India reported its third novel coronavirus (COVID-19) death Tuesday — a 63-year-old man in Mumbai with a travel history to Dubai, and had underlying conditions of high blood pressure and heart disease.
With more fresh cases being reported, the total number of confirmed cases has climbed to 137, including 14 people who have recovered.
And after two COVID-positive Italian tourists — a 69-year-old man and his 70-year-old wife — who were administered the Lopinavir/Ritonavir combination, usually a second-line HIV medication, recovered in Jaipur, the Union Health Ministry recommended use of the antiviral drugs on a “case-to-case basis” for “high-risk patients” aged above 60 years with underlying conditions.
Meanwhile, India extended the travel ban to passengers from Afghanistan, Philippines and Malaysia, after barring the entry of those from “the European Union, the European Free Trade Association, Turkey and United Kingdom” on Monday.
“Travel of passengers from Afghanistan, Philippines, Malaysia to India is prohibited with immediate effect. No flight shall take off from these countries to India after 1500 hours Indian Standard Time (IST). The airline shall enforce this at the port of initial departure,” the new travel advisory said.
On reports that 254 Indians in Iran had tested positive, MEA Joint Secretary Dammu Ravi said: “All Indian pilgrims in Iran are safe, they are in the mission, the mission is taking care of all their needs. About the circulating list, I cannot confirm anything. But the virus is widespread in Iran, there may be some spread.”
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In a related development, the Indian Council of Medical Research (ICMR) said it is “in talks” with 51 NABL (National Accreditation Board for Testing and Calibration Laboratories) accredited laboratories in the country for opening up coronavirus testing to the private sector, with the condition that test results must be conveyed real-time to the local officials of the Integrated Disease Surveillance Programme (IDSP).
“By the end of this week, there will be 72 functional ICMR labs for COVID-19 testing and 49 others in the government system… We are also in talks with 51 NABL-accredited private laboratories to start testing,” said Dr Balram Bhargava, ICMR Director-General and Secretary, Department of Health Research. “They may need 7-10 days for procurement of reagents. Many of them had offered help in the national interest. We appeal to them to make the test available free of cost,” he said.
In addition, he said, two laboratories with the capacity to process 1,400 samples each per day were being readied.
According to the guidelines for private laboratories, “Laboratory test should be only offered when prescribed by a qualified physician as per ICMR guidance for testing… ICMR will share the SOPs for laboratory testing and provide positive controls for establishing the test as soon as the concerned private laboratory has procured the primers, probes and reagents as per SOPs. Adoption of commercial kits for testing should be based on validations conducted by lCMR-National Institute of Virology (NIV), Pune. Appropriate biosafety and biosecurity precautions should be ensured while collecting samples from a suspect patient.”
Senior scientist Dr Nivedita Gupta said equipment for the confirmatory test has been distributed to 51 ICMR laboratories across the country.
The testing criteria has been expanded to include health workers caring for COVID-19 patients who show symptoms. Earlier, it was limited to symptomatic people with travel or contact history. The government has also made it mandatory for all hospitals (government and private), medical officers in government health institutions and registered private medical practitioners to notify COVID-19 cases to the district surveillance unit. Doctors must get self-declaration forms signed by patients who have history of travel to affected countries.
According to the revised clinical management guidelines for COVID-19 patients, “There is no current evidence from RCTs to recommend any specific treatment for suspected or confirmed patients with COVID-19. No specific anti-virals are recommended for treatment of COVID-19 due to lack of adequate evidence from literature. The use of Lopinavir/Ritonavir in PEP regimens for HIV (4 weeks) is also associated with significant adverse events which many a times leads to discontinuation of therapy. In light of the above, Lopinavir/ Ritonavir should only be used with proper informed expressed consent on a case to case basis for severe cases, within the under-mentioned framework along with supportive treatment as per need.”
The drug is to be used in patients who have hypoxia, hypotension, new onset organ dysfunction (one or more) and those in “high risk groups”, including people with “diabetes mellitus, renal failure, chronic lung disease, immuno-compromised persons or those aged above 60 years”.
The government has also issued guidelines for last rites in case of COVID-19 deaths, to ensure standard precautions and prevention of infection.
Taking precautionary measures, the Department of Personnel and Training (DoPT) on Tuesday ordered the installation of thermal scanners and hand sanitisers at the entry points of government buildings, advised against official travel, and called for meetings through video conference.
The government also increased the number of lines on the COVID helpline to 100. Thirty nodal officers of the level of joint secretary and above have been drawn from various ministries to coordinate with states.
While a 76-year-old man from Kalaburagi in Karnataka, who had returned from Saudi Arabia, died last Tuesday, a 68-year-old woman died in Delhi on Friday. The Karnataka man’s daughter and doctor have also tested positive.
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