Dr Rouf Hussain

The first case of Covid-19 in India was reported on 30-Jan-2020 and in Kashmir division on 18-Mar-2020. The cases in Kashmir Division started rising slowly and almost the whole of 2020 witnessed the first wave of Covid-19, with the cases coming down by the end of the year. The second wave started in March 2021 and reached the peak in middle of May at a very sharp pace, subsiding over a period of further 2 months.
The 2nd wave was very much similar to the first wave with respect to mortality and morbidity rates with more deaths among aged and co-morbid people, and generally sparing the younger generation. The recently conducted Sero-prevalence Survey in Kashmir Division suggested a very high (>80%) prevalence of antibodies among people of all the districts. This high prevalence of antibodies is the result of Covid-19 vaccination and previous Covid-19 infections, and is the reason for averting any possible 3rd wave unless the virus changes its antigenic structure.
Srinagar district is witnessing an increase in the positivity rate as well as daily positive cases over the past one month, which seems to be a cause of concern. The most probable reason for the surge in cases (?3rd wave) is a suspected change in the antigenic structure of circulating Covid-19 virus, though the Whole Genome Sequencing results are awaited, pointing to the necessity of having a Whole Genome Sequencing Lab in Srinagar so that the results are available in time-bound manner.

The reason for the surge of cases in Srinagar and the fact that every time the wave starts from Srinagar, are many as described under:
1. Srinagar District is the most populous district in Kashmir Division with a population of around 15 lac people and in addition 5 to 10 lac people from other districts are staying in Srinagar district.
2. The population density of District Srinagar is the highest (630/km2) among all the districts of Kashmir Division (Av. Pop. Density of 124/ sq km).
3. Srinagar District is the commercial hub of Kashmir Division and majority of political and government activities happen in this district.
4. The only airport of Kashmir Division is located within the vicinity of Srinagar District and all the incoming passengers first arrive at Srinagar before subsequently going to destinations like Gulmarg, Pahalgam, etc.

The two main apprehensions for the future are:
1. If the virus changes its antigenic structure to a large extent (becomes a total new variant), it breaks through the immunity gained from vaccinations and previous infections.
2. If the virus changes to such an extent that its effects on children become more aggressive.
The possibility of these two apprehensions is very less but cannot be ruled out.

Solution:
1) Covid Appropriate Behavior (CAB):
Monitoring and enforcement of Covid-19 appropriate behavior so that spread of infection can be prevented.
2) Vaccination:
Enhancement of the vaccination coverage including the 2nd dose shall be the priority so that the morbidity and mortality due to Covid-19 is minimised.
3) Epidemiological Surveillance including the Whole Genome Sequencing.
4) IEC activities and trainings.
5) Augmentation of Health Care Infrastructure including the Pediatric Health care.

—The writer is a Community Medicine Specialist and posted at Divisional Covid Control Room Kashmir

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