Iranian Journal of Medical Microbiology

Pandemic – this word we learned in our community medicine and public health chapters during medical school. Till 2019 November, many people have even not heard about the pandemic but after the SARS CoV-2 pandemic occurred and the whole world has now faced it. SARS CoV-2 (COVID-19) was first notified in Wuhan city of China and it spread all over the world very rapidly (1). In India, a lockdown was declared all over the country after a short time when cases started to rise. COVID-19 spreads globally and affects more than 200 countries in the world.  Previously the world faced a lot of pandemics but this was a unique pandemic of all time. It not only affected the health system but also the world economy, education, society, and much more. It reached first place in the cause of human death in this century. It stopped the world for some time and still, the world has not recovered from the loss due to the COVID-19 pandemic.
From 2020 to today, almost three waves of COVID-19 have occurred in India.  At the time of the first wave of COVID-19, India and the whole world were not very aware of the disease. The world lost many precious human lives due to the unavailability of diagnostic tests and treatment due to unknown virus and their characteristics. A few months later from the first case, various diagnostic methods and treatments were available and people gradually understood the clinical presentation of the disease. Viruses mutate themselves and present as outbreaks. In 2021, the second wave of COVID-19 occurred, and it was far more dangerous than the previous because it came with a new variant (Delta) (2). Patients were reinfected even after COVID vaccine course completion (3). The third wave of COVID-19, an omicron variant of the virus was discovered (2) and it occurred at the start of 2022 but it was only for a few days to weeks. The whole country and world were very happy that 3^rd wave finished early.
The world started recovering from loss and trying to start routine life as previously but healthcare systems still trying to secure from the COVID-19 spreads. The preoperative and pre-admission COVID-19 test was mandatory during the first, second, and third waves of COVID-19 and still few government hospitals, as well as private hospitals, are adding COVID-19 RTPCR test to the pre-operative investigation list (4). Till May-June 2022, COVID-19 cases were very few but at the end of June 2022, suddenly cases started to rise again all over the country (5). Daily New diagnosed cases were increased from 2745 cases on 31^st May 2022 to 20044 cases on 15^th July 2022. This positivity was found in symptomatic as well as asymptomatic patients (6) (Figure 1).
The whole country including the government and clinicians thought that the third wave finished early but every day few positive cases were reported to the national COVID testing registry. As per our opinion, the third wave was not finished early but people and health care workers have taken it lightly. Peoples avoid the test and take self-medication as misinterpreting as common cold and cough. They did the testing only when moderate to severe symptoms were present. Previously few pandemics occurred and they never went back completely. Those diseases and pathogens are part of the human health system. Our children are immunized with their vaccines for the prevention of diseases. When we look back, not a single wave of pandemics just finished in a few days to a few weeks and a new wave did not start in just 3-4 months. So, these sudden raises in COVID-19 positive cases are not a fourth wave of COVID-19 (5).
In a nutshell, the current raised COVID-19 cases are not a pre-phase of the fourth wave of the pandemic. It is a continuous phase of the third wave of the pandemic, maybe it is a post phase or continuous phase of the third wave. Government and clinicians have to be alert and strict watch on the changes in positivity percentages that will give a warning to our health system. Also, people should be maintaining physical distancing measures and mask-wearing compliance because no single protocol can end the ongoing pandemic (6).

Figure 1. Tracking COVID-19 cases in India: Last 90 days trends (From 15 April 2022 to 15 July 2022) (6)