Tale of two cities

Anish Shyadligeri, Goa Medical College

Misba Sayed, Grant Medical College Mumbai

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With Masks and Sanitizers flying off the pharmacy shelves, the second most populous country in the world finally woke up to the corona scare.
The havoc wrought by coronavirus is now there for all to see. India, after staying relatively unscathed for a while, is finally witnessing the dread setting in. As of 9th March 2020 there have been 109 577 confirmed cases and 3809 deaths globally with 43 confirmed cases of COVID19 in the country India’s worst coronavirus fears are seemingly coming true. Having first originated as a outbreak of pneumonia of unknown cause in Wuhan City China in December 2019 to having spread world over, the outbreak has escalated rapidly with the WHO declaring a public health emergency of international concern on 30th January 2020.

The CoronaVirus Disease is a reminiscent of epidemics that have caused panic in recent memory including the SARS,MERS,Zika Virus and the Swine Flu. As per Statistics the coronavirus epidemic is not as deadly as the 2003 SARS with killed around 10% of the 8098 confirmed cases and its far less deadly as the MERS which killed around 34% of the roughly 2500 reported cases since its first outbreak in 2012. But what’s makes COVID19 scary is the rate at which it spreads, it’s far more contagious than the SARS and MERS. having spread to 115 countries already.

If you observe closely there is a clear pattern in the origin and spread of these diseases, SARS (Severe Acute Respiratory Syndrome) like COVID19 has originated from China and first infected humans in the Guangdong province of southern China in 2002. MERS as its name suggests was rampant in the Middle East having originated in 2012 from Saudi Arabia. Nipah virus outbreaks have been reported in MalaysiaSingaporeBangladesh and India. The highest mortality due to Nipah virus infection has occurred in Bangladesh. Nipah virus first appeared in Malaysia in 1998. What’s even more evident is that all of them are zoonotic virus’ (first transmitted from animals to humans) and SARS,MERS,COVID19 all belong to the same family of Coronaviruses. Additionally the avian influenza, SARS and covid19 have all originated in China. So why is China the centre of these outbreaks?

It has been speculated that the meat markets of china are to be blamed. Here’s what a Chinese meat market looks like: numerous shops selling every kind of animal-dogs, chickens , snakes, pigs, civets, sea food and more, all squeezed together in small, narrow lanes. Many animals are hoarded together into small cages with unhygienic conditions. This predisposes the animal itself to get sick. The vendors butcher these animals on live counters. This brings people, live and dead animals all close together combined with the unhygienic surroundings making it very easy for the virus to spread.

Origin and Transmission

1.MERS : Studies have shown that humans are infected through direct or indirect contact with infected dromedary camels. The origins of the virus are not fully understood but, according to the analysis of different virus genomes, it is believed that it may have originated in bats and was transmitted to camels sometime in the distant past. Approximately 80% of human cases have been reported by Saudi Arabia.Cases identified outside the Middle East are usually traveling people who were infected in the Middle East and then travelled to areas outside the Middle East.

2.SARS: SARS-CoV is thought to be an animal virus from an as-yet-uncertain animal reservoir, perhaps bats, that spread to other animals (civet cats) . Transmission of SARS-CoV is primarily from person to person. It appears to have occurred mainly during the second week of illness, which corresponds to the peak of virus excretion in respiratory secretions and stool, and when cases with severe disease start to deteriorate clinically. Most cases of human-to-human transmission occurred in the health care setting, in the absence of adequate infection control precautions.

3.NIPAH: During the first recognized outbreak in Malaysia, which also affected Singapore, most human infections resulted from direct contact with sick pigs or their contaminated tissues. In subsequent outbreaks in Bangladesh and India, consumption of fruits or fruit products (such as raw date palm juice) contaminated with urine or saliva from infected fruit bats was the most likely source of infection. Human-to-human transmission of Nipah virus has also been reported among family and care givers of infected patients.

4.COVID19: Most of the patients In the outbreak reported a link to a large seafood and live animal market in Wuhan. People can catch COVID-19 from others who have the virus. The disease can spread from person to person through small droplets from the nose or mouth which are spread when a person with COVID-19 coughs or exhales.

Let’s come closer to home. India seems to be a sitting duck for these outbreaks to spread in the country.

The first reason is population density: each square kilometre in India accounts for as many as 420 people, way higher than in most countries of the world. The second factor is the exceptionally high rate of internal migration: as per the last census, 45 crore people migrated inside India in search of jobs and other opportunities. This could turn out to be a nightmare in case an outbreak occurs, particularly because Hubei-like lockdowns in India are next to unthinkable.
If an outbreak occurs, India’s public health system — in all likelihood — will be overwhelmed in no time. Add to this India’s generally pathetic hygiene habits, and you have a perfect recipe for nightmare.

But there are experts who see it differently. Veterans in the Medical field have considered India to be largely safe, and this relative safety lies in its weather which acts as a defence against the virus.
That could be exactly the reason why Ebola, yellow fever, SARS and MERS — which took a high global toll over the past one decade — had negligible impact on India
After ravaging the countries that have more agreeable climatic conditions, viruses — no matter however deadly — lose their killer edge once they encounter India’s relatively high temperature and humidity that make life difficult for them.

SARS largely remained off India’s shores with Goa having to deal with a single case of a SARS positive patient having picked up the virus in HONG KONG. Kerala did suffer from a Nipah outbreak in 2018 and reported the first positive COVID19 case in India however .The state government’s initiatives and swift action successfully contained the Nipah outbreak in 2018 limiting it to 17 deaths and effectively contained the COVID19 virus so far and nursed back the first three patients reported in the country, all medical students who returned from Wuhan in China.
Kerala stands out as a prime example of an efficient healthcare system. Round the clock monitoring, effective use of protective measures, fool proof screening and successfully managed quarantine procedures have helped the state tackle with 2 deadly outbreaks in the recent past.


What Next?…. There’s enough evidence to call for an urgent review of food habits in countries consuming possibly infectious animal meat on a daily basis. Successfully containing a virus outbreak on a global scale is a tremendous task in todays’ age with millions of possible carriers flying across oceans on a daily basis. But all of us on a personal level can definitely consider washing our hands even when there isn’t a global virus panic.

 

References:

1.WHO World Health OrganizatioN

2.CDC

3.Economic Times

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