The dark corona

<pre><pre>Who is (not) a citizen?

When a special Air India flight evacuated 324 Indians from Wuhan on January 31, 31-year-old Monika Sethuraman burst into tears when she realized she would not be on the plane. "I couldn't breathe for a few seconds … I'm stuck here in town and it's a huge prison now," she says on the phone from her dormitory. The graduate student in international relations at Central China Normal University in Wuhan was instrumental in contacting the Indian embassy and arranging for evacuation of fellow Indians after the outbreak of the new novel coronavirus (2019-nCoV).

It will not be easy for Sethuraman himself to leave Wuhan. "I did not fly to the airport because I knew I would not be released for departure. Even if I recovered from the cold, you will not be allowed to fly as soon as you are blacklisted," complained she. Since the transport ban on January 23, Sethuraman has stocked up on essentials. According to her, there is no point in getting out. You are discovered by a drone, the building surveillance cameras or the police and sent back to the hall. "The authorities are not interested in testing or checking if you have the virus. They are only interested in control. It doesn't matter whether we live or die as long as the virus is present," she says. "I follow the guidelines of the WHO (World Health Organization), but there is no interface to the people with whom I can connect. When people see you wipe your nose, they run away from you, including the officials. That is the one Kind of panic and despair here. "

First group of Indian evacuees at the quarantine center in Delhi (Photo: ANI)

The difficulties of 38-year-old Vinay Ahuja, who visited business partners in the region when the city was locked, are no different. "Nobody expected it to escalate so quickly," he says as he marks the time before getting permission to fly out. Ahuja and many others are wondering whether India could repeat China's iron attempts to control the outbreak in a similar situation. China has been criticized by human rights groups, but praised by WHO for its aggressive approach to controlling 2019-nCoV. In just 10 days, the country built a 600,000 square meter emergency hospital in Wuhan. The two-story hospital has 30 intensive care units, 1,000 beds and special corridors to limit contact between patient and nurse. A second hospital could be ready by February 5.

Doctors examine 323 Indians and 7 Maldives at the airport (Photo: ANI)

Seldom has a disease – largely a little-known respiratory disease – raised such concerns as the "corona", which is now part of the popular lexicon as a feared threat, and the pleasant connotations of being the aura around the sun and a branded cold brew in the shadows provides. First demonstrated in December 2019, 2019-nCoV is a previously unidentified strain. It comes from the same family of viruses as Severe Acute Respiratory Syndrome (SARS-CoV), which killed 774 people between 2002 and 2003, including three Indians.

The situation in India is nowhere as bad as in the Wuhan epicenter, although three cases have been confirmed by February 5 and 3,935 have been observed in isolation centers across the country, except for the special camps for Wuhan returnees near Delhi Airport. How ready is India to deal with the corona virus if the numbers increase?

Given that there is still no vaccine or trial-proven drug therapy, affected patients are treated symptomatically, depending on clinical severity. "In critical cases with viral pneumonia, supportive care, including ventilation, is required. Large city hospitals can do this if the number is not overwhelming. Small towns and rural areas in most states are poorly equipped when the virus occurs." continues to spread, "said Dr. K. Srinath Reddy, president of the Public Health Foundation of India (PHFI).

Does it spread? A doctor reads the CT scan of a quarantined patient in Wuhan (Photo: Feature China / Getty Images)

The public health system needs to do more to check the spread of the virus. The entry points into the country are closely monitored to evaluate incoming travelers. In the asymptomatic but contagious phase of the disease, there is still a risk that infected people will slip through. Isolation of cases with clinical suspicion is essential, even if a specific virological diagnosis is not immediately available. Close contacts of those affected are advised of clinical assessment and restricted mobility until the end of the incubation period (up to two weeks). "Because the symptoms are not specific to this virus, a high suspicion index based on exposure history is required in a proven / probable case, even if laboratory facilities for specific virus diagnosis are not readily available," explains Reddy. "We need to educate the public with well-designed risk communication messages and health advice, and all healthcare providers need to follow the right diagnostic / clinical protocols."

A comprehensive nationwide surveillance system is still in progress. While this network has expanded since the threat posed by the H1N1 virus a decade ago, competent laboratories are needed at several locations. In 2012, it was proposed to set up 150 diagnostic and research laboratories with virological expertise. Of these, 80 are now operational, but this number is far from sufficient. These are also not linked to the public health response system and only serve as support for ad hoc reporting.

Although India has an integrated disease monitoring program in every district, this is done at the micro level and largely follows a symptomatic approach. "We need case-based monitoring that reports suspicious outbreaks to the labs in real time. We report extreme symptoms at the district level," said Dr. G. Arun Kumar, director of the Manipal Institute of Virology, one of four diagnostic laboratories of the Indian Council for Medical Research (ICMR).

Detailed research showed that the SARS-CoV was transmitted from palm trees to people in China in 2002 and the Middle East Respiratory Syndrome (MERS-CoV) from dromedary camels to people in Saudi Arabia in 2012. The animal source of the 2019 nCoV is still to be identified. It is likely that the source is a live animal market in China.

Laboratories and the health system have also largely overlooked animal research and risk mapping in India. There are different types of human-borne (zoonotic) diseases. They differ in terms of the variety of pathogens (viruses, bacteria, fungi, protozoa, helminths) and animal sources (bats, pigs, chickens, other birds, palm quibbles, dogs, fish, crustaceans and snakes). India has fairly well-established programs to monitor zoonotic diseases such as rabies, brucellosis and Japanese encephalitis. The most worrying is the threat posed by newer viruses that are transmitted from wild or captive animals.

"To identify the emergence and spread of zoonotic agents, we need an approach that combines research data from wildlife, veterinary and human populations, including biology, epidemiology, and clinical trials. Monitoring wetlands, including animal feed sales, requires research at the entry points identify zoonotic pathogens in outbreaks in other countries, "explains Dr. Reddy.

Agencies such as the National Center for Disease Control (NCDC) and the ICMR have advanced their efforts in these areas. However, India is not up to the task, be it to deal with an emergency or to carry out priority research. The weak points lie in the insufficiently integrated epidemiological monitoring of zoonotic pathogens in forests, narrow-minded veterinary clusters and human population groups. This is one of the reasons why Nipah claimed 17 lives in Kerala in 2018. The lack of virological and taxonomic studies on native bats made it difficult to understand the nature of the virus. However, the state has learned from the tragedy. Kerala has declared 2019-nCoV a state disaster and monitored more than 2,000 people in their homes. "This is supposed to exacerbate the vigil rather than cause panic. We don't want to do without it," says state health minister K.K. Shailaja.

This level of vigilance has not been repeated anywhere else. Although India is in the top 30 countries at risk from the virus, there is no statement from the Minister of Health and no central guidelines for the detection and control of infections. In contrast, two weeks after the outbreak, European countries began tracking down visitors from China and publishing strong public advice. Precautionary guidelines for the general public in India still need to be widely disseminated, either in English or in the local languages.

"There are all sorts of misleading reports that give the public wrong information about how to cure the virus. Most people don't know how to protect themselves, what masks to wear, and so on. Public education has so far been neglected . " Chapal Mehra, a health specialist in Delhi. "We need a proactive rather than a reactionary approach. Large-scale screening of high-risk individuals must be a priority. It is a challenge for our public health system that does not yet have a strategic approach," he added.

A concerted response from several authorities, led by a competent public health system, is the order of the day, but is currently hampered by the country's limited expertise. In the medium term, agile outbreak response systems need to be established, primary care facilities (where clinical evaluations are conducted) strengthened, and efforts to develop vaccines need to be stepped up.

If the virus spreads here on the same scale as in Wuhan, it could have catastrophic effects on the economy, health care and public morals. With one of the highest population densities in the world, especially in cities like Delhi and Mumbai, it will be impossible to maintain a distance of one meter between people (as recommended by the WHO) and it will not be possible to block an entire city , Meanwhile, social media broadcasts by individuals in Wuhan paint a grim picture. Lack of food and medication, panic and misinformation, depression, even theft – the virus not only destroys health, it destroys society. It is already visible in Kerala. There are media reports of families of returnees from China who have been "outlawed".