The presentation covers known Variants Covid -19 of medical importance and the second wave Covid - 19 that hit in India. The factors that led to the abrupt raised number of cases in a short time.

1. LIGULA REFERRAL HOSPITAL
Issah kiswagala
M.B.B.S

3. Coronavirus is far from over. Some countries are still dealing
with large epidemics, but even those currently controlling the
virus fear "the second wave".
When the coronavirus pandemic began early in 2020, experts
wondered if there would be waves of cases, a pattern seen in
other virus pandemics.
The second phase of Spanish flu a century ago was deadlier
than the first (17-100M deaths). So, is a second wave
inevitable? And how bad is it be?

4.  Yet there is no formal
definition
 You can think of it like
waves on the sea.
 The number of
infections goes up and
then comes back
down again - each
cycle is one "wave" of
coronavirus.

6. Some describe any rise as a second wave, but it is often a
bumpy first wave. This is happening in some countries like,
US states.
In order to say one wave has ended, the virus would have
been brought under control and cases fallen substantially.
For a second wave to start you would need a sustained rise in
infections. Such as what is happening in India and Brazil.
In most countries, a second wave has been contributed by
emerging of variants on Covid-19.

8. All viruses – including SARS-CoV-2, the virus that causes
COVID-19 evolve over time make copies of themselves to
survive and spread.
When a virus replicates or makes copies of itself, it sometimes
changes a little bit, which is normal for a virus.
These changes are called “mutations”. A virus with one or
more new mutations is referred to as a “variant” of the original
virus.
Most changes are inconsequential, and some can even harm
the virus. But others can make the disease more infectious or
threatening - and these mutations tend to dominate.

9. When a virus is widely circulating in a population and
causing many infections, the likelihood of the virus mutating
increases.
The more opportunities a virus has to spread, the more it
replicates – and the more opportunities it has to undergo
changes.
Depending on where the changes are located in the virus’s
genetic material, they may affect a virus’s properties, such as
transmission (for example, it may spread more or less easily)
or severity (for example, it may cause more or less severe
disease)

12.  There are thousands of different variants of Covid-19 circulating across the
world.
 Those with the most potentially concerning changes are called "variants of
concern" and kept under the closest watch by health officials, and include:
The UK or Kent variant (also known as B.1.1.7) is prevalent in Britain -
with more than 200,000 cases identified - and has spread to more than
50 countries and appears to be mutating again
The South Africa variant (B.1.351) has been identified in at least 20
other countries, including the UK
The Brazil variant (P.1) has spread to more than 10 other countries,
including the UK and prevalent in Japan while cases surpassed the 13-
million mark in Brazil
A particular India variant (B.1.617.2) of which more than 500 cases
have been seen in the UK, and 400,000 cases daily in India.

13. There is no evidence that any of them cause much more
serious illness for the vast majority of people who become
infected.
A variant identified in the U.S. California (B.1.427) and
(B.1.429). These variants appear to spread more easily and
have a small impact on the treatments and reduces the
effectiveness of antibodies generated by a previous COVID-19
infection or COVID-19.
As with the original version, the risk remains highest for
people who are elderly or have significant underlying health
conditions.

14. The COVID-19 vaccines that are currently in development or
have been approved are expected to provide at least some
protection against new virus variants because these vaccines
elicit a broad immune response involving a range of antibodies
and cells.
In the event that any of these vaccines prove to be less effective
against one or more variants, it will be possible to change the
composition of the vaccines to protect against these variants.
 WHO is working with researchers, health officials and
scientists to understand how these variants affect the virus’s
behaviour, including their impact on the effectiveness of
vaccines.

15. WHO has been tracking mutations and variants since the
start of the COVID-19 outbreak.
Data continues to be collected and analysed on new variants
of the COVID-19 virus.
WHO tries to do everything possible to stop the spread of the
virus in order to prevent mutations that may reduce the
efficacy of existing vaccines.
WHO has also established a SARS-CoV-2 Risk Monitoring
and Evaluation Framework to identify, monitor and assess
variants of concern.

16. Stopping the spread at the source remains key.
Current measures to reduce transmission – including
Frequent hand washing and wearing a mask,
Physical distancing and good ventilation and
Avoiding crowded places or closed settings
Reducing the amount of viral transmission and therefore
also reducing opportunities for the virus to mutate.
Scaling up vaccine manufacturing and rolling out vaccines
as quickly and widely as possible will also be critical ways
of protecting people before they are exposed to the virus and
the risk of new variants

17.  India has been hit by a huge second coronavirus wave, but its government
has said the pandemic is showing signs of slowing down in some regions.
 India's surge in infections began around mid-March 2021 and increased
rapidly, reaching a peak of more than 400,000 recorded daily cases on
Friday, 30 April 2021.
 Over subsequent days the numbers fell, with just under 360,000 on
Monday, 3 May 2021 - leading to speculation that a peak had been reached.
 But in the past few days, they have started to rise again, in line with a
weekly pattern of fluctuations that shows the numbers usually dipping on
a Monday.
 And on Thursday, 6 May 2021, the number of new recorded daily
infections reached a new high of more than 414,000.

19.  The rise in case numbers has been exponential in the second
wave. Experts say this rapid increase shows that the second wave
is spreading much faster across the country
 Many Indian cities are reporting a chronic shortage of hospital
beds. It's also evident in the desperate cries for help on social
media platforms.
 Disturbing reports of people dying without getting timely
treatment are coming from all over the country.
 They didn't learn any lesson from the first wave. They had reports
of some cities running out of beds even in the first wave and that
should have been a good enough reason to be prepared for the
second wave.

21.  Right now, appears to be a lack of co-ordination between states
and the federal government over the supply of oxygen and
essential drugs.
 The situation is much more terrible when it comes to ICU beds.
Several cities have just a few dozen ICU beds left and they are
now anxiously trying to build extra capacity in hotels and
stadiums.
 They are creating new facilities but experts say it's going to be
hard to keep up with the pace of the rising number of infections.
 Big religious gatherings, the reopening of most public places and
crowded election rallies are being blamed for the uptick.

24. Crematoriums have been
running day and night

25. Human behavior is the major factor. State and local governments, as
well as individual people, differ in their response to the pandemic.
 Some follow COVID-19 precautions, such as physical distancing, hand-
washing and mask-wearing. Others are not as prescriptive in requiring
these measures or in restricting certain high risk activities.
 In some cities, towns and communities, public places are closed or
practicing limitations (such as how many people are allowed inside at
one time); others are operating normally.
 Some government and community leaders encourage or even mandate
mask wearing and physical distancing in public areas. Others say it is a
matter of personal choice.

26.  Also, places where people live or work closely together
(multigenerational households, long term care facilities, prisons and
some types of businesses) have also tended to see more spread of the
coronavirus.
 Coronavirus outbreaks at Events and Gatherings of people where one
infected person or more transmits the virus to many others — continue
to occur.
 However, the relationship between those precautions and cases of
COVID-19 is clear: In areas where fewer people are wearing masks and
more are gathering indoors to eat, drink, observe religious practices,
celebrate and socialize, even with family, cases are on the rise.

27. Are the spikes in coronavirus cases due to more coronavirus
testing?
 No. During a surge, the actual number of people getting sick with the
coronavirus is increasing. We know this because in addition to positive
COVID-19 tests, the number of symptomatic people, hospitalizations
and later, deaths, follows the same pattern.
 Reopening communities and people ignore COVID-19 precautions,
including physical distancing, hand-washing and mask-wearing, and
monitoring for symptoms. Unfortunately cause the number of
coronavirus infections to rise again and not because of more testing.

28. If measures are relaxed significantly, we may end up with a second wave
in anytime soon like other countries.
 When the coronavirus first appeared in early 2020, it started with a very
small number of infected people, so it took longer to spread.
 Several holidays took place around the end of the calendar year, and
people who celebrated them went to gather, travelled, and visited
friends and family which led the disease widely distributed, also with
many unknowing coronavirus carriers in many different areas of the
country, the risk of transmission is widespread.
 Also, after many months of canceled activities, economic challenges and
stress, people are frustrated and tired of taking coronavirus precautions.
All these are factors that are driving surges and spikes in COVID-19
cases for the second wave to happen.

29. Herd immunity is a public health term that refers to the fact
that, when enough people in a community have immunity
from a disease, the community is protected from outbreaks of
that disease.
Infectious disease experts at The Johns Hopkins University
explain that about 70% of the population needs to be immune
to this coronavirus before herd immunity can work.
Without a vaccine, most doctors and scientists agree that a
herd immunity approach of letting the virus “take its course”
is not acceptable. Letting the coronavirus circulate freely
among the public would result in hundreds of thousands of
deaths.

30. Doctors, researchers and epidemiologists recognize that more
COVID-19 surges are likely to occur.
Here’s what we can do now:
Continue to practice COVID-19 precautions, such as
physical distancing, hand-washing and mask-wearing.
Stay in touch with local health authorities, ministry of
health or W.H.O who can provide information if COVID-
19 cases begin to increase in your city or town.
Work with policy maker to ensure that the country is up
to date on vaccines, which have been developed in other
countries.

31. We are now entering the second phase of covid-19, the so called
“recovery stage,” sandwiched between the crisis and
rebuilding phase.
As the chaotic pace of the last year and few months ago begins
to slow down, doctors, nurses and other health care
practitioners are drawing breath, reflecting and learning from
their recent experiences.
From what we hear from many approaching our service
(patients), and from the stories we hear from other healthcare
professionals, there is a sense that despite facing considerable
ongoing uncertainty, they do not want to return to the Covid-19
crisis days of working.

32. So, while the first phase of covid-19 has left many of us
feeling fatigued, anxious, traumatised and grieving, there is
also hope that the “new normal” may bring with it a fresh
perspective on what matters and what we really need to do
to thrive as health care professionals..
In this gap of period, let’s learn from the first wave and what
other countries are facing now. Continue to practice COVID-
19 precautions, such as physical distancing, hand-washing
and mask-wearing.

33.  The policy makers, politicians and employers have to be
reminded to shift the floodlight focus on workforce (health care
professionals) well-being and equipment necessary for the
uncertainty Covid-19 second wave.
 Countries should adapt or adopt best practices, strategies,
guidelines and recommendations proposed by the Africa CDC
and World Health Organization (WHO), aimed at limiting
transmission.
 Measures taken should strike a balance between saving lives and
minimizing the impact of the pandemic on the economy and
social wellbeing of citizens.

36. KEY: (NEWS) National Early Warning Score

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