The two new cases of coronavirus(Covid-19) disease in travellers who developed symptoms days after landing in Delhi and Hyderabad have increased the chances of community transmission of the virus (called Sars-Cov-2) in India.
One of the cases is that of a 45-year-old man who has been admitted to an isolation ward in Delhi’s Safdarjung hospital along with four other members of his family who are awaiting test results. With instances of infected people with no symptoms spreading the infection to others being reported, the health ministry’s surveillance team is now visiting and calling up everyone the man travelled with or came in contact with since his return on February 26.
In most people, the virus causes symptoms such as fever, fatigue, dry cough, muscle pain and difficulty breathing. A few get headaches, dizziness, nausea, diarrhoea, vomiting and abdominal pain. Those without symptoms will be quarantined at home and asked to call if they develop symptoms, while those with symptoms will be isolated and tested, according to the health ministry. But it is near impossible to track all the strangers the man may have come in contact with over the past week.
Till Monday night, 3,245 samples have been tested at Indian Council of Medical Research (ICMR) labs, of which five tested positive (including the three cases that did in Kerala). Another 23 samples where the disease is suspected are being tested, with 15 labs under ICMR equipped to test for Covid-19. India can make another 19 labs functional within 2-3 days, and even take the number to 50 labs, according to Union health Minister Harsh Vardhan.
With some infected people having no symptom, others developing symptoms several days after being infected, and some others using medicines to lower fever to avoid a 14-18 days quarantine, the World Health Organization’s updated travel advisory on Sunday said temperature screening alone at ports of exit or entry is not an effective way to stop the international spread of the virus.
“…It is more effective to give prevention tips to travellers and to collect health declarations at arrival, including the travellers’ contact details, for risk assessment and possible contact tracing if someone falls ill,” said Dr Dileep Mavalankar, director, Indian Institute of Public Health.
India must work in an emergency mode to stop infection by training hospital staff on quarantine protocols, ensuring adequate stock of protective gear and supporting drugs, scaling up testing, and be equipped to set up isolation wards, especially in underserved states, say experts.
“The virus spreading more easily than other coronaviruses… India must stay vigilant…,” said Professor G Arunkumar, director of the Manipal Institute of Virology, Manipal, Karnataka.
The international team of experts on the ground and a new paper from China with detailed data on more than 44,000 confirmed cases of Covid-19 indicates that 80% of patients have mild disease and recover. Around 14% people have severe disease. The virus has killed between 2-3% of reported cases, mostly older patients.
“None of the three patients from Kerala received antiretroviral drugs. They got better on their own,” said Preeti Sudan, Union health secretary. India’s regulator, Drug Controller General of India, has approved the use of antiviral drugs, lopinavir and ritonavir, to treat coronavirus. “Both drugs are in adequate stock,” said Sudan.
Apart from isolation wards for diagnosed and suspected cases set up in government hospitals in all major cities, the Army and Indo-Tibetan Border Police are equipped to create mass make-shift quarantine facilities in case of an outbreak.
The challenge will be treating those who need hospitalisation and ICU support, given the huge shortage of health workers. The average Government allopathic doctor to population ratio is 1: 10,926, according to the National Health Profile 2019, with there being just 20,48,979 Registered Nurses and Registered Midwives in 2017 to treat 1.35 billion people.
“There are not enough ICU beds in India, which is needed for about 5% of Covid-19 cases…,” said Dr Arunkumar.
The WHO recommends testing of all clusters of pneumonia cases in hospitals with unusual or unexpected clinical course. But this may not work in underserved states may not have the baseline data for pneumonia cases. “Once community transmission begins and people with no known contact to an infected person test positive, the case definition of a suspected case must be changed to test all pneumonia cases for Covid-19…,” said Dr Arunkumar.
A preventive vaccine is unlikely to be ready before 18 months. “Till then, old-fashioned containment measures …are the only shield against the infection,” said Dr Mavalankar.
