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A month ago, on February 15, Italy had three cases of coronavirus infection; South Korea had 28. Today, Italy is the world’s worst-hit after China, with nearly 28,000 infections, over 2,150 deaths, and millions under a countrywide lockdown. On Monday, South Korea had 8,200 infections, some 29,000 quarantined, and no lockdowns. Only 75 have died so far.
US Surgeon General Dr Jerome Adams said on Monday: “We are at a critical inflection point in this country. We are where Italy was two weeks ago in terms of our numbers and we have a choice to make as a nation: Do we want to go the direction of South Korea and really be aggressive and lower our mortality rates, or do we want to go the direction of Italy?”
South Korea had started to prepare even before January 12, when China shared the genetic code of the novel coronavirus with the World Health Organisation (WHO). At the time, China had reported only 41 cases. But South Korea knew it was vulnerable — and it was clear on the path ahead.
By the end of January, even though there were only seven confirmed cases in the country of 52 million, testing kits had been distributed across government laboratories, based on China’s information on the virus. Testing was not to be restricted to those with a travel history — everyone with a cold, cough, and pneumonia was tested. Over 2.2 lakh have been screened so far.
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The Ministry of the Interior and Safety developed a mobile phone app, “Self quarantine safety precaution”, to keep tabs on “super spreaders” of the infection. The app monitors the GPS coordinates of those under home quarantine, and alerts the government if they step out. Once a hospital bed becomes available, an ambulance is sent to the patient’s location. The government is also scanning credit card transactions, immigration entry forms, phone and car GPS, and CCTV footage to track suspected cases.
Deputy Health Minister Kim Kang Lip has been quoted as saying that “traditional responses such as locking down affected areas and isolating patients can be only modestly effective, and may cause problems in open societies”. The government has in some cases made details of infected people public, so that every close contact of the patient can come forward for testing.
Italy’s 60 million population is about 15% more than South Korea’s, but it has tested only 73,000 samples — about a third the numbers tested by South Korea. On March 1, Italy had 1,701 cases — less than half South Korea’s 3,736. It now has three times South Korea’s numbers, and almost 29 times the number of deaths.
Italy delayed large-scale screening, which allowed the virus to circulate unnoticed within northern Italy and beyond. The first lockdowns came on February 23, by which time it was too late.
Given the powerful concerns over privacy, measures such as GPS tracking and making the names of infected persons public would appear very difficult, if not impossible, in India. As of now, India is largely following the protocol of screening symptomatic cases with a history of travel abroad. There is no lockdown, but several states have shut schools, malls, theatres, and gyms, and prohibited public gatherings and advised companies to encourage employees to work from home.
The concern is India’s density of population — 464 per sq km on average and over 32,000 in a city like Mumbai, compared with just 206 in Italy — and the vulnerabilities of its healthcare infrastructure. India’s median age though, is 28.4 years compared to Italy’s 47.3, and its weather is overall very different.
India has started testing pneumonia cases randomly, with no travel history, for coronavirus. The number of testing laboratories was on Monday increased to 63, with another nine set to become functional shortly. An expansion of testing capacity is important because many of the samples that have tested positive — where the tested individuals either had travel history or were close contacts — were asymptomatic.
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Epidemiologist Dr Pradeep Awate said India was basing its screening policy on the country’s “population” and “available resources”. Dr Tanu Singhal, an infectious disease expert, said: “We have to try a cocktail of methods. We need to widen screening for severe pneumonia cases with no history to ensure diagnosis of possible cases, but we also need to prioritise based on our diagnostic capacity.”
