Context

In some ways, China is setting the standard for a public health response that may become a way of life in the 21st century.

Origin of the outbreak and deadly it could turn out?

• Outbreak of unknown virus: In December 2019, an outbreak of viral pneumonia of unknown etiology emerged in Wuhan, a city in the central Chinese province of Hubei.
• Discovery of novel coronavirus:  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.
• Important questions: The two most important questions asked in a fast-evolving pandemic of this nature are:
  • 1) How deadly is the disease, and;
  • 2) 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.

Containment attempts by China and spread to the other countries

• Unprecedented attempt by China: The attempt at containment started late, but has never been attempted in the fashion that China has gone about it.
  • Wuhan lockdown: 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.
• Reports of confirmed cases from other countries: 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.

Research on coronavirus so far

• 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.
  • Genome sequence: The 2019-nCov genome was sequenced in China in early January and reported in The Lancet last week.
  • It suggests that the original host of this coronavirus was a bat reservoir, though it is unclear whether there was an intermediate host.
• A recent entry to the human host: The uniformity of the sequenced genome suggests that the virus has entered human hosts very recently.
• Recent emergence from the animal reservoir: 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.

Tests and vaccine development

• How is the virus tested? Testing for 2019-nCoV requires a reverse transcription polymerase chain reaction test (RT-PCR) which converts RNA into DNA, making study and comparison easier.
• No vaccine yet: 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.

What lessons can India learn?

• Develop framework and capacity: For India, this global health emergency should serve as an eye-opener.
  • If lockdown 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.
  • Under-equipped municipalities: 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.
  • Use of pre-cast: This will require India to accelerate the use of construction methods like pre-cast technology.
• Protocol and instructions: 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.
• Develop capacity in geographically diverse regions: 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 a large number of cases in a specific geographic region.

Conclusion

“Nothing happens quite by chance. It is a question of accretion of information and experience,” said Jonas Salk, the virologist who developed the polio vaccine, 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.

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