Pandemic alarm bell

The cumulative death toll in COVID-19 surpassing the 3,000-mark in Assam and the active caseload being 55,000, it is too early for the state to feel relaxed by falling daily positivity rates. Against 1,100 deaths occurring in the first wave over one year since the detection of the first COVID-19 case on March 31 last year, more than 2,000 deaths have been recorded in less than two months since April 1 in the current wave. High fatalities in the second wave indicate the ferocity of the new mutants of the virus and the spread of the infection. Almost an equal number, if not less, of COVID-positive patients have died for other complications after being tested negative. The figure of death of such category of COVID-positive patients is no longer updated in the health bulletins issued by the National Health Mission, Assam. In the first wave, the death toll of 'COVID positive patients dead for other reasons according to NHM bulletins was put at 1,347 which was higher than the COVID-19 death of about 1,105 till March 31. The Ministry of Home Affairs has rightly asked all states and union territories to continue the ongoing COVID-19 guidelines till June 30 and go for intensive and local containment measures in the districts with high active cases. The MHA directive made it clear that any relaxation may be considered by the states at an appropriate time, in a graded manner after assessing the local situation, requirement and resources. Implementation of this directive will require the states to focus parallelly on the state pandemic curve and district curves and district-specific containment strategy. The guidelines required the states to take necessary action to ensure sufficient oxygen-supported beds, Intensive Care Unit beds, ventilators, ambulances, set up make-shift hospitals, besides adequate quarantine facilities. The state cannot be caught unprepared to handle the third wave and flattening the pandemic curve of the current wave by preventing the spread of infection must remain the top priority. Any relaxation in the restrictions imposed and extended till June 5 must be done after ensuring that it does not lead to a fresh spike in infections. Testing remains the most reliable method of detecting new cases and needs to be ramped up when restrictions are relaxed in a graded manner. Intensifying surveillance against vector-borne diseases to prevent them from overwhelming the health system. National Guidelines on Dengue Case Management during COVID-19 Pandemic states issued by the Ministry of Health last year states that "deaths due to COVID-19 having co-infection of dengue have been reported from the States of Assam, Maharashtra, Punjab and Delhi." The guidelines cautioned the states that when most of the hospitals are busy with managing COVID-19, and a little window is open, to tackle another disease outbreak. Besides, most of the cases of COVID-19 and dengue are asymptomatic (about 80%) and in a setting of coinfection, one might enhance the severity of the other, which make the coinfection a serious public health challenge. These guidelines also state that there is a strong likelihood of a temporal co-occurrence of two or more infections together in a region which may cause co-infections with two viruses/parasites in the same individual, leading to an overlap of symptoms, thus making diagnosis and case management difficult. Making efforts to minimise the vector population before the onset of rains, to lower the number of Dengue, Malaria and Chikungunya cases as envisaged in the guideline can aid better management of the coinfection. An alarming surge in COVID-19 cases and high fatalities in the second wave have sounded the alarm bell for the state to intensify vector control measures to prevent a surge in coinfection. Vaccination against COVID-19 has not gathered the desired momentum due to the non-availability of the required quantities against the demand. Till Friday, only 8.19 lakh people against the total population of 3.12 crore (2011 Census) of the state have received both doses of the vaccine while 31.60 lakh have received only the first dose. This shows the vast majority of the state's population have remained vulnerable against the virus infections and any sense of complacency on the part of the people due to the erroneous conclusion that a sizable population has been fully vaccinated could prove disastrous. Vaccination is going to take time which makes it imperative for the citizens to stay focused on strict adherence to COVID-19 appropriate behaviour and following all restrictions imposed by the government for containing the spared of infections. The alarming spread of infection in rural areas in the second wave with more intensity than the first wave speaks volume about the shortcomings in efforts to take the awareness drive on COVID-19 appropriate behaviour as the most important containment strategy to rural areas of the state. High fatalities in the first two months of the current wave are harsh reminders of the grave consequences of lowering the guards.