Corona Challenge: Can India succeed?
by Ashok B Sharma on 27 Apr 2020 7 Comments

The winter of the Corona crisis is far from over. No green shoots are appearing anywhere across the globe yet. The Director-General of World Health Organisation, Tedros Adhanom Ghebreyesus has already pressed the panic button, saying the “worst” of the novel Corona virus has yet to come. The WHO DG further asserted “it’s a virus that many people still don’t understand”. He compared the present situation with the outbreak of Spanish Flu a century ago that killed 100 million people. Ghebreyesus’ statement needs to be given serious thought.


No one knows the nature of the virus, how to detect it, and the cure. Doctors say that when certain symptoms develop in an individual like coughing, sneezing, fever and respiratory problem, one can assume that the person is suffering from coronavirus infection. But these symptoms can be attributed to disease caused by other viruses as well. What is most mysterious and appalling is that according to global estimates, about 80 per cent of the cases were asymptomatic and had mild symptoms, while 15 per cent were symptomatic and five per cent were critical. The rise of asymptomatic cases is a concern. Many asymptomatic cases have led to death. This shows that the exact symptoms of the infection by SARS-CoV-2 or COVID-19 are yet to be determined.


In India, the Indian Council of Medical Research (ICMR) and its affiliate bodies that analyzed the samples, say that 69 per cent cases were asymptomatic while 31 per cent were symptomatic, out of which 15 per cent were critical. Till early morning of April 24, the ICMR tested 5,41,789 samples from 5,25,667 individuals, out of which 23,502 have been confirmed positive.


Bowing to mounting pressures, particularly from Opposition political parties, the Government distributed rapid antibody testing kits to different states. Most of the kits were imported, particularly from China. But the Chinese kits came under ICMR scanner as states reported malfunctioning. According to ICMR, rapid antibody testing kits are not for detecting coronavirus infection, but for testing immunity power of an individual. Rapid antibody testing is for surveillance, particularly in containment and hotspot areas. ICMR has developed protocols for such tests.


For effectively detecting coronavirus infection, ICMR suggested real time polymerase chain reaction (RT-PCR) test and point-of-care molecular diagnostic assays. But it has limited it to certain categories like all symptomatic individuals who have undertaken international travel in the last 14 days, all symptomatic contacts of laboratory confirmed cases, all symptomatic healthcare workers, all patients with severe acute respiratory illness. It also suggested such tests for asymptomatic persons who had direct and high risk contacts of a confirmed case. They should be tested once between day 5 and day 14 after coming in contact. In addition, ICMR has recommended RT-PCR tests in hotspots and has developed a protocol and updated containment plan for large outbreak.


ICMR has also suggested Cartridge Based Nucleic Acid Amplification Test (CBNAAT) using Cepheid Xpert Xpress SARS-CoV2 and TrueNat testing for COVID-19. At present, a total 265 government labs are reporting to ICMR for all such tests – for RT-PCR tests 220 labs, for TrueNat test 40 labs and for CBNAAT test five labs. Also 87 private testing labs are reporting to ICMR. The number is increasing day by day.


Globally, 17 vaccines are being developed; four are at the stage of clinical trials. COVID-19 virus has mutated in different strains. There three main types of strains found in India – Chinese, European and American. These are mainly from people coming from these countries. In the absence of a perfect drug or vaccine, several therapies for treatment of malaria, cholera, HIV AIDS, Hepatitis B and C and other viral diseases are being tried on patients. ICMR has prohibited indiscriminate use of hydroxychoroquine (HCQ). It has cautioned that it is harmful to consume HCQ without prescription by a doctor as it may have harmful effects. ICMR has recently permitted plasma therapy which is proving to be effective in some cases.


The corona crisis has given India a chance to improve its healthcare infrastructure. However, even though India is the second most populous country in the world, the situation is better contained than in many advanced countries. There are more than 700 COVID dedicated hospitals in the country with more than 100,000 isolation beds. Besides there are dedicated COVID centres for patients with moderate clinical symptoms and dedicated COVID centres for patients with mild or very mild symptoms.


Till April 24, there were 17,610 active cases, out of which 4,748 were cured and 718 succumbed. In March, the doubling of cases happened every three days; now it takes 10 days. The recovery rate has increased to 25.5 per cent. In 78 districts no new cases of COVID infection have been reported in the last 14 days.


The corona crisis has given an opportunity to boost the Make-in-India programme. Personal protection equipment for doctors, masks, gloves and testing kits are now being produced in the country.


Out of 736 districts, there are 326 districts where there has been no prevalence of COVID infection so far. One state, Sikkim, has remained free from coronavirus. Yet, in the second phase of lockdown imposed on April 14, Sikkim gave relaxations only for agricultural and related activities, all health services, plantation, animal husbandry and fishery activities, financial and social sector, some rural activities, public utilities, select industrial, commercial and construction activities and inter-state and intra-state supply of essential goods, movement of cargo and select government offices.


The Government believes that lockdown till May 3 will further improve the situation as staying at home, wearing masks and gloves, maintaining distance between individuals, will further contain the spread of the disease. But now it is time to move on.

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