Covid 19; Challenges in Management

We are still learning about SARS-CoV-2 virus dynamics. In multiple geographies, the pandemic comes in waves as a part of the population, which is unexposed, remains vulnerable and the virus can attack this population and create a new outbreak. No one can rule out the possibility of a third wave in future. However, if everyone universally practises Covid-appropriate behaviour, optimum containment is maintained and vaccination coverage increased, the probability of a third wave diminishes. There are countries that have not experienced the second wave.

As Covid cases rise, there is a need to ensure good infection control practice protocol in hospitals because secondary infections, both bacterial and fungal, are causing more morbidity and mortality.


Covid-associated mucormycosis is becoming a new challenge. Earlier the incidence of fungal infection was low and was a rare infection, seen only in transplant, diabetes and cancer patients on chemotherapy. However, Covid-induced treatments are leading to several cases of mucormycosis. Some states are reporting around 500 cases. It affects the face, eyes and even the brain. The cases of have seen an increase in people with uncontrolled diabetes and on irrational use of steroids. People should monitor their blood sugar levels, which can rise to 400 with steroid use during Covid treatment. Early detection of this infection is the key to treatment. Cerebral mucormycosis manifests as headache and nose congestion; pulmonary mucormycosis can cause blood in cough and infection of the eye can lead to loss of vision.

Vaccination Challenge

In about two months’ time, there is hope that large amounts of vaccines will become available. More vaccines from new companies are also coming to India over the next eight weeks. The supply situation will improve. However, it is better that the elderly and those with co-morbidities be covered first as they are suffering much higher mortality. Vaccination appointments for the younger people can stay a little. Graded vaccination strategy should be adopted.

A lot of concern is raised about Covishield’s second dose being delayed to 12 to 16 weeks. Data suggests that those who took Covishield in under four weeks got immunity in the range of 55 to 60 pc while those who took the vaccine after 12 weeks got immunity in the range of 80 to 85 pc.

Lessons for the Future

Covid-appropriate behaviour, local containment, surveillance and rapid vaccination.

(Dr Naresh Purohit is a Medical Expert and Advisor National Communicable Disease Control Programme. He is also Advisor to six other National Health Programmes. He is visiting Professor in five Medical Universities of  Southern India including Thrissur based  Kerala University of Health Sciences. (The views and opinion expressed in this article are those of the author)


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