Fighting Coronavirus

A Public Health Emergency of International Concern

Fighting Coronavirus
Fighting Coronavirus

Novel Coronavirus or 2019-nCoV was first detected in Wuhan- City of Hubei province of China, in mid December. Since then it has spread across all provinces of China and even outside China cases have been reported. The pace of increase of the cases have been reported. The rapid increase of cases of 2019-nCoV has become a cause of threat. On January 25,1975 cases were reported till then, however the number rose to 2744 on January 26,2020 and 4515 on January 27,2020. As per WHO statistics of 8th February,2020 “34886 confirmed cases of 2019-nCoV have been reported globally with China itself accounting for 34598 cases and 288 cases being reported outside China spread across 24 Countries”.

The number of deaths due to the virus in China has crossed 1000 and outside China the number stands at just 2.

The virus has spread across Singapore, Japan, Australia, Malaysia, Vietnam, Thailand, India, Nepal, Sri Lanka, USA, Canada, Germany, France, France, Italy, UK, Spain, UAE, among other countries. As per reports the Virus has jumped species from birds or mammals and has infected humans. However, several people who were infected never visited the seafood market in Wuhan from where the virus is suspected to have started affecting humans. This indicates cases of human-to-human transmission and can further be confirmed by a report that one injected patient in hospital of Wuhan, infected around 10 health care workers and 4 other patients.  Based on these- Statistics and its rapid spread the emergency committee convened by WHO declared the Coronavirus outbreak as a ‘Public health emergency of international concern’ on 30th January 2020. The pace of spread of the virus has made it a major global concern.

What is Coronavirus and Similarities with SARS And MERS Viruses?

Coronavirus refers to a group of viruses that causes illness like Common Cold, Middle East Respiratory Syndrome (MERS), Severe Acute Respiratory Syndrome (SARS), Pneumonia. The recent outbreak of Virus in China is being called Novel Coronavirus or 2019-nCoV as it is a new strain that has not been previously identified as having infected humans. The 2019-nCoV is a Zoonotic virus like SARS, MERS which means that these viruses are transmitted from animals to humans. Coronaviruses are a large family of viruses and are circulating among animals. Not all such viruses have infected humans, only some like SARS (transmitted from civet cats), MERS(transmitted from dromedary camels) and 2019-nCoV (transmitted from Wuhan’s live animal and seafood market and suspected to have transmitted from bats or snakes) are the ones identified to have infected humans in this century. Coronavirus are pathogens causing respiratory illness in birds and animals and have infected humans. Coronavirus can cause symptoms like fever, cough, shortness of breath, pneumonia, kidney failure and even death. People infected by 2019-nCoV report fever with symptoms like cough, breathing difficulties, etc.

Coronavirus spread during 2002-2003 causing SARS. It claimed lives of around 800 people and infected around 8000 people from across the world. SARS spread across nearly 30 countries. In case of SARS Coronavirus, it was transmitted from bats to civet cats and then to humans. SARS infected people reported symptoms like fever, malaise, myalgia, headache, diarrhea, cough, shortness of breath. SARS was reported 1st in 2002 in Guangdong province of China. Human to Human transmission had turned SARS into an epidemic. Similar to SARS, during 2012 another strain of Coronavirus caused MERS. MERS is a viral respiratory disease which was 1st identified in Saudi Arabia. Common symptoms of MERS were fever, cough, shortness of breath. MERS was also spread from animals and was a Zoonotic virus. MERS primarily spread due to animal-to-human transmission and human to human transmission in case of MERS were limited. From 2012 upto January 2020, around 2500 confirmed MERS-CoV Cases were reported with around 860 deaths.

The primary cause for Coronavirus which are Zoonotic in nature is close contact of humans with animals including animal consumption. Population explosion leading to clearing of vegetation brings the virus carriers -rodents, animals, poultry etc. into closer contract with humans. This combined with genetic makeup of most viruses which allow easy animal to human transmission results in spread of such viruses Drug-resistance and ability to adapt to human immune system among Coronaviruses make them a grave threat to humans.

What is Public Health Emergency of International Concern (PHEIC)?  

PHEIC is a declaration by WHO of an “extraordinary event which is determined to constitute a public health risk to other states through the international spread of disease and to potentially require a coordinated international response”. Such situations are grave in nature and affect health beyond a country’s national boundary hence may demand a cooperative and coordinated global response.

The PHEIC declaration is done by an Emergency Committee comprising of experts from all over the globe and the committee functions under International Health Regulations (2005) that was constituted in the aftermath of SARS outbreak of 2002-2003. From 2009 till now, 6 PHEIC declarations have been made in cases of 2009-swine flu, 2014-polio declaration, 2014-Ebola outbreak, 2015-16-Zika virus epidemic, 2018-20- Kivu Ebola epidemic and the recent 2019-20- Novel Coronavirus Outbreak. In the recent novel Coronavirus spread due to the pace of spread of the Virus, increase in human to human transmissions and its similarity to SARS, hence having potential to spread like SARS. On January 30,2020 the Novel Coronavirus outbreak originating from Wuhan, China was declared as a PHIEC. On the date of declaration, Coronavirus reported cases numbers were at 7818 affecting 19 countries.

Steps taken against 2019-nCoV

In order to curb the spread of 2019-nCoV, China shutdown the city of Wuhan, suspending all modes of transport in and out of the city. Plans are also on the way to stop public transport services in areas of Huanggang, Chibi. In this backdrop considering the global impact of the virus and its ability for human to human transmission, the emergency committee of WHO declared the virus as PHEIC on January 30. China’s response compared to its approach in case of SARS outbreak was quite prompt. China’s sharing of genetic sequence of the virus with other countries, travel restrictions, fast information relay to WHO are laudable. Unlike SARS outbreak case where China was trying to suppress the spread of the news and adopt to callous approach to deal with SARS, this time China’s approach has been fast, open and transparent.

In beginning of January, animal market of Wuhan was closed and disinfected and China has temporarily banned the sale of wild animals. The PHIEC declaration by WHO was also a prompt step keeping in view the global impact of 2019-nCoV. Considering the spread of the virus outside China’s boundary, some of the major and busiest international airports in the world have announced preventive safety measures. Flights to China of United Airlines, Air Canada, British Airways, Air India, Indigo Airlines etc. have also been cancelled. The US department of state passed a level-4 advisory to China with caution to the people against travelling to China The Centre for Disease Control has given a travel warning of level-3 for entire China. Thailand, Turkey, South Korea, Paris, New Zealand, USA, UAE and other nations have put in place safety measures at airports along with proper screening measures to detect 2019-nCoV. Though currently no exact drugs exists in either traditional or modern medicine to prevent and cure the virus, but it is expected that medicines will soon be developed.

India has three reported cases of the virus so far. However, India’s dismayal rank of 57 out of 100 in the Global Health Security Index, dense population, low literacy rates, lack of general hygiene awareness, costly and less number of private hospitals, understaffed government hospitals etc. puts India in a danger zone for dealing with the case of spread of 2019-nCoV. India has taken steps to prevent the spread of the virus with the National Institute of Virology, Pune and some other laboratories equipped for testing of the virus, India is trying to keep up its pace in dealing with the virus. Thermal screening of passengers at airports are being done in some airports and will be extended to more airports. Currently, India has one isolation facility at Delhi to deal with 2019-nCoV. India has reviewed protocols for screening people, reporting cases and setting up of isolation wards. In a laudable step, India is preparing for evacuation of Indian nationals from Wuhan. Besides this, India has stepped up vigil at border checkpoints, mainly in states bordering Nepal and other bordering countries of India where Coronavirus cases have been reported. The 2018-Nipah virus outbreak in Kerala should serve as reminder for India. Surveillance lag and callous approach of the government whereby it has spotted monitoring the Nipah virus calling it a local occurrence is considered the reason for recurrence of Nipah virus. Similar lack of proper awareness and action in 2017-Zika virus case on part of the government whereby it kept hidden the detention of 3 cases of Zika virus in Gujarat, should not be repeated in the case of 2019-nCoV. Similar tendency of China in SARS claimed lives of around 800 people globally and 2019-nCoV may mutate and has capability to spread like SARS and hence needs urgent and immediate action for containing its spread.

Conclusion

The novel Coronavirus is a zoonotic virus with the ability to exhibit human to human transmission. It is almost similar to SARS Coronavirus of 2002-03 and in order to prevent an epidemic condition as in case of SARS, 2019-nCoV needs to be dealt effectively. Governments of number of countries have adopted screening measures to detect the virus and more awareness among people need to be created so as early detection of the virus can be done. Simple measures like maintaining personal hygiene, washing hands regularly, avoiding careless contact with live animals, reporting to hospital in case of any symptoms like fever, sneezing, cough etc. avoiding direct contact with infected people etc. are essential in order to prevent any further spread of the virus. The 2019-nCoV needs cooperative, coordinated, transparent and efficient actions at national and international levels. India needs to setup more isolation centres and further step up its screening measures as it has high risk of spread of the virus due to dense population and number of other factors like lack of proper water, lack of hygienic condition of living etc. Coordinated and collective action of nations will be essential to curb the 2019-nCoV spread.

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