Coronavirus: What India is doing to prevent the spread of an epidemic

Three infected students from Kerala placed in isolation; Air India Air India has flown twice to China to ferry back citizens; isolation camp set up in Manesar

The first few cases of a new infection had been reported in Wuhan, China, in December 2019. The initial response of the Chinese authorities was suppression of any information. People were silenced and this reluctance on the part of the authorities prevented emergency measures on time, which led to the Novel Coronavirus (2019-nCoV) infection spreading out of Wuhan. Till February 5, the infection has claimed 490 lives and more than 24,000 have been infected, mostly in China but some across the globe.

In India, three students from Kerala have been infected and are placed in isolation. All of them had been studying in Wuhan and had returned to India when the infection spread. Air India has flown twice to China to ferry back Indians, especially students from Wuhan. In India, the army set up a Coronavirus isolation camp in Manesar, near Gurgaon.

As the world came to know, the WHO sprung into action. On January 30, the Director-General of the World Health Organization convened a meeting of the Emergency Committee under the International Health Regulations (IHR) (2005). This was the second meeting of the EC.

The Emergency Committee is the body that determines whether or not an outbreak is to be classified as a Public Health Emergency of International Concern (PHEIC). After the first meeting the committee’s advice had been to not declare the outbreak of novel coronavirus (2019-nCoV) in China as PHEIC, but this advice was overturned in the second meeting. 

As per IHR (2005) procedures: 

The term Public Health Emergency of International Concern is defined in the IHR (2005) as “an extraordinary event which is determined, as provided in these Regulations:

• To constitute a public health risk to other States through the international spread of disease; and
• To potentially require a coordinated international response”. This definition implies a situation that: is serious, unusual or unexpected; carries implications for public health beyond the affected State’s national border; and may require immediate international action.

Before 2019-nCoV, WHO had declared such a public health emergency on five occasions. H1N1 "swine flu" pandemic in 2009, a declaration in 2014 after the resurgence of wild poliovirus, the West African Ebola epidemic in 2014, the Zika emergency in 2015-16 and the Ebola outbreak in Kivu in 2018-19.

Why WHO’s PHEIC declaration matters

As the specialised agency under the United Nations, WHO’s remit is international public health. It is the body that helps frame responses and protocols that help the world fight an outbreak like 2019-nCoV. Countries that are signatories to the UN charter are members of the WHO (except Cook Islands and Niue). There are two associate members and some observer countries as well. The member countries follow the PHEIC protocols for dealing with an emergency like 2019-nCoV. India also follows the PHEIC protocols in managing an emergency like this one.

The WHO has provided detailed technical guidance to countries to help them deal with 2019-nCoV. The technical guidance deals with issues like surveillance, laboratory preparedness to patient management et al.

On February 3, the government had announced temporary suspension of e-visa facilities for Chinese passport holders. It also temporarily suspended any e-visas already issued to Chinese passport holders.  The government’s advisory also asked those who had compelling reasons to visit India to get in touch with the Indian embassy or consulates in Beijing or Shanghai or Guangzhou respectively.

The National Centre for Disease Control (under the Ministry of Health and Family Welfare) has released detailed guidelines for dealing with the 2019-nCoV challenge. Whether it is travel guidelines for those visiting China or guidance for sample collection to ambulance transfer to laundry management  to format for test reports, among other things, the NCDC guidance covers it all.

At the same time the Indian Council for Medical Research (ICMR) has released a list of laboratories in the country to conduct tests for 2019-nCoV. A total of 11 Viral Research and Diagnostic Labs (VRDL) spread across India are equipped for this purpose. 

Testing Laboratories in India
Apex Laboratory – ICMR-NIV, Pune
1. AIIMS, Delhi	2. KGMU, Lucknow
3. SMS, Jaipur	4. NICED, Kolkata
5. IGGMC, Nagpur	6. Kasturba Medical College, Mumbai
7. Gandhi Medical College, Secunderabad	8. BMCRI, Bengaluru
9. KIPMR, Chennai	10. NIV Field Unit, Kerala

The ICMR has also issued detailed guidance for states to follow for collection transportation of samples. There are 28 labs across all states which are responsible for sample transportation to the testing laboratories.

As per news reports, the ICMR is also working on a standard treatment protocol for dealing with coronavirus infections. The treatment might include antiretrovirals used in treatment of HIV. This will be similar to the protocol being followed in China as there is no known treatment for this infection.

The WHO has thus far not issued any advice for global travel restrictions. As the world rushes to contain the fallout of this outbreak, the coming few weeks may keep the world and the Indian government on tenterhooks.