OUR FIGHT AGAINST THE PANDEMIC
The world is grappling with an invisible, deadly enemy, trying to understand how to live with the threat posed by a virus. At the New York Review of Books, Ali Bhutto writes that in Karachi, Pakistan, the government-imposed curfew due to the virus is “eerily reminiscent of past military clampdowns”:Beneath the quiet calm lies a sense that society has been unhinged and that the usual rules no longer apply. Small groups of pedestrians look on from the shadows, like an audience watching a spectacle slowly unfolding. People pause on street corners and in the shade of trees, under the watchful gaze of the paramilitary forces and the police.
His essay concludes with the sobering note that “in the minds of many, Covid-19 is just another life-threatening hazard in a city that stumbles from one crisis to another.” The astonishing consequence of this pandemic is that times seem to be returning that in many places had long ago become museum-like. The world in which we are living is shuffling along again, in crab-like fashion.
On December 31, 2019, the first cases of a novel coronavirus were identified in Wuhan City, Hubei Province, China. Since then, the disease, now officially known as COVID-19, has spread to several countries and claimed the lives of over 453,000 . Following a number of discussions, the outbreak was declared a PHEIC (Public Health Emergency of International Concern) by the WHO on January 30, 2020, signifying the global public health risk of the disease and the need for a coordinated international response. By this time, preventative measures such as travel restrictions had already begun to be put in place. Many people are using face masks in a bid to protect themselves, however the effectiveness of this is questionable. The outbreak was declared a pandemic on March 11, 2020, in response to the number of cases outside China increasing 13-fold, and the number of affected countries tripling over two weeks.
Novel coronavirus is the seventh member of its family to attack humans. Except the two SARS and one MERS coronaviruses, none have caused an outbreak. Both Severe Acute Respiratory Syndrome (SARS) and Middle-East Respiratory Syndrome (MERS), had rapidly spread across the world from countries of their origin (i.e. China and Middle East respectively) but largely remained out of India.
Severe acute respiratory syndrome (SARS) reached Hong Kong in March 2003. From 11 March up to 6 June, a total of 1750 cases had been identified , and during the same period 286 people died of the disease. Before the advent of SARS in Hong Kong, the nearby Guangdong Province in Mainland China had experienced an intense outbreak of the atypical pneumonia later termed SARS. This outbreak started in November 2002 and reached its peak in February 2003; up to 5 June 2003, Guangdong had recorded 1511 cases and 57 deaths.
India responded by ensuring that the virus did not enter the country. It was easier back in 2002 to have surveillance over international passengers coming into India. The number of international passengers arriving in India in early 2003 was 1.20 lakh a week. This was the time of SARS outbreak, which for some reason did not spread as fast as its newer cousin.
Another step that was undertaken was to expand a five-year-old pilot project by the National Surveillance Programme for Communicable Diseases (NSPCD) from five districts in 1997 to over 100 districts. This is how India found all its probable and suspect cases of SARS. All the three probable and nine of the 10 suspect cases of SARS were people who had to India from other countries. The other suspect case had never gone out of India. The authorities traced and quarantined 60 of her contacts. No further cases were reported.
Like COVID-19, the Middle East Respiratory Syndrome (MERS) is also a viral respiratory disease caused by a novel coronavirus also known as MERS-CoV that was first identified in Saudi Arabia in 2012. The MERS spread to nearly 27 countries across the world and infected close to 2,500 persons in its wake and claimed 858 lives. Like COVID-19 and SARS, the MERS coronavirus is also zoonotic in nature, which means the virus was transmitted from animals to humans. As a response to prevent the potential spread of MERS,Ministry of Health and Family Welfare, Govt. of India had issued guidance for the Hajj and Umrah pilgrims (returning from Saudi Arabia) and travellers (returning from Saudi Arabia, Republic of Korea and/or any of the other MERS-CoV affected countries) to report immediately at the immigration desk if they suspected of being infected with MERS-CoV . Although there were no confirmed reports of MERS in India, but the risk of transmission to the general public couldnot be ruled out and nationwide surveillance was carried out at airports as a precautionary measure. Flight crews and Emergency Medical Service (EMS) units at airports were instructed to report MERS suspected cases. MERS suspected patients were kept in isolation and tested to prevent/restrict the spread of the disease to the general public.
However, SARS-COV2 has come down heavily on us this time. Infections are rising sharply, up from 536 cases on 25 March when the first phase of the world’s harshest lockdown was imposed. The growth of infections is outpacing growth in testing – tests have doubled since April but cases have leapt fourfold. EpidemiologistsEpidemiologists say the increase in reported infections is possibly because of increased testing. India has been testing up to 100,000 samples a day in the past week. Testing criteria has been expanded to include asymptomatic contacts of positive patients.
Most experts say a one-size-fits-all strategy to contain the pandemic and impose and lift lockdowns will not work in India where different states will see infection peaks at different times. The reported infection rate – the number of infections for every 100 tests – in Maharashtra state, for example, is three times the national average. India is facing its most daunting challenge of preventing a cataclysmic wave of contagion. The lack of data being made available to the medical and scientific fraternity is becoming a huge limiting factor in our fight against Covid-19. It has forced us to rely on Chinese or Western data, on anecdotal reports (often forwarded by doctors as Whatsapp messages) or simply on conjecture and hope. None of these are great strategies to tackle the pandemic. India needs to drastically improve the quantity and quality of data it produces, analyses, and shares to give us and our patients a level-playing field.