Tackling Covid remains public health challenge

Former Regional Officer, WHO 

The emergence of the novel coronavirus in China in December 2019 followed by its rapid spread, first in China and then to other countries, is a cause of great concern. Especially in the last two weeks, a sharp increase in cases and deaths in South Korea, Italy and Iran indicates the transmission of the disease is under way in these countries. This marks a profound shift in the epidemic globally, indicating that we are entering an entirely new phase, with local transmission in various countries, while cases and deaths are declining in China, the epicentre of the outbreak.

At present, 29 confirmed cases, including that of 16 Italian nationals, have been reported in India, including three reported initially from Kerala. Many of them have a history of travel to Italy and Dubai. A few cases are among family members in a cluster. However, there are no reports of community transmission happening so far in the country.

In stepping up its preparation in response to the novel coronavirus outbreak, the Government of India constituted an inter-ministerial coordination for inter-sectoral response comprising the Ministry of Health and Family Welfare, External Affairs, Civil Aviation, Shipping, Home and National Disaster Management Authority.

The government had initiated several measures for the early detection of imported cases with universal fever screening initiated at 21 airports, 12 major seaports, 65 minor seaports and land crossings, particularly those bordering Nepal. So far, nearly five lakh incoming airline passengers and 12,500 passengers coming through seaports have been screened. For community engagement, special gram sabhas are being organised to boost awareness and sensitisation regarding the novel coronavirus disease, its symptoms, preventive measures, reporting etc in villages in the border districts of India.

The Integrated Disease Surveillance Programme at the National Centre for Disease Control at Delhi has strengthened its acute respiratory illness surveillance. It has developed guidance on surveillance, investigation and laboratory detection of cases and disseminated to all state health departments.

A network of 15 laboratories across the country has been identified as testing facilities to test for coronavirus and 19 more are coming up. A 24×7 call centre has been operationalised at the NCDC to guide healthcare providers and communities about the testing facilities, sample collection, transportation and dissemination of information on symptoms. The states and union territories are being put on alert and the stocking of personal protection equipment and masks has been beefed up.

The Ministry of External Affairs has issued travel advisories to the general public to avoid non-essential travel to the affected countries. eVisas issued for nationals of China, Italy, South Korea and Japan have been cancelled. The Indian government is also releasing daily updates about the situation in the country.

The government is also planning for the next phase of the outbreak, currently seen in many other countries reporting focal clusters of cases in the community. This requires establishing public health surge capacities which include active surveillance, contact-tracing and follow-up besides early detection, isolation and management of cases. To strengthen capacity for surveillance and outbreak investigation, there is a plan to map out and effectively utilise the trained field epidemiology workforce.

Given the evolving situation, our existing health system can easily get overwhelmed by a large increase in patient load, with many requiring hospital inpatient treatment. As a part of the surge capacity, hospitals and health facilities, in both public and private sectors, need to be mobilised to care for an increased number in cases, and financing must be made available for ramping up these facilities.

To prevent new infections and save lives, each hospital and district health facility should have lab capacities for early detection of cases by testing all those with influenza-like illnesses, isolating them if positive, and tracing and monitoring their contacts. Ideally, every major hospital, including district hospitals, should have the capacity to test for the new virus.

Good clinical management practices can improve the chances of survival of patients. Every state must ensure adequate human resources like doctors and other paramedical staff which will be essential to care for the large number of patients expected in case the outbreak expands and community transmission starts to occur. It will also be critical to help trace their contacts at various levels of healthcare, in particular at districts, and monitor contacts daily to check for symptoms. In addition, the health personnel need to be trained and the availability of guidelines and an adequate amount of supplies, such as personal protection equipment, gloves, masks, medicines, test kits for diagnosis and ventilators, ensured.

The government is urging individuals and communities to take precautions and avoid getting infected with the virus. They include staying at home when sick, thereby preventing infection to others, regular and thorough hand-washing with soap and water, covering the mouth or nose while coughing or sneezing or practising cough etiquette, avoiding touching eyes, nose or mouth, and cleaning and disinfecting frequently touched surfaces at home or workplaces. Face mask or personal protection equipment can be used when ill or while visiting a health facility.

In the event of community transmission, communities can decide whether to advocate ‘social distancing’ measures, such as limiting public gatherings, closing schools or postponing social events, based on available data on the risk of transmission. In general, keeping a distance of at least three feet at a workplace or school setting, or separating an employee or individual who might be infected from those who are well or sending them home to isolate themselves from others, can help reduce person-to-person transmission.

Clearly, people need timely, accurate and easy-to-understand information which will encourage protective behaviour. It will help limit the spread of misinformation which otherwise would lead to panic or hysteria. Social media requires careful use so that it is not used to spread fake news and alarm that may harm the society and undermine response to the outbreak.

As the situation continues to evolve at a rapid pace, we urgently need to invest in a stronger public health system which can enable us to find cases faster, stop the outbreak sooner, and prevent the consequences of new infectious disease threats we will inevitably face in the coming days and years.

Investing in robust surveillance and lab diagnostic facilities, risk communication and a strong health system capacity with adequate human resources could save the country countless lives and limit the grave social and economic impact of this virus or the next new infection when it strikes. The time to do so is now!