The novel coronavirus differs from other pandemics because of its exponential speed of transmission. The coronavirus is a novel virus because the genetic RNA has undergone mutation recently to infect humans from an animal source, thus converting a zoonotic disease to an anthroponotic one. Coronavirus RNA is new to the human immunological system. Therefore, there are a lot of unanswered questions with regard to immunity, recurrence, carrier state, treatment and vaccines. The incubation period is 2-14 days. However, research has revealed that the virus can remain in circulation for much longer in affected individuals.
The economic status of a country influences implementation of its policies. As India is a lower-middle-income country with a healthcare expenditure that is consistently below 1.5% of the GDP, it needs to be prudent and pragmatic in its approach to withstand it in the event of community spread. Therefore, the government must focus on continued surveillance, prompt diagnosis and adopt robust treatment modalities to reduce morbidity and mortality.
Increase in testing
An increase in testing will identify the actual number of cases that would require quarantine and prompt treatment. The Indian Council of Medical Research has to increase random sampling and screening of the high-risk population. Nationwide, the government has identified 75 government hospitals for testing and has allowed private labs with NABL accreditation to conduct real-time PCR assay of the RNA virus. The National Task Force has recommended that the maximum cost for testing sample should not exceed ₹4,500. The country’s per capita annual income for 2019-20 is ₹1,35,048 and the average middle-class annual income is ₹10-15 lakh. Out-of-pocket expenses in healthcare is what pushes a lot of low-income Indians below the poverty line.
COVID-19 is a national emergency. Therefore, the government should include the test under the ambit of all private and government health insurance schemes. The primary goal of the government is to ensure availability and accessibility to diagnostic tests free of cost. Setting up diagnostic centres in every district general hospital should be the top-most priority. Travel bans and quarantines are imperative measures, but testing alone can reveal the extent of the disease in the community.
Misinformation, especially on the use of facial masks, alternative medicine, and availability of a cure, should be avoided. With limited resources, India requires protection gear such as three-layered facial masks for its healthcare workers and for those in service industries.
Where does India stand on the coronavirus curve?
There is no vaccine to fight the virus yet. Randomised controlled trials for antiviral treatment are difficult to execute during pandemics. Researchers need to make tough choices during clinical trials, while ensuring the safety of the patients. Medication was elusive in the past for H1N1, HIV and many other viral illnesses but the human mind proved invincible. Anti-COVID-19 drugs may be available sooner than later.
The true incidence of the disease is still unknown. Evidence from the identified cases worldwide suggest that 80% of the infections will be mild with people having flu-like symptoms, about 15% will be severe requiring hospitalisation due to breathlessness or pneumonia, 3-5% will require ventilatory support, and about 1% will succumb to the virus.
Every individual at risk, and not just those in power, should be tested on request. There are authentic reports that several individuals have been denied diagnostic tests despite a contact history.
The WHO categorised India as having local transmission. If so, lessons can be learnt from South Korea which is taking 6,388 tests per million of the population compared to India’s 11.6. Every life is equally invaluable.