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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

Alappuzha, Apr 5: Coming to the rescue of a toddler in need of crucial treatment for cancer, the Kerala health department scrambled its resources for transporting a toddler from here to Hyderabad on Sunday.

In a co-ordinated action, the department arranged for an ambulance and necessary travel permits for the nearly 16-hour 1,100 km inter-state journey that started at 7.15 am from Cherthala in this district with the entire cost to be borne by the state government.

Health Minister K K Shailaja on Saturday said all steps have been taken to facilitate the travel of the toddler and her family members to Hyderabad after local media reports highlighted the plight of the child.

The state Chief Secretary had discussed the matter with his counterparts of other states en route to ensure a smooth journey,the Health Ministry said.

"The travel permit and directions to other states through which the ambulance has to pass were issued from the police headquarters. All district police chiefs were given instructions from the headquarters to arrange for passage of the ambulance," it said in a release.

The journey started at 7.15 am and they are expected to reach Hyderabad at 11 pm.

"The state government will bear the expenses incurred for the journey. The ambulance will remain in Hyderabad and will return with the family," it said.

The first phase of treatment was done at the L V Prasad Hospital in Hyderabad and the family was supposed to travel again within 21 days for the next phase of treatment.

As the family could not undertake the journey in view of the nation-wide lockdown to check coronavirus scare, the state government swung into action to help the child.

The number of confirmed novel coronavirus cases in the country climbed to 3,374 on Sunday while the death toll rose to 77, according to Union Health Ministry data.

New Delhi, May 14: India may witness the death of additional 1.2-6 lakh children over the next one year from preventable causes as a consequence to the disruption in regular health services due to the COVID-19 pandemic, UNICEF has warned.

The warning comes from a new study that brackets India with nine other nations from Asia and Africa that could potentially have the largest number of additional child deaths as a consequence to the pandemic.

These potential child deaths will be in addition to the 2.5 million children who already die before their fifth birthday every six months in the 118 countries included in the study.

The estimate is based on an analysis by researchers from the Johns Hopkins Bloomberg School of Public Health published in the Lancet.  

This means the global mortality rate of children dying before their fifth birthday, one of the key progress indicators in all of the global development, could potentially increase for the first time since 1960 when the data was first collected.

There were 1.04 million under-5 deaths in India in 2017, of which nearly 50% (0.57 million) were neonatal deaths. The highest number of under-5 deaths was in Uttar Pradesh (312,800 which included 165,800 neonatal deaths) and Bihar (141,500 which included 75,300 neonatal deaths).

The researchers looked at three scenarios, factoring in parameters like reduction in workforce, supplies and access to healthcare for services like family planning, antenatal care, childbirth care, postnatal care, vaccination and preventive care for early childhood. The effects are modelled for a period of three months, six months and 12 months.  

In scenario-1 marked by 10-18% reduction of coverage of all the services, the number of additional children deaths could be in the range of 30,000 plus over three months, more than 60,000 over six months and above 120,000 over the next 12 months.

Coronavirus India update: State-wise total number of confirmed cases, deaths on May 13

The numbers sharply rose to nearly 55,000; 109,000 and 219,000 respectively for scenario-2, which was associated with an 18-28% drop in all the regular services.

But in the worst-case scenario in which 40-50% of the services are not available, the number of additional deaths ballooned to 1.5 lakhs in the three months in the short-range to nearly six lakhs over a year.

The ten countries that could potentially have the largest number of additional child deaths are Bangladesh, Brazil, Congo, Ethiopia, India, Indonesia, Nigeria, Pakistan, Uganda and Tanzania.

In countries with already weak health systems, COVID-19 is causing disruptions in medical supply chains and straining financial and human resources.

Visits to health care centres are declining due to lockdowns, curfews and transport disruptions, and due to the fear of infection among the communities. Such disruptions could result in potentially devastating increases in maternal and child deaths, the UN agency warned.