Coronavirus | Study warned of epidemic in February

Focus must have been on finding transmission in community.

March 23, 2020 10:49 pm | Updated March 25, 2020 12:16 pm IST - NEW DELHI

Shoppers queue outside a supermarket in Croydon, south London, due to the coronavirus outbreak.

Shoppers queue outside a supermarket in Croydon, south London, due to the coronavirus outbreak.

Scientists and mathematical modellers — including prominent scientists at the Indian Council for Medical Research (ICMR) — concluded in February that a coronavirus ( COVID-19 ) “epidemic” in India is inevitable and the most aggressive airport screening would have delayed India’s first 1,000 cases by at most 45 days. India’s health system should have focussed early on finding transmission in the community and quarantining , instead of border control, independent experts who have analysed the paper told The Hindu .

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There is no projection of the number of expected cases, or mortality from the epidemic, but the paper notes that five per cent of the infected patients will require intensive care and half of those admitted in the intensive care will require mechanical ventilation, says the research paper published online as part of a special issue on COVID-19 in the Indian Journal of Medical Research. The researchers include scientists from multiple ICMR institutes — many of whom are at the forefront of India’s defence against COVID-19 — as well as mathematical modelling experts from School of Public Health, Imperial College and St. Mary’s Hospital, London, U.K.

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“Our results suggest that in order to have an appreciable effect on delaying the establishment of transmission of COVID-19 in India, airport arrival screening will need to have near-complete capture of incoming COVID-19 cases, including asymptomatic cases. Our analysis shows that even if symptomatic cases are comprehensively identified and quarantined, the delay in epidemic timing within India would be in days, and not weeks,” the study notes.

Importantly, these projections only considered traffic from China and did not account for incoming infected Indians from Italy, the United States and Europe. While air traffic into India has entirely ceased from Monday night, there’s no evidence to conclusively tell how many Sars cov2 symptomatic passengers were apprehended early on. Yet a projection cited in the study suggest that this has been nowhere near ideal.

The modellers said that data shared by the Delhi Health Department, till February 13, 2020, found that 17 of 5700 passengers, or 0.3% of passengers who had arrived from China and other COVID-19-affected countries prior to the beginning of airport screening from January 15, 2020, were found to be symptomatic and hospitalised, while the rest were advised home isolation. “Our results suggest that it may be possible to interrupt the transmission of COVID-19 in India, but only in the most optimistic scenarios... symptomatic quarantine can still achieve meaningful reductions in peak prevalence... However, such measures would have very little effect on the overall epidemic size. The actual numerical impact will be highly sensitive to the natural history of COVID-19, the parameters for which are very uncertain at present,” the authors noted.

The study also did not say how many beds or ventilators were necessary for COVID-19 cases in February.

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Experts not connected to the study said that the modelling study ought to have made more detailed projections, such as whether there would have been gains from aggressively increasing testing to look at all suspected patients who showed symptoms of COVID-19 as opposed to the government’s focus on maintaining that there was no evidence of “community transmission” and focussing on imported infections. “Containment here refers to the strategy of screening incoming international passengers from COVID-affected countries at the port of entry and testing them and their contacts across the period of their quarantine. The basic message of the paper is that we should abandon containment and not spend resources on that and focus instead on mitigation,” said Gautam Menon, a mathematical modeller and professor at the Ashoka University, Sonepat. Containment refers to screening at airport and mitigation means focussing on symptomatic surveillance and quarantining those showing symptoms. The ICMR-recommended and government strategy has largely focussed on monitoring those coming from abroad and their contacts. Only last week, it expanded surveillance to health care workers treating COVID infected patients and patients with severe respiratory illnesses.

ICMR officials have maintained that there were no instances of community transmission, premised largely on randomly collected 1000-odd samples from 70 collection centres of instances of severe respiratory illnesses. “The paper also doesn’t account for the impact of social distancing, seasonal impact and the ongoing lockdown. I would have also expected an increased analysis of the impact on the healthcare system as a consequence of the epidemic,” Mr. Menon told The Hindu .

Another senior scientist familiar with infectious disease patterns but who didn’t want to be identified said the model did not really capture what was happening in India. It rather relied on the experience from elsewhere. “We did very limited actual testing. This paper is saying, “Our strategy is wrong because we are missing a lot. We accept that we have missed a lot, and there is no way we could have prevented it from it getting into the community.”

“It would be surprising if India didn't follow the trajectory as in the rest of the world,” said Mr. Menon.

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