Our expectations could mutate in response to the coronavirus (Mint)

Context:

• In December 2019, an outbreak of viral pneumonia of unknown etiology emerged in Wuhan, a city in the central Chinese province of Hubei.
• A few weeks later, the World Health Organization (WHO) and Chinese health authorities announced the discovery of a novel coronavirus, known now as 2019-nCoV, as being responsible for the pneumonia.

Vulnerability:

• The outbreak led to an unprecedented escalation and an equally unprecedented response.
• The two most important questions asked in a fast-evolving pandemic of this nature are:
• How deadly is the disease, and;
• Can it be contained?
• The latest available figures suggest that the death toll in China is 304 and 14,411 have been infected.
• The current fatality rate estimate of 2% is unstable and is likely to fall as more cases are detected.

Measures taken by the countries:

• The attempt at containment started late, but has never been attempted in the fashion that China has gone about it.
• Belatedly, on 23 January, China locked down Wuhan and 12 other cities, quarantining 52 million people in one sweeping action.
• This is the first known case in modern history of any country locking down an entire large city. Confirmed cases have since been reported from Hong Kong, Macau, Taiwan, Thailand, South Korea, Japan, Singapore, Australia and the US.
• India reported its first case from Kerala of a medical student from Wuhan University, followed by two more.
• Singapore and the US have now banned foreign nationals who have recently been in China from entering the country.
• Russia, Canada, the UK and India have begun evacuating citizens from Hubei province.

Outbreak epidemic in the past:

• The two outbreaks in recent memory that can shed light on the effectiveness of containment are the 2002-2003 SARS outbreak, which spread from China and was contained in nine months, and the 2009 H1N1 influenza pandemic, which began in Mexico and spread globally.
• The case fatality for the H1N1 flu eventually turned out to be 0.1% and for SARS, 10%.
• The one distinguishing feature of the new coronavirus appears to be that it can be transmitted even when patients are asymptomatic, making detection of febrile cases at checkpoints an inadequate method of containment.

Novel Coronaviruses:

• Coronaviruses (CoVs) are characterized by club-like spikes that project from their surface, an unusually large RNA genome and a unique replication strategy.
• CoVs cause a variety of diseases in mammals and birds, ranging from enteritis in hoofed animals to potentially lethal human respiratory infections.
• The 2019-nCov genome was sequenced in China.
• It suggests that the original host of this coronavirus was a bat reservoir, though it is unclear whether there was an intermediate host.
• The uniformity of the sequenced genome suggests that the virus has entered human hosts very recently. Chinese health authorities were the first to post the full genome of the 2019-nCoV in public international databases.
• Subsequently, several other countries, including the US and France, have sequenced the RNA of the 2019-nCoV as well.
• These sequences and their similarity to the initial samples from China suggest a single, recent emergence from an animal reservoir.
• Testing for 2010-nCoV requires a reverse transcription polymerase chain reaction test (RT-PCR) which converts RNA into DNA, making study and comparison easier.
• There are no vaccines yet for this virus, but promising paths have been identified, borrowed from the SARS related vaccines.
• Development of an effective vaccine may only come after the 2019-nCoV is contained, but it may still be useful if there were to be a subsequent outbreak. The frequency of future outbreaks is only likely to increase because of climate change, global travel and fast mutating viruses.

Challenges to India’s health system:

• For India, this global health emergency should serve as an eye-opener. Only time will tell if the lockdown of Wuhan was an effective or draconian measure.
• If it turns out to be a useful tool to prevent the spread of a deadly virus, India will need to develop the framework and capacity to implement such a drastic measure.
• Our municipalities are hopelessly under-equipped to implement strict isolation and containment strategies.
• We will need to develop the capacity to build large facilities for housing patients in isolation wards.
• This will require India to accelerate the use of construction methods like pre-cast technology.
• The National Centre for Disease Control (NCDC) has been proactive in updating its protocol related to the 2019-nCov and has clear instructions for reporting and assay preparation.
• Samples in India need to be sent to the National Institute of Virology in Pune.
• While the public health and epidemic escalation framework appears capable of handling a small number of cases well, it is not clear how it will stand up to large number of cases in a specific geographic region.

Way ahead:

• Even though there is some criticism of China for having initially reacted slowly, once the Chinese authorities began to move in January, they have proceeded with dramatic purpose and tremendous speed.
• In some ways, China is setting the standard for a public health response that may become a necessary way of life in the 21st century.
• India must use this as a guidepost to greater preparedness