03/25/2020, 18.41
INDIA
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For Indian doctor, if the virus reaches the countryside it would be a nightmare

by Pascoal Carvalho

In India, the Covid-19 test costs too much: US. The country is unable to apply WHO health directives. There are not enough public laboratories. Private ones should be involved, but first they need to be prepared. Quarantine, social distancing and innate immunity could help isolate the infection.

Mumbai (AsiaNews) – We dread to imagine what will happen when the virus reaches the rural population and in areas with no proper access to healthcare,” writes Dr Pascoal Carvalho, a Mumbai doctor and member of the Pontifical Academy for Life. According to the scientist, there is only one reason for India’s limited number of COVID-19 cases, 562 infected and 10 deaths out of a population of 1.3 billion inhabitants: India does not apply World Health Organisation guidelines to "test, test and more test" because it does not have enough laboratories. Meanwhile, as of today, the country is in a total lockdown for three weeks, and the first cases of panic have already been reported. Some videos show some policemen grabbing vegetables from the street stalls. Dr Carvalho’s analysis follows.

As is well documented, the Coronavirus disease 2019 is a respiratory tract infection caused by a newly emergent coronavirus, COVID-19.  Genetic sequencing of the virus suggests that COVID-19 is a beta coronavirus closely linked to the SARS virus. 

While most people with COVID-19 develop mild or uncomplicated illness, a few develop severe disease requiring hospitalization and oxygen support with some requiring intensive care. COVID-19 can be complicated by acute respiratory disease syndrome (ARDS), sepsis and septic shock, multi-organ failure, including acute kidney injury and cardiac injury.

The cases of novel coronavirus are increasing in India with the count already exceeding 200. India has to date reported four deaths due to COVID-19. 

Despite a huge population of over 1.3 billion, the number of cases in India would appear to be very low when compared with China or Europe. However precisely because of the large population and if strict measures to contain the pandemic are not in place immediately, there could be an explosion of cases in the near future.

The virus is observed to spread mainly from person-to-person and between people who are in close contact with one another through respiratory droplets produced when an infected person coughs or sneezes and by touch and then contact with the mouth, nose and eyes. 

In the crowded spaces of Indian cities, identifying patients with symptoms of COVID-19 and isolating them is challenging. Most persons with the symptoms would prefer not to disclose them to the authorities, at best preferring to home quarantine themselves for a period of 14 days. However, during this period there is always a high chance of spreading the virus to their relatives and friends who may be more vulnerable. 

It is commendable that the authorities in India have been very proactive in addressing this global crisis. Very stringent travel restrictions are in place to prevent any persons with a travel history to Coronavirus affected countries, from entering India without proper screening.

As with other viruses, there are no drugs which can be given to cure the patient. The patient has to build his or her own immunity to neutralise the virus. Drugs are given only to prevent secondary bacterial infections which could otherwise complicate treatment especially in patients who are already immunocompromised. 

Scientists around the world are pushing all resources to develop a vaccine to prevent COVID-19. Till such time as a vaccine is available, which will probably take one to two years, the best way to prevent illness would be to avoid being exposed to this virus.  Being a new virus and persons having no previous exposure, the transmission rate and infectivity are much higher than other known viruses of the same family like SARS and MERS. 

Preliminary screening for temperature is by no means an effective method of identifying patients with COVID-19 or carriers.  The incubation period for the virus to show external symptoms can range from 2 to 14 days. Patients would report fever, cough, fatigue and shortness of breath at the onset. Older adults and people who have severe underlying chronic medical conditions like heart or lung disease or diabetes seem to be at higher risk for developing more serious complications from COVID-19 illness. If we include those malnourished, then India will begin to see COVID-19 severity even in a large number of children and middle aged.

The nCoV Real-Time PCR Diagnostic test for the detection and diagnosis of COVID-19 is based on nucleic acid amplification technology. It is an expensive test (Rs. 1000/- per test) and also requires specialized equipment and trained technicians. If testing is to be done on a mass scale as recommended by WHO, then just having a few Government laboratories will not suffice. Private laboratories with the necessary competence will have to be given permission for testing which is currently not the case. The government apex body Indian Council of Medical Research (ICMR) will have to provide immediately provide guidelines and training to private laboratories across India and equip them with the necessary resources.

India has not yet been able to successfully implement the WHO guidelines of ‘Test, Test and Test’ for the virus due to sheer logistic and testing facility issues, yet, whenever a case is reported the authorities have been quick to respond and test the neighbourhood and trace and test all persons associated with the affected individual.

No community transmission has as yet been reported among the Indian population. This could perhaps be due to lack of testing and lack of self-reporting by individuals. The deaths so far have been of persons above 60, who have already had other illnesses and life-threatening medical problems. We dread to imagine what will happen when the virus reaches the rural population and in areas with no proper access to healthcare.

Despite limited testing resources, the Government of India continues to put measures in place to check contact transmission of the virus. The PM has asked for a “Janata Curfew” or ‘Peoples Curfew’ from 7.00 am to 9.00 pm on Sunday 22nd March to get people accustomed to such desperate measures, if required in future.

The awareness of the virus among the population of India is already very high. I am hopeful that India will experience a great degree of success in controlling the spread of the virus. This may well be because of a combination of factors – Government initiatives of surveillance and quarantine, social distancing measures, inherent natural racial immunity levels of the population and to some degree the high temperatures prevalent in the country.

The next two weeks will be most critical in understanding and controlling the spread of the disease.

(Nirmala Carvalho contributed to this article)

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