access to testing facilities determines whether or not people are tested in a timely manner. If the testing centre is one kilometre away from their home, a symptomatic person is more likely to get a test than if it is 20 kilometres away. Paid and free (at government facilities) testing are likely to make an impact, particularly for the poor.

According to the Indian Council of Medical Research’s (ICMR) Covid-19 Sample Collection Management System, testing facilities in places like Bihar and Uttar Pradesh are significantly imbalanced. According to the data, the median number of sample collection centres (including mobile units) across districts in states like Karnataka and Gujarat was 90 and 68, respectively, as of June 12. In states like Bihar and Uttar Pradesh, this number was only two. It’s important to remember that these are median figures, which means that half of the districts would have fewer sample collecting centres.

Thirty-one of the country’s 735 districts listed on the portal have no sample collection centres, while 99 have only one. This clearly needs to change if the pandemic is to be adequately monitored.

People (especially the poorer section) needs to be encouraged to seek medical advice

To be sure, adding testing centres will only address a portion of the issue. The National Statistical Office’s (NSO) 2017-18 health consumption survey demonstrates why. In India, whether or not people seek medical help when they are ill is determined by their financial situation. According to Monthly Per Capita Consumption Expenditure (MPCE), the poorest 20% of persons are nearly three times more likely than the richest 20% not to seek medical assistance. The impoverished are more likely than the wealthy to avoid seeking medical advice due to a lack of nearby health facilities and affordability. The most common reason for not seeking medical advice across classes is that the disease isn’t considered serious.

Because Covid-19 starts with basic symptoms like a fever or a cold, a transformation in thinking is needed when it comes to suspected patients seeking early testing and treatment.

Recognizing the financial burden due to Covid-19 hospitalisation

There is no accurate estimate of the cost of health care caused by Covid-19 infections. The NSO survey can be used to quantify the impact of the healthcare spending shock on household budgets. According to the report, family income or savings covered 81 percent of hospitalisation costs (excluding delivery); borrowing covered 11 percent of costs; 3.5 percent of costs were covered by contributions from friends and relatives, and 0.4 percent needed the sale of tangible assets.

To be sure, the NSO assessment found that the average cost of a hospitalisation was Rs 22,380 per case. Borrowing, contributions from friends and family, and the sale of tangible assets all climbed dramatically in the top 10% of spending category, which includes expenditures of Rs 50,550 or more. The average cost of a Covid-19 hospitalisation case is anticipated to exceed Rs 50,000. These figures seem extremely stressful for the low income groups in our country.

Expanding the health insurance cover is need of the hour

According to the 2017-18 NSO survey, nearly three-quarters of hospitalisation cases in India involved persons who were not covered by health insurance. The fraction of hospitalisation cases not covered by any sort of insurance rises from 68 percent among the richest 20% to 85.5 percent among the poorest 20% as income rises. Even when health insurance was available, it did not cover the total expense of treatment.

According to the NSO survey, health insurance covered only 10.2 percent of medical costs and 9.1 percent of total costs (which includes the cost of transporting the patient as well as the cost of food, lodging, transportation, and other household expenses) in cases where hospitalisation was required.

To be clear, the survey was done prior to the implementation of the Pradhan Mantri Jan Aarogya Yojana (PM-JAY), which seeks to cover 107.4 million families or 500 million beneficiaries with health insurance. As a result, the insurance coverage figures may be understated. According to the PM-JAY website, the programme has resulted in 18.6 million hospital admissions since its inception.