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New Delhi, Apr 24: The trajectory of COVID-19 cases could have plateaued and might even fall for some weeks after the lockdown is lifted but India is likely to see a second wave in late July or August with a surge in the number of cases during the monsoon, say scientists.

The timing of the peak will depend on how India is able to control physical distancing and on the level of infection spreads after restrictions are relaxed, they said.

It looks apparent that the trajectory of daily new cases has reached a plateau and eventually it will take a downward fall, maybe for some weeks or even months, Samit Bhattacharya, associate professor at the Department of Mathematics, Shiv Nadar University, said.

Still, we may get a surge of new cases of the same coronavirus and this will be considered a second wave, Bhattacharya explained.

The second epidemic may come back in late July or August in the monsoon, although the peak timing will depend on how we control social distancing during that time, he said.

Rajesh Sundaresan, professor at Bengaluru's Indian Institute of Science (IISc), agreed.

“Once we return to normal activity levels, there is a chance that infection may begin to rise again. China is seeing this to some extent post easing of some restrictions on travel,” Sundaresan, corresponding author of a working paper by researchers at IISc and the Tata Institute of Fundamental Research (TIFR) in Mumbai, said.

On March 25, when the number of coronavirus cases was 618 with 13 deaths, the government announced a nationwide lockdown that was later extended to May 3.

On Friday, the death toll due to COVID-19 rose to 718 and the number of cases to 23,077, according to the Union Health Ministry.

In good news, officials said this week that the doubling rate of cases has slowed down in the period, going from 3.4 days before lockdown to 7.5 days, with 18 states doing better than the national average. The recovery rate has also almost doubled in the last 10 days.

"Looking at the new cases in the past few days, it seems the growth of new daily infection is much slower than earlier. This apparently indicates that we might have reached at the plateau of the growth curve, Bhattacharya said.

He noted that recent studies in China and Europe observed that the infection might relapse in those people who have already recovered from earlier phases.

So, there is no evidence that the earlier infection may help acquire immunity against the second infection. And in that way, the entire population may be vulnerable to the second wave to some extent, said the scientist.

In their study unveiled this week, IISc and TIFR researchers analysed the impact of strategies such as case isolation, home quarantine, social distancing and various post-lockdown restrictions on COVID-19 that might remain in force for some time.

The study modelled on Bengaluru and Mumbai suggests the infection is likely to have a second wave and the public health threat will remain, unless steps are taken to aggressively trace, localise, isolate the cases, and prevent influx of new infections.

The new levels and the peaking times for healthcare demand depend on the levels of infection spreads in each city at the time of relaxation of restrictions, they said.

The lockdown is currently upon us. It has given us valuable time. Let us test, trace, quarantine, isolate, practice better hygiene, search for a vaccine, etc. We should do these anyway, and these are being done. When and how to lift the lockdown is going to be a difficult decision to make, said Sundaresan.

It's clear that it's going to be phased. What our team is focusing on is to come up with tools to help the decision makers assess the public health impact of various choices, he said.

According to the experts, infectious diseases spread via contact between infectious and susceptible people. In the absence of any control measures, an outbreak will grow as long as the average number of people infected by each infectious person is more than one.

Once enough people are immune there will be fewer people susceptible to the infection and the outbreak will die.

However, when an outbreak is brought under control by social distancing and other interventions, it is possible only a small proportion of the population will have been infected and gained immunity, they said.

This means enough susceptible people may remain to fuel a second wave if controls are relaxed and infection is reintroduced.

Until the vaccine comes on the market, we have to remain alert Once sporadic cases occur here and there in the country, we immediately need to implement quarantine or social distancing locally for the people in that region, and also need to perform tests to identify positive cases irrespective of showing symptoms, Bhattacharya explained.

Note that these monsoon months are also flu season in many places of India. So, we should not ignore the early signs of the flu symptoms. Irrespective of symptoms, we need to increase tests in the hotspots to identify people and contain the surge, he said.

Sundaresan added that the timeline for a second wave will depend on a lot of circumstances which may change as the time passes.

Significant testing may have been underway, there may be behavioural changes with people becoming more careful about their hygiene, wearing masks may become more common, etc. All these responses may help restrict the second wave, he said.

A study published in The Lancet journal earlier this month modelled the potential adverse consequences of premature relaxation of interventions, and found it might lead to a second wave of infections.

The finding is critical to governments globally, because it warns against premature relaxation of strict interventions, the researchers said.

While interventions to control the spread of SARS-CoV-2 are in place, countries will need to work toward returning to normalcy; thus, knowledge of the effect of each intervention is urgently required, they said in the study.

According to a recent analysis by the Harvard Chan School of Public Health, the best strategy to ease the critical care burden and loss of life from COVID-19 might be on-again, off-again social distancing.

In the absence of such interventions, surveillance and intermittent distancing may need to be maintained into 2022, which would present a substantial social and economic burden, the researchers wrote.p

Srinagar, Jan 15: The Jammu and Kashmir administration on Tuesday evening allowed mobile Internet in parts of Jammu region and broadband in establishments providing essential services, days after the Supreme Court ordered a review of the curbs imposed in the Union Territory.

The order comes into effect from January 15 and shall remain in force for seven days, a government communication said.

In a three-page order, the administration asked Internet service providers to offer broadband facility (with Mac binding) to all institutions dealing with essential services such as hospitals, banks and government offices.

In order to facilitate tourism, the broadband Internet services would be provided to hotels and tour and travel establishments, the order said.

Mac Binding essentially means to enforce a client machine to work from a particular Internet Protocol address.

"Prior to giving such facility, the service providers have been asked to install necessary firewalls and carry out white-listing of sites that would enable government websites and website dealing with essential services like e-banking," the order said.

However, all social media sites remain out of bounds. "There shall be complete restrictions on social media applications allowing peer-to-peer communication and virtual private network applications for the time being," the order said.

The institutions and government offices that are being provided Internet access shall be responsible to prevent misuse, according to the order.

It said the 2G mobile connectivity on post-paid mobiles for accessing white-listed websites including e-banking will be allowed in districts of Jammu, Samba, Kathua, Udhampur and Reasi -- all in the Jammu region.

The order said that the police has brought material relating to the terror modules operating in Jammu and Kashmir including handlers from across the border who are attempting to aid and incite people by transmission of fake news and targeted messages through use of Internet.

The relaxation came days after the Supreme Court said access to the Internet is a fundamental right under Article 19 of the Constitution.

The SC verdict had come on Friday on a batch of pleas challenging the curbs imposed in Jammu and Kashmir after the Centre's abrogation of provisions of Article 370 on August 5 last year.

The court had also asked the Jammu and Kashmir administration to review within a week all orders imposing curbs in the Union Territory.

It had asked the J-K administration to restore Internet services in institutions such as hospitals and educational places providing essential services.

The J-K administration's Tuesday communication said that in view of the Supreme Court directions, the situation has been reviewed and Internet has been opened whereever it was possible keeping in view the security consideration.

In Kashmir, 400 additional Internet kiosks will be established, besides the 900 terminals which are already operational in the Valley.

More than 50 million people in India do not have access to effective handwashing, putting them at a greater risk of acquiring and transmitting the novel coronavirus, according to a study.

Researchers from the Institute for Health Metrics and Evaluation (IHME) at the University of Washington in the US found that without access to soap and clean water, over 2 billion people in low- and middle-income nations -- a quarter of the world's population -- have a greater likelihood of transmitting the coronavirus than those in wealthy countries.

According to the study, published in the journal Environmental Health Perspectives, more than 50 per cent of the people in sub-Saharan Africa and Oceania lacked access to effective handwashing.

"Handwashing is one of the key measures to prevent COVID transmission, yet it is distressing that access is unavailable in many countries that also have limited health care capacity," said Michael Brauer, a professor at IHME.

The study found that in 46 countries, more than half of people lacked access to soap and clean water.

In India, Pakistan, China, Bangladesh, Nigeria, Ethiopia, Democratic Republic of the Congo, and Indonesia, more than 50 million persons in each country were estimated to be without handwashing access, according to the study.

"Temporary fixes, such as hand sanitizer or water trucks, are just that -- temporary fixes," Brauer said.

"But implementing long-term solutions is needed to protect against COVID and the more than 700,000 deaths each year due to poor handwashing access," Brauer said.

He noted that even with 25 per cent of the world's population lacking access to effective handwashing facilities, there have been "substantial improvements in many countries" between 1990 and 2019.

Those countries include Saudi Arabia, Morocco, Nepal, and Tanzania, which have improved their nations' sanitation, the researchers said.

The study does not estimate access to handwashing facilities in non-household settings such as schools, workplaces, health care facilities, and other public locations such as markets.

Earlier this month, the World Health Organization predicted 190,000 people in Africa could die of COVID-19 in the first year of the pandemic, and that upward of 44 million of the continent's 1.3 billion people could be infected with the coronavirus, the researchers said.