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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

Seventy-seven per cent children below five years of age in Jammu and Kashmir were not able to access basic healthcare services like immunisation during the lockdown imposed to curb the spread of COVID-19, CRY said on Monday citing a study.

The 'Rapid Online Perception Study about the Effects of COVID-19 on Children' was conducted during the first and second phases of the lockdown based on responses of parents and primary caregivers from all across the country, including Jammu and Kashmir, the NGO said in a statement.

It said a total of 387 respondents from Jammu and Kashmir participated in the study.

"Seventy-seven per cent children of age 0-5 years were not able to access basic healthcare services such as immunisation during lockdown - necessarily imposed to curb the spread of COVID-19 pandemic in Jammu and Kashmir," Child Rights and You (CRY) said.

It said as immunisation programmes witnessed a major setback during the lockdown across the country, the results of the survey across 23 states and Union Territories found nearly 50 per cent of parents with children below five years of age unable to access immunisation services.

"Worryingly, the figure was considerably high in Jammu and Kashmir with 77.14 per cent children below five years unable to get immunisation services," it added.

According to the study, in Jammu and Kashmir, nearly 35 per cent of the respondents said their children did not receive medical help during the lockdown, resulting in difficulties to cope with their children's illnesses and health hazards.

The study also talks about more systemic arrangements and logistical preparedness to ensure that children with no or compromised digital reach are not deprived from their Right to Education.

With online classes introduced as a substitute of schools during the lockdown, access to education for children remained a major issue of concern, as many of them, especially the ones from marginalised and financially poorer backgrounds found it difficult without smartphones and internet access.

The survey's findings revealed that nationally only 41 per cent households with children of school-going age could access online classes on a regular basis.

"Almost 90 per cent parents and primary caregivers reported that the lockdown has increased the screen time of their child to great or some extent. About half of the households recorded an increase of children's exposure to online activities during lockdown," it said.

The NGO said around 76 per cent parents agreed that they could keep a watch of their children's online activity to some extent.

New Delhi, Jun 10: Delhi recorded 1,366 fresh cases of COVID-19 on Tuesday, taking the tally to 31,309, while the death toll mounted to 905, authorities said on Wednesday.

According to a health bulletin issued by the Delhi government's health department, there are 18,543 active cases, while 11,861 patients have either recovered, been discharged or migrated.

No health bulletin was issued on Tuesday.