Time to implement mitigation strategies, not just react to health threats

Prof. Arunkumar Govindakarnavar | Updated on February 15, 2020

Hospital infrastructure must be prepared in a more permanent way to handle epidemics

The novel coronavirus disease (COVID-19), thought to be a localised, self-limiting, outbreak in Wuhan city in China’s Hubei province in December 2019, became a public health threat of international concern by mid-January 2020.

Confirmed cases, though primarily in China, have since been seen across 24-odd countries. China has taken unprecedented, extraordinary steps to contain the disease by shutting down several cities, transport systems, including airports, and quarantining millions of people. This has apparently slowed the spread of the disease to other provinces of China though its effectiveness remains questionable.

The concern now is that several countries are showing signs of onward transmission, particularly among people who did not have a definite exposure. And this is particularly worrying as it is a surrogate marker of potential community spread.

As the Director General of the World Health Organization reminds us, all countries should use this window of opportunity to prepare for the mitigation of a novel coronavirus epidemic.

India reported three cases, all medical students who returned from Wuhan to Kerala, late in January 2020. Like other countries, India too is in the containment phase.

Just this week, the Union Health Minister said in Parliament that 1,97,192 passengers were screened for fever though only 9,452 passengers were followed into their communities.

Isolation and home quarantine was meticulously implemented in Kerala and helped identify the infected. But even in Kerala, the tracking and quarantining of passengers was not complete. Containment activities started only from January 17, 2020.

We now know the outbreak in Wuhan started in early December 2019. Surely it would have entered other countries well before the implementation of entry screening.

Extended hospitalisation

There is a good chance that the n-coronavirus might have entered into the community in multiple locations in India. Majority of cases being mild or asymptomatic, it will be difficult to detect community spread as only around 10 per cent cases become severe, particularly in elderly persons, leading to hospitalisation. The only way to detect early evidence of this is to implement laboratory supported sentinel pneumonia surveillance. Current data from China indicates prolonged period of hospitalisation of severe cases, spiralling the requirements of beds, ventilators, supplies including oxygen, personal protective equipment and manpower.

Early indications from Singapore and Hong Kong are no different. This is crucial as Indian hospitals are not ready to receive a large number of severe cases requiring intensive care.

Though the mortality may be near 1 per cent, at least 10-15 per cent cases require hospitalisation, that too for nearly two weeks. The absolute numbers of cases requiring hospitalisation in India will be enormous in the backdrop of our population.

Further, there is already an increase in the activity of Influenza A H1N1 virus in India. During the monsoon, we may be dealing with two circulating viruses capable of sustained human-to-human transmission, and hospitalisation. Hence, there is an urgent need for preparing the country to face these challenges.

While strengthening and continuing containment efforts, it is important to plan and prepare for the mitigation of an imminent epidemic. Establishment of a laboratory supported pneumonia surveillance to identify early community spread along with preparation of hospitals needs to be fast-tracked.

Hospital infrastructure needs to be prepared in a more permanent way for such unforeseen viruses and not just react every time one surfaces as only preparedness, and not fear-mongering, can protect the public and ensure the economic security of the country.

The writer is Director, Manipal Institute of Virology, MAHE, Manipal. Views are personal

Published on February 15, 2020

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