Last week, the 2019 novel coronavirus (nCoV) strain was declared a global health emergency by World Health Organization. India has, so far, confirmed two cases in Kerala. Dr Bharat Pankhania, senior clinical lecturer at University of Exeter, Department of Medicine and Health, in London, is an expert in communicable diseases and public health. He talks to The Indian Express about the outbreak and how a megapolis like Mumbai needs to handle such an outbreak. Excerpts from an interview:
Why is the present strain of coronavirus causing panic?
The emergence of this virus is a concern because not only has it jumped from bats to humans, but is now being transmitted from one human to another.
The 2019 strain and Severe Acute Respiratory Syndrome (SARS) virus, were first reported in China and belong to the same coronavirus family. How are they similar and yet different?
There is still a lot that we don’t know about this virus. It is related to SARS, but still different. SARS caused severe illness and at least 10 per cent patients died. This virus is infecting people faster and, at the moment, it is causing death in three per cent cases. But this three per cent may not be truly representative of the virus. In China, many people may have been infected but never got seriously ill and never consulted a doctor. So, we only know when a case becomes severely ill and is reported. As of now, we do not know how lethal the virus is. It’s behaving differently from SARS, it is more infectious in humans.
Have researchers managed to assess how it reached humans?
Zoological and veterinary experts are researching the matter. Right now, we don’t know. We can only guess it transmitted from bats to some other animals and finally to humans. There are field workers doing environmental sampling, in animals, to work out who are the natural carriers. Tests will be conducted to check presence of the antibody in animals.
The virus may behave differently with change in weather. How will it behave in India?
Talking empirically, these viruses prefer damp conditions and spread quickly in crowded places. In a crowded situation, where there is poor infection control, it will spread faster from person to person. Crowded trains, walkways and malls are good places for the virus to thrive. The only advice we can give is if a person is unwell, they must remove themselves from circulation to prevent infection. You catch it in a tissue paper when you cough or sneeze. The tissue can’t just be thrown anywhere but disposed of in a dustbin after which you should thoroughly wash your hands with soap and water, and dry them. This precaution is necessary.
How are Mumbai and Wuhan similar?
Most Indian cities are similar to Wuhan. Mumbai is similar to any crowded city in China, and I expect the virus to behave in a similar manner.
Is infection control protocol in India safe enough? Government hospitals lack negative pressure, HEPA (high-efficiency particulate air) filters and separate air conditioning, which is an international mandate for quarantine rooms.
With respect to a possible pandemic outbreak of coronavirus, we do not expect people to be put in negative pressure rooms. It is just not sustainable. The best infection policy is self-isolation. If I cough in my room, the virus is unlikely to spread elsewhere as it spreads through large droplets that can infect only those near you. If we are dealing with a pandemic and thousands are going to need such rooms, there is no way we can produce that many. It is impossible to have HEPA filters and negative pressure rooms.
Is India’s decision to airlift its nationals a wise one, knowing that the virus can also transmit from one person to another even before the symptoms emerge?
It is an individual matter for each country. But these are also political decisions. Indian nationals under lockdown may feel it is best to go home. They may face shortage of services, of food, of masks. Having said that, it is not that China won’t look after Indians; they will look after patients of every nationality. But airlifting Indians is a political decision rather than a medical one. There is a fine interface between medical science and politics. Sometimes, you must be seen as doing something. Airlifting Indians from Wuhan is doing just that.
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