Novel coronavirus 2019 and India – a perspective

The world today is staring at an unprecedented crisis. The SARS-COV-2, more popularly known as Novel Coronavirus 2019, that originated from city of Wuhan in China’s Hubei province in December 2019 was recognized as a global pandemic by the World Health Organization (WHO) on March 11th, 2020. Till date, the virus has spread to more than 180 countries across the world with no. of affected at more than 245, 000 globally with death count at over 10, 000 on date. The novel coronavirus spreads primarily between people via respiratory droplets from coughing and sneezing. It is considered most contagious when people are symptomatic although spread is also possible from asymptomatic host bodies. As on date, there is no known definite cure or vaccine for this virus. The spread of the covid19 is broadly classified into 4 distinct stages:

Stage I | Imported cases: these are the origin cases – people who were infected while being abroad mostly in severely affected countries and came back to India

Stage 2 | Local transmissions: spread of the virus from the imported cases to those who came in contact with them

Stage 3 | community transmissions: this is the most critical stage. This happens when the disease spreads to those who have neither travelled abroad nor came into direct contact with any such person. When the disease reaches stage 3, it is very difficult to stop it’s progress to stage 4

Stage 4 | the disease at it’s worst stage. It is an epidemic with no clear end point in sight

According to the Ministry of Health & Family Welfare, Government of India, the total number of covid19 affected cases in India as of writing of this article stands at 223 with 4 confirmed deaths. The number has seen a rapid increase in the last 2-3 days with several new cases coming to light. The Indian Council of Medical Research (ICMR) carried out random testing of 826 samples across India and all returned negative, suggesting the disease has not reached stage 3 yet. Although, ICMR has not conclusively ruled out stage 3 due to the huge population of the country and the limited number of samples tested.

The spread of an infectious disease can be controlled through two strategic approaches:

  1. Containment: this is done in the early stages of an outbreak. It aims to trace and isolate those infected in order to stop the spread of the disease to the rest of the population
  2. Mitigation: this comes into play when containment was not done or has not been successful. Here measures are taken to slow down the rate of spread and mitigate its effect on the society

India, at this point of time, is somewhere between containment and mitigation. While containment efforts are on, in some states like Maharashtra, Kerala, NCT Delhi, the disease is probably past the containment stage and needs immediate mitigative approach. Many state governments have already put in place containment strategies like:

  • Closure of academic institutions
  • Closure of public gathering places like malls, theatres, gyms, community swimming clubs etc.
  • Several major religious institutions and tourist attractions have also closed down
  • Major sporting events like the ongoing Indian Football League and the upcoming Indian Premier League cricket have been cancelled

Now let us examine the spread of the SARS-COV-2 in Italy, right now the most severely affected country in the world 3405 deaths till date and compare the same with India

  • The first cases in Italy were identified on 31st Jan in form of two Chinese tourists in Rome
  • One week later, an Italian man repatriated from China tested positive
  • There were 16 cases tested positive on 21st Feb and 60 on 22nd Feb
  • By the beginning of March, the disease had spread to entire Italy
  • On 9th March, the entire country was placed in forced lockdown but by then it was probably too late as current affairs in the country show

Looking at India:

  • First case in India was also identified around 31st Jan in Kerala
  • By 3rd Feb, this number stood at 3 – all in Kerala
  • On 21st Feb, all 3 were considered cured and discharged from hospital. There were no new cases
  • Between 27th Feb and 9th March, the number of cases in India jumped to 44 across 10 states/UTs
  • By 14th March, the number of affected went up to 84 with 2 deaths. No. of states/UTs affected stood at 13
  • In the last 1 week, it has close to trebled. between yesterday and today, around 50 new cases have come to light

The above statistics make the need of effective social distancing extremely critical. Yesterday, the Government of India has announced a number of emergency measures to inhibit the spread of covid19 in India. These include:

  • Complete suspension of international flight arrivals from 22nd & 29th March
  • All citizens above 65 years and children below 10 years asked to remain at home (except for medical emergencies)
  • Railways and airlines asked to stop concessional travel with immediate effect except for students, patients and divyangs
  • States requested to enforce work from home for private sector except those working in emergency/essential services
  • All group B & C central government employees asked to attend office on alternate weeks and staggered timings
  • A 14-hour voluntary curfew to be observed on Sunday 22nd March from 7 am in the morning to 9 pm in the evening. All citizens except those engaged in essential/emergency services requested to remain at home during this time period

A research conducted by the New England Journal of Medicine looked at the survivability of the SARS-COV-2 outside a host (human) body i.e. on non-living surfaces. The study produced varied results:

  • On copper surfaces, no trace of the virus was found after 4 hours from the commence period
  • On cardboard surfaces, the virus was found living at the 24-hour mark
  • On steel and plastic surfaces, traces of the virus were observed even after 72 hours

However, while the virus presence was longer on cardboard, steel and plastic, the threat factor was highly diminished. For e.g. on plastic surfaces, the no. of micro-organisms at 6.8 hours from commencement was exactly halved vis-Ã-vis what it was at the beginning. This implies that with passage of time, count and hence threat from the virus decreases substantially. In the light of the above, social distancing and quarantine becomes of criticality.

To illustrate, if all Indians confine themselves largely to home for 14 hours on Sunday, the presence of the virus on infected surfaces in public space will likely to be reduced in that time. In absence of access to a live host, the virus will fail to multiply and die down. This should have a reasonably positive effect. Moreover, assuming there are people out there either with symptoms or asymptomatic, isolation from the rest of the society would mean a significant reduction in community transmission from such infected hosts. It makes adherence to the government’s request very critical at this juncture of time.

However, in places like large towns of Maharashtra, Delhi, Bangalore, Kerala, the spread of the virus is already at an advanced stage and progress to stage 3 already happening cannot be ruled out. These places need to go on full lockdown for the next 7-14 days at the minimum to curb the spread of the disease. As a matter of fact, the government of Maharashtra has earlier today announced shutdown of all offices and commercial establishments (except essential/emergency) in Mumbai, Pune, Pimpri Chinchwad and Nagpur till 31st March. The Delhi government has also announced closure of non-essential services in the city. These drastic measures need to be expanded in all the major urban locations of affected territories.

In other places where the disease has not yet progressed to severe proportions, containment efforts should continue. Moreover, intermittent closure/lockdown of public life should be seriously considered in these places to ensure that the disease spread is contained and it does not proceed to advanced stages.There is no doubt that covid19 crisis is the biggest global crisis since probably the world war II. To come out of with minimal damage has to be the only objective of every nation in the world. This cannot be the responsibility of the state/government only. Each and every citizen must share in this fight to ensure that we come out on the winning side. IPD sincerely hopes that our great nation and it’s wonderful citizens would come out on the right side of history at this critical juncture of human civilization.

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