Abstract
Background: – This time last year in 2020 India was under
lockdown phase, many theories about India’s surprisingly low rates of
Sars-CoV-2 infection included variety of factors including hot weather,
natural immunity, heard immunity, robust health system, highly qualified
doctors and the country’s high proportion of young people; some also
attributed it to the country’s harsh lockdown. India was doing so well
that in megacities like Mumbai and Delhi, officials had begun
dismantling temporary COVID-19 facilities. Comparing it to current
scenario in April 2021, cases and deaths are soaring. The shortage of
beds and space is so acute that people are dying in car parks and other
places while waiting to be admitted in hospitals. Daily rates are
currently over 300,000, the world’s highest-ever daily infection
rate.11https://www.gavi.org/vaccineswork/why-indias-covid-19-pandemic-skyrocketing
The SARS-CoV-2/ Covid -19 pandemic is still going on and globally as
well as in India particularly healthcare system is overstressed with
this new burden added with previous NCD(non communicable diseases) &
CD(communicable diseases). The First human case of this global pandemic
was reported from Wuhan city of China in December 2019.22https://apps.who.int/iris/bitstream/handle/10665/332197/WHO-2019-nCoV-FAQ-Virus_origin-2020.1-eng.pdf
The first case of covid-19 in India was found in January 2020. Today
India is having more than 3 lakh cases per day and thousands of deaths
daily due to this pandemic. The situation is very worse as compared to
previous year and is worsening day by day due to several factors.
Objective: – The main objective of this study is to illustrate
the key features of Covid -19 virus, host human beings factors,
irresponsibility’s and environmental factors responsible for
continuation and recurrence of this pandemic as well as worsening of
pandemic day by day. Setting and design: – Different aspects
of Covid -19 structural variations, mutations, host factors,
environmental factors (internal & external) and its effect will be
analysed. Brief details about epidemiological triad will be outlined.Methodology : – The explanation will be given to title through
analysis of several factors responsible for increase in cases. The cause
of perpetuation of Covid -19 can be understood by the way of infections
and other related factors. Result : - Several factors are
responsible for the continuation and worsening of pandemic situation in
India of the pandemic. Of great concern today is a new ‘double mutant’
B1617 variant, identified in India last year, that is spreading across
the country as well as triple variants discovered recently and studies
are going on to know more. Although scientists are still investigating
whether or not the variant is more deadly & more infectious, it does
contain the L452R mutation that affects the virus’ spike protein. This
protein is very significant because through this the virus hooks on to
our cells receptor. Early research suggests that this mutation makes the
virus more infectious. This doesn’t necessarily mean that the variant
will be any more deadly, but it means that more people are at
risk.33https://www.gavi.org/vaccineswork/why-indias-covid-19-pandemic-skyrocketing
Conclusion : – In the epidemiological triad we have
agent/host/environment. The clinical approach is based on individuals &
standard treatment guidelines-protocols and public health approach is
based on population strategy to control this pandemic. Various
strategies and approaches are required to prevent epidemic through
assessment of important parameters and indicators (see figure 1) to
control the ongoing disaster and hazards of pandemic
Keywords: – SARS-Cov-2, Covid-19, Pandemic, Strain,
Background – This time last year in 2020 India was under
lockdown phase, many theories about India’s astonishingly low rates
of COVID 19 infection included
variety of factors including hot weather, natural immunity, heard
immunity, robust health system, highly qualified doctors and the
country’s high proportion of young people; some also attributed it to
the country’s harsh lockdown. India was doing so well that in megacities
like Mumbai and Delhi, officials had begun dismantling temporary
COVID-19 facilities. Comparing it to current scenario in April 2021,
cases and deaths are soaring,
leaving hospitals
running out of oxygen & beds with other medicines and required
facilities. The shortage of beds and space is so acute that people are
dying in car parks and other places while waiting to be admitted in
hospitals. Daily rates are currently over 300,000, the world’s
highest-ever daily infection rate
The SARS-CoV-2/ Covid -19 pandemic is still going on and globally
healthcare system is overstressed with this new burden added with
previous NCD & CD in existence. The First human case of this global
pandemic was reported from Wuhan city of China in December 2019. The
first case of covid-19 in India was found in January 2020. Today India
is having more than 3 lakh cases per day and thousands of deaths daily
due to this pandemic. The situation is very worse as compared to
previous year and is worsening day by day due to several factors.
The SARS-CoV-2/ Covid -19 coronavirus belongs to a large family of
coronavirus. Usually they cause respiratory infection in humans like
other respiratory viruses such as rhinoviruses/ human respiratory
syncytial virus/ parainfluenza viruses/ adenoviruses/influenza A & B
viruses / enteroviruses / herpes simplex viruses/ human
metapneumoviruses etc.44Harrisons Principles of Internal
Medicine-18th edition volume 1 If we look at the history
SARS-2002/2003 – south china outbreak begin with 8096 recognised cases
in 28 countries & added to this 90 % of cases occurred in china and
hongkong. Now the world is moving very fast or we can say the host
factors related spread have exaggerated the pandemic added with various
climatic changes. That time the natural reservoir of SARS-CoV appeared
to be horseshoe bat. The 2002-2003 outbreaks thought to be originated
due to human contacts with infected domestic animals. The striking fact
is that in 2002-2003 as well as 2019-2020-2021 most cases spread from
human to human and there are multiple ways of spread particularly
respiratory droplets. The 2002 outbreak ceased in 2003 but 2019 outbreak
is going on and global fast movement is one of the most important
factors. The super spreaders may remain symptomless while spreading the
virus.
WHO (world health organisation) have notified and actually its alarming
and alerting that globally new covid-19 cases are rising again or we can
say alternatively that incidence rate is increasing. In the last week of
March 2021 the new cases reported globally are more than 3.8 million. At
the same time the number of deaths also increased consecutively for the
second consecutive week. The deaths increased by 5 % compared to
previous week. The total number of death for above mentioned period was
over 64000 new deaths. The more alarming fact is that all regions have
reported an increase in incidence rate in last week of March 2021. If we
talk about deaths then except African region all regions reported an
increase in the number of deaths due to covid-19. Added to above facts
still the European region with region of Americas are on the top
accounting for 80 % of all cumulative cases and deaths.55https://www.who.int/publications/m/item/weekly-epidemiological-update-on-covid-19—31-march-2021
There is sharp rise in south East Asia region or actually it’s the
largest increase on global basis that is 21 % increase in deaths with
continued increasing trends in the 3rd consecutive
week.
The south East Asian region is also having a huge population as well as
many nations are in developing stage with stressed and overburdened
health system. The health system administration and management in India
is such that the topmost positions are acquired by people who are not
from the medical, clinical or public health backgrounds. All the
important decision is taken by these non technical persons as well as
India is always having problems of corrupt practices and haphazard
system failures in critical circumstances. Added to this there is lack
of human resources, infrastructure, and capacity building, to cater the
huge population which is growing day by day. The number of beds and
medical resources are not enough and not sufficient as per international
norms and this pandemic have added an extra demand on the system which
is already overburdened.
Objective - The main objective of this study is to illustrate
the key features of Covid -19 virus and mutations as well as strains
added with host and environmental factors responsible for continuation,
recurrence & increase in number of death and cases in India. The global
scenario of covid-19 pandemic see table 1- Newly reported and cumulative
COVID-19 confirmed cases and deaths, by WHO Region, as of 28 March 2021-
source – WHO & table-2- Overview of variants of interest (VOIs), as of
30 March 2021 – source – WHO
The whole group of coronavirus is very peculiar. They are pleomorphic,
single stranded RNA viruses measuring about 100-160 nm in diameter.
There are several factors responsible for the continuation of covid-19
pandemic. Broadly we can look at the epidemiological triad i.e. agent,
host and environmental factors.
Setting and design – Different aspects of Covid -19 structural
variations (see table 2) and its effect will be analysed. Brief details
about epidemiological triad will be outlined. All the triad of
epidemiology is detailed (see figure 1) to tackle the pandemic in proper
way.
Agent coronavirus is having continuous variations one of the factors
responsible for the ongoing covid-19 pandemic. These viruses have crown
like appearance produced by club shaped projections that studs the viral
envelope. The coronavirus group actually infects a wide variety of
animals of different species. These are divided into three antigenic and
genetic groups.
Methodology – Beside host and environmental factors the cause
of perpetuation and increase in number of Covid -19 cases and deaths can
be understood by the way SARS (SARS – CoV) CORONAVIRUSES is causing
human infections. They fall in group 1 and 2. The old human isolates
were HCoV-229E and HCoV-OC43. SARS-CoV-2 was earlier considered to be a
novel group of viruses (novel coronavirus, n covid-19) but now they are
placed in group 2 (SARS-CoV-2). The covid-19 virus has shown variations.
There are variations and mutations see table-2 which is taken into
consideration added with host factors and environmental factors.
Result- Several factors are responsible for the continuation of
the pandemic. Of great concern today is a new ‘double mutant’ B1617
variant, identified in India last year, that is spreading across the
country as well as triple variants discovered recently and studies are
going on to know more. Although scientists are still investigating
whether or not the variant is more deadly & more infectious, it does
contain the L452R mutation that affects the virus’ spike protein. This
protein is very significant because through this the virus hooks on to
our cells receptor. Early research suggests that this mutation makes the
virus more infectious. This doesn’t necessarily mean that the variant
will be any more deadly, but it means that more people are at risk.