Declared by the World Health Organization as a Public Health Emergency of International Concern, the novel coronavirus (nCoV) has infected more than 37,000 people and killed more than 800. The Indian government and health authorities have responded in a robust manner to contain the epidemic in various ways on the basis of available knowledge, but there are no grounds for complacency. While logistical challenges have been overcome by the Ministries, States, the military and civilians together, Indian scientists have shown their eagerness to attain world-class skills by rapidly developing diagnostics and treatment protocols.
A swift response
Swift diplomacy was at work during the Wuhan airlift. The External Affairs Ministry obtained permission and ground support from its Chinese counterparts and coordinated with Air India through the Civil Aviation Ministry. The Health and Family Welfare Ministry provided the team of medical personnel to accompany the students home, and arranged for their health check-ups and quarantine at special camps organised by the Armed Forces Medical Services in Manesar and the Indo-Tibetan Border Police facility in Delhi. Temporary visa restrictions have been put in place. All the 645 evacuees have tested negative for nCoV. They are being monitored on a regular basis and will be tested again.
India issued its first advisory on January 17. The Emergency Medical Response Unit in the Health Ministry was activated, the National Centre for Disease Control opened a 24X7 helpline, and the Indian Council of Medical Research (ICMR) worked to quickly put in place a testing facility at the National Institute of Virology (NIV), Pune. The Joint Monitoring Group under the Chairmanship of the Directorate General of Health Services was activated to continuously assess the risk and review the preparedness to manage any case that might get imported to India.
Thermal entry screening of passengers from China is taking place in 21 airports. Universal screening at earmarked aerobridges for all flights from China, Hong Kong, Singapore and Thailand is carried out. There are inflight announcements and self-declaration forms in international flights, so that passengers with any symptoms can volunteer for screening. Screening at international seaports by the Shipping Ministry and border crossings by the Home Ministry is in place. Hospitals with isolation facilities near all international airports are prepared to meet any emergency requirements.
In Kerala, where the three people with nCoV are quarantined, the health authorities have responded in a stellar manner. Kerala has not only traced hundreds of contacts of the confirmed cases and notified them to the Integrated Disease Surveillance Programme for monitoring, but also used unique community-based isolation methods, innovated while dealing with the Nipah virus outbreaks. Its model of monitoring, with the District Collector as the administrative unit, has been shared as a best practice with all States. All the States have put together a robust system of contact tracing, community surveillance with community engagement, earmarking isolation facilities, sharing information, updating surveillance data, issuing daily health bulletins, skilling health workers with new guidelines, etc. The States bordering Nepal have even held special gram sabhas to empower people with information.
Till date no antiviral treatment for the coronavirus infection has been effective but studies among SARS-CoV patients show that the combination of lopinavir and ritonavir was associated with possible clinical benefit. Based on this research as well its own docking studies, ICMR has obtained approval to use this combination therapy as part of a public health emergency within a research framework and restricted use. On the diagnostics front, the NIV has leveraged its considerable expertise in real-time reverse-transcription polymerase chain reaction testing to develop assays for in-vitro qualitative detection of nCoV, using primer and probe sequences of the virus provided by the WHO. Scientists at NIV are also carrying out genomic sequencing of nCoV and attempting to isolate the virus in order to replicate it for further research. Fourteen Viral Research and Diagnostic Laboratories have been upgraded to carry out nCoV testing.
India has also offered help to other countries in the South Asia region as part of its Neighbourhood First policy. It evacuated seven Maldivian nationals from Wuhan. It has extended technical assistance to several countries to set up testing laboratories.
The public too has helped deal with the crisis, particularly by preventing the dissemination of wrong information. We should all observe good hygiene and sanitation practices to prevent infection, avoid crowding in public places and perhaps even replace the handshake with the traditional Namaste.
Preeti Sudan is Secretary, Health Ministry; Balram Bhargava is Secretary, Department of Health Research