A novel crisis

India did successfully manage to contain the spread of Ebola, which is rare and fatal than Novel Coronavirus or COVID-19 and is 'confident' of containing the disease that has been declared as a global emergency by the World Health Organisation (WHO). By now, India already has 34 confirmed cases of coronavirus of which three were discharged and are reported to be stable.

If the claims of the government, particularly Ministry of Health and Family Welfare (MoHFW), are to be believed there is no need to panic about the disease as the government is capable to manage the outbreak of the epidemic that has claimed the lives of over 3,526 people in world and 41,950 are still affected out of total 1,04,025 worldwide positive cases of coronavirus.

The moment Health Ministry gauged the possible damages that this virus can have on our "vulnerable" healthcare system, it swung into action and issued the first advisory on January 17 to restrict of the spread of the disease among masses. Surprisingly, after 13 days of the first advisory, COVID-19 reached India on January 30 when a student from Thrissur in Kerala was tested positive for coronavirus. The student, who had returned from Wuhan – the epicenter of COVID-19, had reportedly recovered on February 10 as the student's fresh samples had tested negative.

The Health Ministry in its first advisory had issued necessary directions to all concerned on laboratory diagnosis, surveillance, infection prevention and control (IPC) and risk communication. Integrated Disease Surveillance Program (IDSP) was geared up for community surveillance and contact tracing. The state governments were also advised on the necessary precaution to be taken up on the issue. Screening of passengers coming from China was also started at some airports.

As the positive cases and deaths figures started mounting in other countries, the Indian government started working on a war footing mode and frequency of official meetings increased.

Union Health Minister Harsh Vardhan is on his toes as COVID-19 positive cases started increasing in India. Besides him, Special Secretary Sanjeva Kumar and Health Ministry's chief publicity officer, Manisha Verma, are working laboriously to provide every single update on COVID-19.

Also, there are four from Delhi and NCR, (two with travel history from Italy, one with travel history of Iran and one of Thailand); six contacts of the first Delhi case with travel history of Italy; one from Telangana with history of Dubai travel and Singapore contact; 16 Italians and one driver (Indian) who was with the Italian tourist group.

Besides, the earlier two suspected cases of Telangana have tested negative at NIV, Pune. Also, the 14 Italian cases and all the Indian patients are stable and being monitored. Total of 6,49,452 passengers has been screened at the airports till date from 6,550 flights. Also, 29,607 persons are under the IDSP community surveillance and contact tracing.

Prime Minister Narendra Modi himself started taking the stock of the situation which resulted in 'active' participation of all the concerned ministries in managing the spread of the COVID-19. The ministries who have joined hands in monitoring and containing the spread of COVID-19 spread include Ministry of Home Affairs, Ministry of External Affairs, Ministry of Shipping, Ministry of Civil Aviation, Ministry of Defence, HRD Ministry, etc. Paramilitary forces such as Indian Indo-Tibetan Border Police (ITBP), Sashastra Seema Bal (SSB), CRPF, etc also worked in tandem with Health Ministry in restricting COVID-19 spread.

Furthermore, India has pre-emptively restricted export of 26 pharmaceutical ingredients and formulation alongside restricting the export of certain medical equipment. Naturally, the private sector has also been asked to pitch in by the Health Ministry with a vast scope of cooperation in this time of crisis. Addressing equipment shortages, establishing more testing sites, etc., are all urgent needs that can be met through such cooperation.

Explaining the role of ITBP in handling any emergency, ITBP Spokesperson Vivek Pandey said, "Right from the start till now it's a new experience for ITBP team. We prepared a team of our doctors and administrative staff and motivated them psychologically to face the challenge."

As the concerns over the COVID-19 rise, the Health Ministry has asked the state governments to ramp up the formation of rapid response teams which will be deployed at the village, district and block levels. The India-EU summit, which was slated to be held later this month, has now been rescheduled given the coronavirus outbreak. Also, India and EU decided to reschedule Prime Minister Narendra Modi's visit to Brussels.

Besides this, several steps have been taken by the Health Ministry to confine the viral disease. Many officials are asked to set-up detention centres at all entry-points in the country as well as railway stations and airports. Also, apart from creating isolation and quarantine facilities, the government has advised proper surveillance of those people who are under home quarantine.

Vardhan, in Parliament, had said, "We have taken various measures to deal with the deadly disease. Regular review meetings with various ministry officials and secretaries are taking place. Health Ministry and the Prime Minister's Office are directly monitoring the situation. India has initiated required preparedness and action since January 17, much before the advice of the World Health Organisation (WHO). Universal screening for all international passengers will now be conducted."

The Health Ministry has also imposed additional visa restrictions on people travelling from or having visited Italy and South Korea, making it mandatory for them to submit a certificate of having tested negative for COVID-19 from laboratories authorised by the health authorities of their countries.The government has announced the cancellation of several social gathering events as Holi Milan and closed down primary schools in Delhi till March 31 as a precautionary measure.

No doubt the government is working tirelessly to contain the spread of coronavirus, but some questions need to be answered to instil confidence among people of the country. The doubts still prevail over the role of ICMR in finding the behavioural pattern of the COVID-19 as the research wing of Health Ministry had started some study during the outbreak of Ebola and Nipah virus. Even after making several attempts to get the latest update in this regard, no response came either from ICMR or Health Ministry.

However, the ICMR has created COVID-19 testing facilities at over 30 labs across the country with NIV, Pune as its apex testing lab. (See box)

Reacting to the preparedness of India's public health system to tackle coronavirus, Congress leader and Lok Sabha member from Thiruvananthapuram (Kerala) Shashi Tharoor said, "There is no comprehensive nationwide surveillance system in place. Even though testing facilities were expanded following the swine flu threat arose a decade ago, lab testing facilities are a few and samples from different parts of the country are being sent to a virology lab in Pune for final confirmation."

On the COVID-19 outbreak, Chief Scientist at WHO, Soumya Swaminathan, said, "Given the risk associated with the disease, WHO has now raised the risk to the highest possible level of risk which means every country – whether they are affected or not – would now have to prepare themselves to contain the spread of the deadly virus. This is a new virus. Its existence was unknown until December 2019. There are other coronaviruses of the same family, but this particular variant is completely new for us as it's neither SARS (Severe Acute Respiratory Syndrome) nor MERS (Middle East Respiratory Syndrome)."

At a time, when WHO is yet to find a curative medicine to contain coronavirus, the opinion of experts saying that virus causing COVID-19 cannot survive beyond 27 degree Celsius is a much-awaited relief for the people residing in India. The experts believe that India is on a safer side as the climatic condition of the country wouldn't allow the coronavirus to stay here for a long. The moment temperatures would start increasing in March, viruses of the Coronaviridae family wouldn't survive.

According to experts, who have closely monitored the patterns of Swine influenza virus, the germination patterns of both the viruses are almost similar and after a certain temperature, both the viruses get vanished. We are on a safer side in comparison to other countries which are in the grip of coronavirus. The construct of our body system is different from the people living in colder countries as we sweat a lot during summers that compel us to keep ourselves clean by taking regular baths. If someone suspects that he/she may be a doubtful case of coronavirus, then they may go for Reverse Transcription Polymerase Chain Reaction (RT-PCR) test at any major laboratory to clear their doubts. In case of positive case, the patient would immediately be quarantined and treated with anti-virus medicines for the first two weeks and if the patient shows lesser improvement, the treatment would continue for another two weeks. The mortality rate of coronavirus is about 2 per cent – much lesser than that of swine flu.

Vulnerability

People who are older and those with weakened immune systems or other health conditions such as diabetes, heart and lung disease are more vulnerable to serious illness from COVID-19. Few children appear to develop serious illnesses when infected with COVID-19, although experts warn the disease is still ongoing and that could change. Many agencies across the world is encouraging older people and people with severe chronic medical conditions to "stay at home as much as possible."

FINANCIAL DENT

It's hard to be exact about the scale of effects and come up with universally acceptable numbers, particularly in the case of economic effects. Much of this is because the projected losses to the global economy are still a little ways off in being realised and hope is very much springing eternal in global economic circles. This crisis is uniquely slotted to hit at all the vulnerable points of our current interconnected global lifestyles. At the centre of this complex and fragile web is China, the second-largest economy and a key middleman and propelling force of global trade. China's share in world trade was estimated at 12.5 per cent in 2018. In the same period, China's share in global vehicle production reached 29 per cent, making it the largest car manufacturer on the planet. With all this said, it isn't hard to see how a crisis that clamps down on China's imports, exports and production will affect the global economy. Coming at the tail end of a year of trade wars and tension, this isn't an ideal scenario for nations like Japan and Germany which had just started recovering from these trade fiascos of 2019. The conservative estimate for the economy shrinkage of China sits at 0.5 per cent, a shortfall which many hope can be countered with the stimulus packages being introduced by the government. Many agencies like S&P Global have lowered China's forecast for GDP growth down to 5 per cent from the previous estimate of 5.6 per cent. At the same time, IMF slashed global GDP growth projections down to 3.3 per cent with certain worst-case scenarios being floated that put the total loss to production worldwide as high as $2.7 trillion. Everything from the global luxury market to mining, mobile phone chip industry, oil and gas, etc., have been severely impacted. And this does not even take into consideration the lull in business for the transport industry, particularly aviation which may see almost $113 billion worth of global revenue go up in smoke just this year. In the middle of all this doom and gloom, what about India? The scenario isn't a whole lot better. Many observers put the economic damage to India at an even greater scale than China and this very much has to do with India's trade dependence on China. China is India's largest trade partner and most importantly, a source for 70 per cent of the pharmaceutical ingredients and reagents used in India's $55 billion pharma-industry. Roughly a quarter of the car parts used in the Indian automobile industry are also sourced from China leading to already wavering supplies. Many industry leaders have seen this as both a warning and an opportunity. While still less reliant on China than its other neighbours, India's economic reliance on China is, all the same, quite significant. India must develop its manufacturing capabilities and perhaps capitalise by filling in the regional manufacturing provider void left by China during this crisis. The Indian film industry is also slated to take a beating with pushed back production schedules and the shuttering of 70,000 theatres across China which is the largest international market for the Indian film industry. With delayed releases, the global film industry has seen losses of $2 billion which are expected to continue magnifying.

Terminological Inexactitude

The COVID-19 crisis is interchangeably referred to as an outbreak, an epidemic and a pandemic across newspaper articles and day to day conversation. While there may be little difference for the terms in the case of a layman, for a medical professional proper terminology means everything. This is a tiny guide to getting the basics straight. First, there are endemic infections which fall within the expected level of an infection within a geographic area that takes place indefinitely. So something like dengue is endemic to many parts of the world. Then there is an outbreak, which is an unexpected increase in infection levels limited to a certain geographical area. Then comes an epidemic which is similar to an outbreak but spread over a wider geographical area like a country. Finally, there is the dreaded pandemic. An epidemic on a global scale. While certain other technical factors must be considered while assigning such terms, this is a basic guide. The COVID-19 is in between an epidemic and pandemic for the moment due to these additional factors. The WHO, which is typically responsible for such labels has as yet refused to put a pandemic tag on this crisis.

AFFECTED COUNTRIES

China, South Korea, Italy, Iran, Germany, France, Japan, Spain, USA, Switzerland, Singapore, UK, Hong Kong, Sweden, Norway, Netherlands, Australia, Kuwait, Bahrain, Malaysia, Belgium, Canada, Thailand, Taiwan, Austria, Iraq, Iceland, Greece, India, UAE, San Marino, Denmark, Algeria, Israel, Lebanon, Oman, Vietnam, Ecuador, Ireland, Czechia, Finland, Macao, Croatia, Georgia, Portugal, Brazil, Qatar, Palestine, Azerbaijan, Belarus, Mexico, Romania, Slovenia, Philippines, Estonia, Pakistan, Saudi Arabia, New Zealand, Russia, Senegal, Chile, Hungary, Egypt, Indonesia, Luxembourg, Morocco, Argentina, Bosnia and Herzegovina, Afghanistan, Andorra, Armenia, Cambodia, Dominican Republic, Jordan, Latvia, Lithuania, North Macedonia, Monaco, Nepal, Nigeria, Sri Lanka, Tunisia, Ukraine, Bhutan, Costa Rica, Gibraltar, Liechtenstein, Poland and South Africa

Rumours, conspiracies and racism

As can be expected in the interconnected modern age, the spread of rumours and conspiracies regarding COVID-19 has far outstripped the pace of the contagion spread itself. Some of these rumours are born of fear, others of incorrect or half-understood and imbibed bits of information, while still others come from darker places still, born of racism and a knee jerk tendency to lean towards segregation at the first sign of trouble. It does not exactly help that 3 of the 4 major global outbreaks in the recent past have been linked to wildlife trade in China.

The conspiracies, predictably begin by discussing the source of the outbreak. A common internet-based theory is that the COVID-19 was engineered for study or weaponisation by Chinese scientists working at the Wuhan Institute of Virology, which as it were, is China's only level 4 biosafety lab and is the only one with adequate enough facilities to study the virus. Depending on what version you read, the virus was then leaked due to poor safety protocol or intentional malevolence. Another popular theory on Chinese social media is that the Ameican government engineered the COVID-19 outbreak to arrest China's rapid growth which threatens American hegemony. The theory goes on to creatively state that US soldiers, visiting Wuhan for the 2019 Military World Games planted the virus at Hunan Seafood Market. This view has been seemingly consolidated by the fact that certain retired and active elements in the People's Liberation Army have used this timing to assert that China needs a biodefence force to guard against a new generation of biowarfare. All this back and forth conspiracy jabs by the US and China stem from a lack of trust and cooperation between the two governments. China repeatedly prohibited international health officials, from the US in particular, from visiting Wuhan. This ban was only recently lifted through the mediation of WHO. All the same, this isn't the first time and will likely not be the last time this blame game is played out.

The genetically engineered theory has, unfortunately gained much traction. On 31st January for instance, a paper was published on the bioscience preprint server bioRxiv which made dubious claims about the COVID-19 sequence having short insertions that bear an uncanny resemblance to HIV. The paper, which was authored by a group of Indian scientists from the school of biological sciences at IIT Delhi and Acharya Narendra Dev College of the University of Delhi made the assertion that these insertions were unique to COVID-19 and suggested that it could be a product of bio-engineering. The paper was subsequently withdrawn with apologies but not before the damage was done. Everyone from Alex Jones of Infowars fame to health conspiracy websites like Health Impact News touted this discovery as proof of their theories. Certain public figures waded in too, like US Arkansas State Senator, Tom Cotton who repeatedly pushed the genetic engineering angle in US Senate and on Fox News. Many others in the media similarly politicised this rumour, using it to air out grievances against the Chinese government at its most basic and the Chinese people themselves at worst. Worryingly, such behaviour is slowly moving out of backroom conspiracy channels to more established news and discussion forums.

Most studies have concluded that the unique nature of the COVID-19 sequence is proof in itself that the virus has its origin in nature and not some lab. Simply put, it's too unique for the current level of bioscience to be created. Others have debunked the bioweapon theory by simply noting that COVID-19 would be a very poor bioweapon for use. Compared to other options, the virus quite simply has very limited spread and even more limited rate of fatality.

But, as we move past conspiracies, racism lurks around the corner. A video of a Chinese woman consuming bat soup is among the many hundreds that have been bouncing around the internet. Bats, as has been widely discussed, have been debated as the source of COVID-19 as they have been known to carry many other related viruses. It must be stated however that current scientific consensus is leaning more towards the endangered Pangolin as being a more likely source of COVID-19. All the same, trafficking and consumption of wildlife are fairly well-established practices in China, this is also a fact. And so, as one might imagine, these videos have become ample fuel for people to heap blame and disdain on Chinese people and culture. The absence of clear information has clearly led to an unfortunate blending of biases into this hodge-podge of information, resulting in oft-stated stereotypes of Chinese people being "dirty" and their culture being "strange". This has led to innumerable incidents that have clear racial undertones. These range from simple things like Chinese restaurants in Italy and the US seeing fewer customers every day to outright attacks and evictions targeted at Chinese nationals in Ukraine. A sweet shop in Kanagawa Prefecture in Japan was also recently condemned on social media for a sign the management put up outside the shop that bans Chinese customers from entering the store. The backlash did result in the sign being taken down but there is full expectation for such incidents to not only become more common but also much worse unless competent authorities step in and start clamping down.

52 testing labs Apex Lab: niv, Pune

1. Sri Venkateswara Institute of Medical

Sciences, Tirupati

2. Andhra Medical College, Visakhapatnam, Andhra Pradesh

3. GMC, Anantapur, AP

4. Regional Medical Research Centre, Port Blair, Andaman and Nicobar

5. Gauhati Medical College, Guwahati

6. Regional Medical Research Center, Dibrugarh

7. Rajendra Memorial Research Institute of Medical Sciences, Patna

8. Post Graduate Institute of Medical Education & Research, Chandigarh

9. All India Institute Medical Sciences, Raipur

10. All India Institute Medical Sciences, Delhi

11. National Centre for Disease Control, Delhi

12. BJ Medical College, Ahmedabad

13. M.P. Shah Government Medical College, Jamnagar

14. Pt. B.D. Sharma Post Graduate Institute of Medical Sciences, Rohtak, Haryana

15. BPS Govt Medical College, Sonipat

16. Indira Gandhi Medical College, Shimla, Himachal Pradesh

17. Dr. Rajendra Prasad Govt. Med. College, Kangra, Tanda, HP

18. Sher-e-Kashmir Institute of Medical

Sciences, Srinagar

19. Government Medical College, Jammu

20. MGM Medical College, Jamshedpur

21. Bangalore Medical College & Research Institute, Bangalore

22. National Institute of Virology Field Unit Bangalore

23. Mysore Medical College & Research

Institute, Mysore

24. Hassan Institute of Medical Sciences,

Hassan, Karnataka

25. Shimoga Institute of Medical Sciences, Shivamogga, Karnataka

26. National Institute of Virology Field Unit, Kerala

27. Govt. Medical College, Thriuvananthapuram, Kerala

28. Govt. Medical College, Kozhikhode, Kerala

29. All India Institute Medical Sciences, Bhopal

30. National Institute of Research in Tribal Health (NIRTH), Jabalpur

31. NEIGRI of Health and Medical Sciences, Shillong, Meghalaya

32. Indira Gandhi Government Medical College, Nagpur

33. Kasturba Hospital for Infectious Diseases, Mumbai

34. J N Institute of Medical Sciences Hospital, Imphal-East, Manipur

35. Regional Medical Research Center,

Bhubaneswar

36. Jawaharlal Institute of Postgraduate Medical Education & Research, Puducherry

37. Government Medical College, Patiala, Punjab

38. Government Medical College, Amritsar

39. Sawai Man Singh, Jaipur

40. Dr. S.N Medical College, Jodhpur

41. Jhalawar Medical College, Jhalawar, Rajasthan

42. SP Med. College, Bikaner, Rajasthan

43. King's Institute of Preventive Medicine & Research, Chennai

44. Government Medical College, Theni

45. Government Medical College, Agartala

46. Gandhi Medical College, Secunderabad

47. King's George Medical University, Lucknow

48. Institute of Medical Sciences, Banaras Hindu University, Varanasi

49. Jawaharlal Nehru Medical College, Aligarh

50. Government Medical College, Haldwani

51. National Institute of Cholera and Enteric Diseases, Kolkata

52. IPGMER, Kolkata

MEDICAL ADVANCEMENTS

T houghit is difficult to get a global consensus on when a cure might be available, most competent health authorities have conceded that any such cure is unlikely to be developed within this year and even if it was, mass producing it would take more time still. China is predictably leading the race in the number of clinical trials undertaken for finding a cure with close to 300 trials on record. These trials have been wide-ranging in their efforts, testing everything from HIV drugs to anti-malarial drugs. Anti-viral drugs have been seen as more favourable possible cures for the outbreak with Gilead developed remdesivir leading this race. As it were, remdesivir was initially developed as an experimental drug to use as a cure for Ebola but it failed its trials in achieving its intended purposes. Now it has been repurposed for use for COVID-19.

While the drug has shown limited success in arresting the onset of COVID-19 and related MERS and SARS Coronavirus, its use as a cure is still under trial. Gilead has started investing in increased production capacity for when and if the drug passes the trials. There are many others like Inovio Pharmaceuticals' INO-4800 which will also be given in for human trials later this year. All the same, the real barrier to a cure may well be a lacking financial incentive for real progress on a cure for pharmaceuticals worldwide. Such has been the case for all the recent global outbreaks where initial enthusiasm for a cure dries up fast in the face of financial considerations of providing an affordable, globally available cure.

REACTIONS

China: Many have deemed China's quarantine and shutdown of a city of millions to be unprecedented in human history. Though Wuhan's authorities claimed the establishment of a purpose-built hospital for quarantine and treatment in 6 days, it took them 10 days – an impressive achivement! The rapid completion of the 366,000 square-feet Huoshenshan Hospital was caught on a live stream and even with pre-fabricated portions, comes replete with double-sided cabinets, infrared sensors and robust ventilation systems that all help facilitate effective quarantine and treatment. For all its awe-inspiring theatrics, the hospital is but a drop in the bucket of the requirements for more hospital beds. Similar facilities are now being built across China. The situation in Wuhan, however, is anything but encouraging. Journalists have been arrested and a theatrical portrayal of normalcy more suited to North Korea prevails. On a recent PR visit to the quarantine zone, Chinese Vice Premier Sun Chunlan was heckled on video by angry residents decrying the theatrics arranged for her visit by Wuhan city authorities. Floors were scrubbed and grocery deliveries made to portray a false sense of normality.

SOUTH KOREA: Ever the innovator, South Korea recently came up with a drive-thru Coronavirus testing facilities. Two of the stations have been set up at Yeungnam University Medical Centre and Kyungpook National University Hospital in Daegu. These stations allow potential patients to get a test done in about ten minutes and all without exiting their vehicle which leaves less room for contagion spreads. The results for the tests are delivered within three days via text messages. With over 6,500 active cases, South Korea is constantly trying to invent faster and safer ways.

IRAN: COVID-19's rampage in Iran is well publicised. 23 MPs including the Deputy Minister for Health have been infected. Ongoing US sanctions and accusations of mass coverups have made it hard to be certain about the scale of the outbreak in Iran. Whatever little is known, points to Iran being the third worst hit nation in the world aside from China and South Korea with 3,710 active cases and 4,747 confirmed cases. Iran's response has been slow and fraught with misinformation as the nation's intimacy with China, combined with sanctions threatens to blow apart the like an overfilled pressure cooker. Iran has 'temporarily' freed 54,000 prisoners to alleviate the virus spreading in crowded settings.