Friday, 31 January 2020

India's response to Wuhan Coronavirus lacking

In one word the Indian response so far to Wuhan Coronavirus seems 'casual'. There have been some news reports of a shortage of N95 respirators and surgical masks in India due to demand in China.  But the public concern as well as more importantly the response from GOI on a threat of nCoV epidemic has been lacking any real urgency. We have seen the action which has been taken in terms of body temperature screening of inbound passengers from China on airports and some reports of certain states monitoring the returnees. But the effectiveness of such a screening is suspect. Given the studies emerging that this virus is infectious even in asymptomatic patients. China's health minister has also said the same. A study in Germany has shown that the virus is infectious both before the onset of symptoms and after the symptoms have disappeared. This makes is very difficult to contain the spread of this virus in populations since there is no existing immunity to it yet in any population cluster.

There have been some people returning from Wuhan who have been found with flu likes symptoms and have been isolated in certain hospitals across India out of which one person has so far tested positive in Kerala. Other tests have either come negative or are still awaiting results. From the news reports about the diagnostics which have come out till now it appears that the turn around time of PCR testing result from National Institute of Virology, Pune is upwards of 2 days. NIV itself takes 3-6 hours to test and total of 12-18 hours to prepare and upload a report. So far it remains the only centre for testing this virus. A report suggested that NIV was awaiting fast diagnostic test kits from abroad. One report even suggested that for a certain patient in Kolkata NIV determined not to conduct an nCoV test based on description of symptoms and other report of the patient. All this points to the expected current scenario that testing infrastructure is not adequate yet. Also it is not clear if  proper contact tracing is being done to ensure that all potentially infected people are being tested. This is a clear case where media should be asking questions to GOI and union health ministry should be addressing this seriously.

There are a number of Indian medical students studying in China and the infected person is also one of them. Indian government is also airlifting some 600 odd students from Hubei province and plans to house them in a military establishment in Haryana for a duration of 14 days. Now that may be fine but here are some lax deficiencies which are visible already. The Wuhan returnees will be housed in dormitories. With such a large number of 600 people I suppose India lacks infrastructure to be able to provide them all with isolated accommodation. The is a huge risk factor and shows how this epidemic can cause devastation in India which lacks woefully in terms of infrastructure. China which has a much better infrastructure than India is struggling to control this epidemic, for India this will be 10 times tougher.

It appears that nCoV is much more contagious than a normal flu and the severity of infection in some patients and percentage of complications including death rate is much higher. Though the severity is lower than SARS or MERS but is much more contagious with exponential growth rate so far. Clearly given the risk of an epidemic in India a lot more needs to be done and to avoid any panic among the people a transparent communication is needed regularly from the health ministries in state and centre both. I find that the updates from government about what action they are taking are very low especially when compared to what is being done across the world. This needs to change fast. In a media briefing today the Ministry of External affairs has mentioned that while preparations are on way to get the stranded Indians from Wuhan back to India there have been no moves to restrict any travel to and from China. Only the ministry of health has issued an advisory to avoid travel to China but no VISA restrictions have been placed on Chinese nationals visiting India nor has there been any action by the civil aviation ministry to issue any instructions to airlines to stop flying to China/ Hong Kong.

Given the kind of disease we are dealing with and the severity of contagion in China, one would expect that GOI will do more than a mere airport screening, which they keep repeating as a reply to every question, as if its going to solve the issue. It is clearly not effective in preventing this disease from spreading in India. GOI ministers seems to be acting this was to avoid panic when in fact they should be erring in favour of caution here and take a leaf from what other countries are doing. Russia and Mongolia have stopped land border with China. US has issue strong warning to its citizens against travel to whole of China. Several foreign airlines have already stopped all to and fro flights to China or have curtailed the number of flights. So far Indian airliners like Air India and Indigo have curtailed the number of flights and destinations in China and Hong Kong but there is no blanket ban yet.

While World Health Organisation has declared this a world wide health emergency, but it has cautioned countries against taking any travel or trade restrictions on China. In its press conference on 30/Jan/2020 it even suggested that it would be questioning countries which declare a unilateral trade or travel restriction on China. This seems puzzling to say the least. On the one hand WHO commends China for its quarantine efforts, while the spread of the disease in China and around the world looks quite extensive including the disease spreading from person to person outside of China, including cases of asymptomatic spread and yet WHO is favouring economic reasons over health reasons in its advisory. So far it seems GOI is not going to do anything to restrict movement of people to and from China and other affected counties. One hopes the truth dawns on GOI soon and these travel and VISA restrictions are put in place. Israel has decided to suspend all flight to China and quarantine all travellers from China. Singapore has decided to not issue VISA to any Chinese passport holder nor to anyone who has been to China in last 14 days. I hope India too takes some drastic steps now when there may still be time.