From the point of its origin in Wuhan in December, coronavirus is rapidly spreading across the world, engulfing new areas. Extreme containment measures brought the number of patients down in China, but the spread of the virus has become a matter of concern for governments and health workers. India too has added several cases to the first three in Kerala. We expect to see a surge in COVID-19 cases in the coming days.
While India is still in the containment stage, it is time to revise the surveillance strategy to include sentinel tertiary care hospital-based testing for COVID-19 among pneumonia cases without a definitive diagnosis to check for possible community transmission. Further, the existing influenza virus surveillance system can also be used. Thereby, public health system will be able to identify the places where early community transmission is happening and subsequently contain it.
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There is no easy comparison between COVID-19 with the previous viral outbreaks we have seen. If you recall the H1N1 pandemic, we had a drug in hand at the time, so testing was limited to only the severe cases as the others could be treated. But in this case, at least in the initial 1-2 months, we need tests to identify cases because containment is important. There’s a chance that the virus could spread, and when it does, we just don’t want it to overwhelm the system. Hence, early identification of community transmission and effective containment is required to slow down the spread of the disease.
Nipah too was a very different virus—its human-to-human transmission was limited and non-sustainable, and that it occurred once the patient was at an advanced stage of the disease. Also, in Nipah or SARS or MERS, we know that there were super-spreaders—for example, in Kerala’s Nipah one person had transmitted to 19 people, but there were only three more cases.
Now, we may possibly be looking at a larger number at some point in time. Information coming from China is that around 20 per cent infected people require hospitalisation, which can vary from two to six weeks. So you need all facilities to be ready because beds will get occupied for longer periods of time. It is critical to have strategies to decide who really needs hospitalisation and who can be managed at home. If not, hospitals will be overwhelmed and it can lead to increased mortality. Nipah was a much focused outbreak; the major challenge with COVID-19 is doing the same sort of thing in multiple places, which is energy-exhaustive and people-exhaustive, besides the other aspects of logistics and supplies. Hence, it is critical to identify early community spread and implement containment measures to slow down the epidemic. This will allow confidence in public health response, and optimal use of manpower and resources.
The 2009 pandemic flu outbreak really gave a push to increase the virus diagnostic capacity in India. In the last decade, several laboratories have been equipped under the Indian Council of Medical Research and the National Centre for Disease Control to diagnose Influenza and other viral diseases using real-time polymerase chain reaction test. However, this is time-consuming and done in batches. So it is important to consider developing rapid point-of-care test to enable rapid diagnosis at the hospital level.
It is not only the responsibility of the government, but also of every member of the public to prepare to face this common enemy. Together we shall triumph.
Dr G. Arunkumar, Director, Manipal Institute of Virology