The coronavirus, or COV- ID-19, has been around for about two years. We are in the second wave of the pandemic, says the government, while a few experts claim it is already the third wave. The second wave began in the last week of April when the first wave had not ended and the caseload had not significantly come down. It may be recalled that the second wave emerged in the country after a surge in cases in India.

The number of infections and deaths in the second wave has far exceeded those in the first wave.

After the number of infections came down, the restrictions were relaxed, and most of the people began disobeying the health safety protocols. They quit wearing masks, using sanitisers and maintaining social distancing. As a result, the number of infections and deaths worryingly rose although restrictions in certain areas like party palaces, cinemas, sports venues, gyms and educational institutions were still in force.

As we know now, for every symptomatic case, there may be 50 asymptomatic cases. About 80 per cent of the patients can be managed at home, while 15 per cent of the new cases will require oxygen after seven days and 3 per cent ventilators. Hence, the importance of social distancing, masking, hand hygiene, respiratory hygiene and cough etiquette, selective elderly lockdown and lockdown of patients with comorbidities (presence of two diseases in a patient) should be kept in mind.

We must learn to live with COVID-19 as the virus is going to stay. For the next few years, we will have to avoid gatherings. Medical consultation is possible with tele-medicine. I must start walking or cycling for shorter distances, walk the stairs and avoid lifts when possible. I must have fully ventilated areas to stay, work or sleep and build immunity; practice Pranayama when alone.

I must now start wearing masks, shoe and head covers, get impermeable clothes, prefer fully-ventilated hospital wards over closed AC single rooms. If I am TB positive, I must be isolated till the report turns negative. And it's time to quit smoking as it can spread the virus.

Asian countries are behaving differently in terms of mortality. Most serious patients do not require ventilators as they do not have problem with the lungs. Although the disease can involve practically every organ of the body, mild cases can be treated with home to hospital strategy. Hospitals can spread more than 40 per cent of new cases if PPEs are in short supply.

We need to follow the strategy that every stranger we meet is coronavirus positive and any unknown surface we touch is coronavirus positive.

WHO has started a large global trial called Solidarity to evaluate potential treatments against this deadly virus. WHO is looking for drugs which have already been approved for other diseases and known to be largely safe. It is also looking at unapproved drugs that have performed well in animal studies to treat SARS and MERS. It is also looking for treatments to be given prophylactically to protect healthcare workers and others at high risk of infection. Treatments may also reduce the time patients spend in intensive care units, freeing critical hospital beds.

The Solidarity trial is testing four different drugs or combinations and comparing their effectiveness to fight the virus. For instance, Chloroquine is included in the treatment guidelines by China's National Health Commission and was associated with reduced progression of the disease. In the US, the Food and Drug Administration is accepting emergency new drug applications for patients with severe COV- ID-19.Enhancing the body's immunity plays an important role in maintaining optimum health.

The spread of COVID-19 can also be linked to cult practices in India, Nepal, South Korea, Malaysia, Indonesia and Paki¬stan. In March, a Muslim congregation of over 2,000 people was organised in Nizamuddin, Delhi, by the Tablighi Jamaat, leading to the spread of the virus all over India and in Parsa and Udaypur of Nepal, too.

In South Korea, Almost 63.5 percent of all confirmed cases can be traced back to the mysterious Shincheonji Church of Jesus, where one person is likely to have spread it to others. S ome of its practices included secrecy, banning of health masks, praying in close proximity, kissing each other's hands, singing hymns, not caring about worldly things and focusing on conversions even when someone is sick.

Clinical experience suggests that certain situational or developmental features appear to make people more receptive to cults.

These include high stress levels or dissatisfaction, lack of self-confidence, gullibility, desire to belong to a group and frustrated spiritual search.

Most cult leaders have a narcissistic personality disorder, an excessive need for admiration, disregard for others' feelings, an inability to handle any criticism and a sense of entitlement. As for the followers, most would be going through a mental crisis, and the cult seems to offer relief. Many ex-followers have issues readjusting to society.

The lockdown or prohibitory order of the past gave us enough prevention guidelines and prepared Nepal for any eventuality.

By continuing with the lockdowns we would only be postponing the doubling rate by a few days. So we must introduce smart lockdowns in the critical parts of the country.

As per the WHO guidelines, the case positivity rate should be below 5 percent.

Vaccinations are a remedy against the transmission of COVID-19.

The more vaccines are administered to the people, the less the impact will be.

The possibility of the pandemic entering the third wave depends on public behaviour as well as the status of the vaccination.

People should strictly follow the health safety protocols to break the chain of transmission. It's time to start smart lockdowns, de-locking, locking or sealing 2 km of area around active and new cases, and open areas with no new cases in the last 14 days.

Dr Budhathoky is central treasurer of Nepal Medical Association

A version of this article appears in the print on September 14 2021, of The Himalayan Times.