Is India ready for Corona Virus?
Back in 2018, Bill Gates gave a warning that the world wasn't prepared for pandemics. WHO has declared today that the novel coronavirus (2019 nCoV) is a public health emergency of international concern. Can the second most populated country in the world handle this pandemic? A HE report.
The coronavirus which has claimed the lives of 132 people in China, has reached India.
According to a study, India is among the top 30 countries at "high-risk" from the spread of the deadly coronavirus, based on the number of air-travellers predicted to land in the countries from the worst affected cities in China.
The Spanish flu of 1918, claimed the lives of 17 million people in India. Today, the population of the country is almost five times as that of 1918. But are we prepared for epidemics, as much as we are ready for a war?
Ramping up Preparedness
The government has announced its first case of a novel coronavirus in Kerala. Within a short span of time, Kerala government has set up a control room at Thrissur District Medical Office and district collectorate. Thrissur medical college converted a general ward to a special isolation ward consisting of 20 rooms, within five hours. Even a team of virology experts from Pune have also reached Kerala. Further, masks have been made compulsory for patients as well as health care workers in Thrissur.
According to an official press release, the National Institute of Virology in Pune has 5000 testing kits. Twelve more labs started functioning at NIV Bengaluru Unit, Victoria Hospital Campus, KR Road, AIIMS, NewDelhi, NCDC DELHI, Kasturba Hospital Mumbai, ICMR-NICED, Kolkata, GMC Secunderabad, KGMU Lucknow, SMS Jaipur, IGGMC Nagpur and KIPMR Chennai, according to the official government press release.
Dr Mahesh Kumar, Consultant Internal Medicine, Narayana Health City, points out that with Kerala reporting the first case of coronavirus in India, it is crucial for people from neighbouring states like Karnataka especially Bangalore, Tamil Nadu to be cautious. "Unlike the earlier coronavirus, Severe Acute respiratory syndrome (SARS) and Middle Eastern Respiratory Syndrome (MERS), the current virus (Novel Coronavirus) is a mutated variant. Most of the deaths have been amongst the elderly or people who have weak immunity. Some of the common symptoms are nasal congestion, cough and cold and body pain. Depending on how virulent the virus is, a cough, sneeze or handshake could cause exposure. Symptoms may appear as early as 24 hrs or up to 7 to 10 days post-exposure," he explains.
Dr Tedros Adhanom Ghebreyesus, Director-General of the World Health Organization, recently expressed his concern at the sort of damage nCoV could do, if it were to spread in a country with a weaker health system.
Early Recognition and Source Control is the Need of the Hour
Dr Joshy Jacob, Professor of Microbiology and Immunology at the Emory School of Medicine, Atlanta, points out that 2019 nCoV is a highly transmissible virus. "The Chinese authorities suggest that it can even be transmitted before an exposed individual exhibits overt symptoms. This is worrisome. The practical solution is the self-quarantine of those who have come in contact with the virus. Those who have recently returned from China or have been exposed to someone with the virus must avoid public places for two weeks even if they are symptom-free. The silver lining is that the mortality rate is estimated to be 3%. Still, these numbers could rise based on the age and co-morbidities of the afflicted."
The Global Health Security Index 2019 states that no country is fully prepared for epidemics or pandemics, and every country has significant gaps to address.
According to a recent report by TOI, patients who self-reported themselves at the Rajiv Gandhi Institute of Chest Diseases, don't want to stay at the hospital due to unsatisfactory conditions at the government hospital.
Safety of healthcare workers is as important as the safety of patients during such health emergencies.
Public health experts recommend that Health Care Workers should use a medical mask, eye protection (goggles), clean, non-sterile, long-sleeved gown and gloves or facial protection (face shield) to avoid contamination of mucous membranes. There is already a shortage of N-95 masks in Mumbai pharmacies.
WHO Guidelines for Healthcare Facilities
According to the Interim Guidance published by WHO, Infection Prevention and Control (IPC) strategies to prevent or limit transmission in healthcare settings include the following:
Ensuring triage, early recognition, and source control (isolating patients with suspected nCoV infection);
Applying standard precautions for all patients;
Implementing additional empiric precautions (droplet and contact and, whenever applicable, airborne precautions) for alleged cases of nCoV
Infection;
Implementing administrative controls;
Using environmental and engineering controls.
Risk Communication
According to Dr Anup R Warrier, Senior Consultant - Infection Control, Aster Medcity, Cochin, the new virus is spread through respiratory droplets.
The key factors important in preventing this from becoming an epidemic are - avoid overcrowding, cough etiquette and hand hygiene. Practically speaking, we have serious challenges in achieving all these three requirements. "Hopefully, like the previous coronavirus (MERS and SARS), we hope the transmissibility is not too high; or else we could be facing the next H1N1 like situation very soon. Infection Prevention is difficult because it needs upgrading of infrastructure, education of public and staff, inventory of protective gear and appropriate behaviour changes. This cannot happen all of a sudden, and hence, we have a long way to go," explains Warrier.
"This has the potential to become the global pandemic - meaning every country could be affected and impacted with the spread of this infection. In symptomatic persons (those who have fever & cough) and if travel to the areas affected (mainly China as of now) - the throat swab or respiratory secretions are sampled for PCR which identifies this virus. This is possible only in specialised and designated Labs," he explains.
According to experts to facilitate the early identification of cases of suspected nCoV infection, healthcare facilities should
Encourage HCWs to have a high level of clinical suspicion;
Establish a well-equipped triage station at the entrance of health care facility, supported by trained staff;
institute the use of screening questionnaires according to the updated case definition and
post signs in public areas reminding symptomatic patients to alert HCWs.
The promotion of hand hygiene and respiratory hygiene are essential preventive measures.
Psuedo-Scientific Medicine
It is important to bust the myths about the disease too.
Meanwhile, the Ministry of AYUSH report about using homoeopathy and Unani medicines for prevention and treatment of coronavirus sparked a wave of criticism on social media.
"At a time when government agencies around the world are focusing their efforts on new treatment options, new vaccines, and other scientific medical countermeasures, it is disheartening to see that the Government of India's official press channel is promoting the use of homoeopathic and Unani medicines as prophylaxis and treatment for the new coronavirus. It is not only irresponsible, but it is also dangerous for the Indian population," says Prashant Yadav, Professor at INSEAD and Visiting Fellow at Center for Global Development.
Needs Participation of Private Sector
The mortality rate of Nipah Virus was between 40- 75 per cent. Compared to that Corona Virus has a mortality rate of 2-4 per cent. Kerala has already defeated diseases like Nipah twice and clearly has learned a few lessons from it. "It is important to ask questions about the preparedness of private healthcare providers because many patients visit private hospitals. There should be clear protocols for private hospitals, about what to do, until the test reports come from the National Institute of Virology," says Anant Bhan, a public health expert.
Pandemics seem like an inevitable outcome of a shrinking, connected world. Shouldn't we need to be better prepared? Yes. Bill Gates had suggested that "world leaders should invest in approaches such as antiviral drugs and antibody therapies that can be stockpiled or rapidly manufactured to the spread of these future diseases." But, it remains to be seen, whether India will invest in new technologies like AI or viral repositories, any time soon.