The media is flooded with reports of an increasing number of coronavirus cases and deaths from various parts of the world. While China was the epicentre of the epidemic, it has now spread to Europe, the United States (US), West Asia, and India. In February, several Indian students from Wuhan (China) were evacuated and quarantined. This was the first political response by the Government of India on the growing epidemic. Subsequently, a few cases have been detected and confirmed in several states, but they are mostly from urban areas. So far, there have been no deaths in India, but the fear is palpable among the middle and upper-middle classes, thanks to the media coverage of the coronavirus.
All epidemics evoke fear and panic since they result in fatalities. However, in its management, three elements need to be addressed: Science, common sense of the public health system, and political support from the government. There is a better understanding today about the virus, and the nature of the disease it produces. The current evidence suggests that around 80% of the infected cases are mild, 18% are severe, and only 2% require intensive intervention. Since there is no medication available, the cases need close monitoring, and treatment of secondary complications if the need arises. Special attention is needed for the elderly and other vulnerable sections of the population. So monitoring is key to containing the epidemic.
The outbreak of the novel coronavirus disease, COVID-19, which began in China in December 2019, has since spread rapidly around the world. The disease has now been detected in more than 75 countries, including India, causing over 3,000 deaths worldwide. It is caused by SARS-like corona virus. Other members of the group cause the common cold.
The symptoms of COVID-19 include fever, fatigue, and a dry cough. Some patients have aches and pains, a sore throat, or diarrhoea. The good news is that for most people, the disease is mild; about 80% will recover from the disease without the need for special treatment.
However, older people and those with medical conditions such as high blood pressure, heart disease, and diabetes, may become seriously ill. About 2 to 3% of people with the disease have died. This death rate is much higher than for seasonal influenza (0.1%). Only 2% of confirmed cases have been in children and adolescents of less than 20 years — it is unknown what role children play in transmission of the disease.
There are as yet no specific treatments to treat the disease, nor is a vaccine available. Vaccines are in development, but it will be at least 12-18 months before any are ready for use. Many repurposed drugs (including those used to treat HIV, influenza and other viral infections) are undergoing clinical trials, along with adjunctive treatments. Currently, management consists of symptomatic and supportive treatment. India should participate in the research and development effort to develop new tools — diagnostics, vaccines and therapeutics — for this novel virus, as well as contribute to better understanding of its epidemiology and transmission dynamics.
The virus appears to spread through droplet transmission. When a person with COVID-19 coughs or exhales, small droplets from the nose or mouth land on surfaces and objects around them. When others touch these surfaces and then touch their eyes, nose, or mouth, or they breathe in droplets from an infected person, they can catch the virus.
Fortunately, there are several things people can do to protect themselves. The most important is hand hygiene. People should wash their hands often with soap and water for 20 to 30 seconds; when water is not available, alcohol-based hand rubs should be used.
Stay at least one metre (three feet) away from anyone who is coughing or sneezing. Avoid touching your eyes, nose, or mouth. Practice good respiratory hygiene; cough or sneeze into a tissue or into your bent elbow. Dispose of used tissues immediately. People who feel unwell should stay at home.
People who do not have symptoms do not need to wear a medical mask. But those who do have symptoms and those who are caring for people with symptoms should wear masks. The World Health Organization (WHO) is deeply concerned by disruptions to the global supply of personal protective equipment, including medical masks, gloves, gowns, and aprons. Some of these shortages have been caused by irrational panic buying.
Everyone should follow the latest advice from national and local public health authorities.
What should these authorities be doing now?
All countries, including India, should have already activated their national public health emergency management mechanisms. For many countries, this will mean adapting an existing preparedness plan for influenza pandemics. The Integrated Health Information platform (IHIP) of the ministry of health can be used for epidemiological surveillance for unusual outbreaks of influenza-like illness and severe pneumonia. Large-scale laboratory testing is critical, as is information sharing. Cases need to be rapidly detected and their contacts comprehensively and rapidly traced. Infection prevention and control practices in health facilities and communities should be reviewed and enhanced where necessary.
Health care facilities and staff should be prepared for large increases in numbers of people with suspected COVID-19. Geographic spread of the virus should be monitored, as well as transmission intensity, disease trends, characterisation of virologic features, and assessment of the impact of the disease on health care services. Information should be available for travellers and staff at points of entry (airports, ports).
One of the most critical things governments can do is to communicate clearly and accurately with the public. People need to understand what public health authorities do and do not know about the disease, and what they are doing to contain it. Clear and consistent messages from trusted experts and community leaders need to be disseminated in local languages. Two-way channels, such as text and telephone hotlines, and social media should be established so the population can get information and ask questions. This is also key to combating the spread of myths and misinformation.
When citizens believe their government is being candid with them, they are more likely to take protective measures for themselves and their communities. Public health measures need to be tailored to particular situations and be frequently evaluated and updated, based on changing epidemiology. WHO is ready to assist India and all other countries in this outbreak. Technical guidance has been assembled, as well as a freely accessible database of publications on COVID-19. A wealth of resources, including a daily situation report, news releases, summaries of press briefings, and infographics for printing and social-media sharing, is available for the public, policymakers, clinicians, and public health officials.
Coordination and collaboration are essential to combat this common threat. As the director general of WHO Dr Tedros has said “Our greatest enemy right now is not the coronavirus itself. It’s fear, rumours and stigma”. And our greatest assets are facts, reason and solidarity.
The Chinese data on coronavirus fatalities shows that a large proportion of fatalities has been among the elderly. The number of deaths is higher among elders, as compared to the young. Those with pre-existing conditions are much more at risk than others. This understanding is essential for the layperson so that they are informed about the nature of the disease, along with a rational public health system that can respond to containing the spread through monitoring and surveillance strategies.
We also need to learn from the strengths and failures of managing several viral influenza outbreaks in the recent past such as the avian and swine flu (H1N1) that has and continues to spread across the country.
