With anecdotal accounts from a doctors network suggesting presence of severe respiratory tract infections between December and January — before the first Covid-19 case was detected in India — an attempt is being made by doctors in Bengaluru to assess whether Covid 19 infections occurred prior to January 30. The move is part of a larger effort to find plasma donors for Covid 19 patients.
“We have about 134 reports — about 70 plus are from doctors — and the trend is showing a peaking of cases of respiratory infection in December-January. There have been quite a few people who have had illnesses similar to Covid-19 but between December to January,” said Dr Jagadish Chaturvedi, an ENT surgeon at the Fortis Hospital and a medical innovator from Bengaluru, who is conducting a survey in his medical network to assess the situation.
The doctors who are exploring the hypothesis that Covid-19 cases existed in India as early as November 2019 are doing it as part of an effort to expand the pool of plasma donors (people with immunity provided by Covid 19 antibodies) for treating Covid-19 patients. Plasma therapy has shown promise in curing Covid-19 among a few moderately affected patients.
“The hypothesis has gathered interest among some research organizations who are presently studying the efficacy of plasma therapy on COVID 19. They would like to initiate a formal study based on this survey and evaluate the possibility of pre-existing disease to potentially increase the pool of donors and maybe benefit treatment for Covid-19,” Dr Chaturvedi said.
Dr Chaturvedi has gathered basic data from a network of doctors and others to conduct a formal study to understand whether there were Covid-19-like infections seen in the medical setup around the country between November and December 2019.
“If the survey data is compelling we will initiate a proper clinical study and see if there are IGg positive persons (those with the immunoglobulin g which indicates a person who was infected and is now immune) and then it can help in plasma therapy,” Dr Chaturvedi said.
Until the first case of Covid-19 was detected in the country in Kerala on January 30, 2020, no testing was being done for the coronavirus among people with serious respiratory infections — as is being done at present to find people infected by the Covid 19 virus.
A French study — published online on May 3 in the International Journal of Antimicrobial Agents — which showed a case of Covid 19 in France as early as December 2019, was one of the triggers for doctors to explore if Covid-19 was in India prior to January 2020.
“The French paper provided the first evidence of the presence of Covid 19 outside China, in France, in December itself. If it had gone to France in December then it could have been carried to other countries as well,” Dr Chaturvedi said.
“A lot of the people in our network are reporting from Bengaluru and other parts that they had the worst flu of their lives in December and January. It is very uncanny” he said.
“There is one person, a doctor, who has put out information saying he was sick even before Covid 19 was detected in India and that he did a immunoglobulin test (antibodies test) after he recovered and the IGg test showed he had been infected with Covid 19,” he said.
“We cannot be sure if it (Covid 19) was there or not prior to February in India but it encourages our team to do some immunoglobulin study and if we see some immunoglobulins it will help plasma therapy studies in some patients. This is the only benefit ,” Dr Chaturvedi said.
“I, as a doctor, and other colleagues are aware of a trend where there was a very high number of respiratory tract infections in November- December itself. It was covered in the media as well but it was attributed to pollution,” he observed.
Findings from a recent study of the genomes of the Covid-19 coronavirus prevalent in India, conducted by researchers at the Centre for Cellular and Molecular Biology in Hyderabad, indicating possible origin between November 26 and December 26 for Covid-19 genomes in India, has also spurred efforts to explore anecdotal accounts of early prevalence.
The study put out on the preprint server for biology papers bioRXiv on May 31 by researchers from the CSIR’s CCMB and the CSIR Institute of Genomics and Integrative Biology which has reported the existence of a unique strain of the Covid 19 virus in India – has also reported the possibility of emergence of Covid 19 genes in the country prior to January 2020.
“The date of the most recent ancestor for the dataset of all Indian SARS-CoV-2 genomes, with WH1 (the first Wuhan) genome sequence included, was computed using BEAST. The median tMRCA ( time to most recent common ancestor) was found to be 11 December 2019 (95% HPD 26 November to 25 December), confirming the previous estimates of the origin of the epidemic in Wuhan city of China,” says the CCMB-IGIB preprint paper.
Data available from the Public Health Information and Epidemiological Cell for the Bruhat Bengaluru Mahanagar Palike for Acute Respiratory Infections and Influenza Like Illnesses – which are now considered as key signs for testing for Covid 19 infections — reveals a high incidence of ARI/ILI in Bengaluru city in November and December of 2019.
In November 2019, as many as 545 cases of ARI/ILI was recorded, 769 in December, 620 in January, 869 in February and a peak of 1273 in March (when Covid 19 cases began) followed by a tapering to 125 in April and 139 in May as hospitals and clinics shut down in the wake of the Covid-19 lockdown. The PHEIC diseases data is provided by hospitals/clinics in Bengaluru. The data collection system started in 2017 has been working effectively since 2019.
Bengaluru has so far recorded 45 Covid 19 cases in March when the outbreak began, 141 in April and 171 in May according to the official bulletins of the Karnataka health department. There have been 29 deaths due to Covid 19 so far.
However, despite doctors exploring the possibility of Covid-19 prevalence prior to January 30, 2020 a sero surveillance study conducted by ICMR in May to estimate public exposure to Covid 19 revealed that only 0.25% of the surveyed population in Bengaluru and Kalaburagi in Karnataka had been exposed to Covid-19 at the time of the survey.
The study tested for Covid-19 antibodies among 400 people in Bengaluru, Kalaburagi and Chitradurga regions of Karnataka and found only one person each with immunity to the virus from exposure in Bengaluru and Kalaburagi respectively and none in Chitradurga — suggesting that only a very number in the population may have been infected by the virus upto May.
“The high prevalence of ARI/ILI cases in 2019-2020 in Bengaluru before the detection of Covid 19 could also be a seasonal factor of the winter months,” said Dr Komala the district surveillance officer for the Bruhat Bengaluru Mahanagar Palike region.
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