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All you need to know about coronavirus cases in India

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The number of coronavirus cases in India has increased sharply from six to 31 this week, as the epidemic that originated in China has infected nearly 95,000 people worldwide.

Authorities in the capital, New Delhi, on Thursday ordered the immediate closure of primary schools until March 31 to prevent local transmission, while the central government made universal screening mandatory for all international passengers arriving in India.

The government also imposed travel restrictions on people from badly affected nations such as Italy, Iran and South Korea, adding to the previous screening of travellers from countries including China and Japan.

According to the World Health Organization (WHO), more than 94,900 confirmed COVID-19 cases and at least 3,272 deaths have been reported globally.

More than 14,500 cases of the virus have been confirmed in 79 countries outside China, with Italy, Iran and South Korea recording 272 deaths.

More than 3,000 have died in China with more than 80,400 cases since the disease known as COVID-19 was first reported last December in Hubei province, the epicentre of the outbreak.

Travel advisory

India's travel advisory came after 16 Italian nationals tested positive for the virus on Wednesday.

The southern city of Bengaluru – an IT hub – New Delhi and its satellite cities, Gurgaon and Ghaziabad, reported one case each.

The patient in Ghaziabad had recently travelled to Iran, which has seen more than 100 deaths and 3,000 infections so far, becoming the worst-affected nation in the Middle East.

India's Health Minister Harsh Vardhan told Parliament on Thursday that stranded Indian pilgrims and students in Iran were a major concern. "Government of India is following up with Iran authorities for their wellbeing and to tie up evacuation as per need," he said.

Last month, New Delhi airlifted its nationals from Wuhan, the capital of Hubei province.

Two private schools in Noida, a satellite city of New Delhi located in Uttar Pradesh state, were also shut down. The authorities maintained that the closure was a precautionary measure and not a government directive.

The health ministry has said that cases of local transmission have also been observed.

"It has been decided to involve district collectors and states have been asked to form rapid response teams at the district, block and village levels. Private sector shall also be engaged for COVID-19 management," Health Minister Vardhan said in a statement.

'Need for preparedness'

As India braces for impact, the main concerns emerging within public health circles include weak surveillance capacity and laboratory strength in the country of a billion-plus people.

"All countries with weak health systems will face challenges in dealing with a widespread outbreak. That is why WHO has been underlining the need for preparedness - surveillance and proper use of data, training of health care workers, referral systems, laboratory capacity, health information systems and community engagement," said Dr Soumya Swaminathan, Chief Scientist, WHO.

"In India, there is wide variability between states in health system capacity and urgent attention needs to be paid to the weaker states."

To date, only government laboratories have the approval to test for COVID-19, a situation which may change with an increase in cases. Clinical samples can be handled by 15 government laboratories, and another 19 laboratories are being prepared to test samples to ensure adequate geographical spread across the country.

With the number of cases rising, the health ministry is considering creating, "a pool of beds in private hospitals", and collaborating with private laboratories for testing samples, according to the health ministry.

The government has identified 35 private laboratories, and plans to expand it to 100 in coming days, it said in a statement.

"I feel if we took the common-sense precautions that apply to infectious diseases, we should be able to get past this without calamitous impact on the population. I am worried more about the hoarding of masks, gloves, etc, which health workers need to respond to the crisis," said Dr Giridhara R Babu, Professor of epidemiology at Indian Institute of Public Health based in Bengaluru.

"My second concern is that weaker health systems, in cases of all kinds of outbreaks, have a heavier toll. Shortages of doctors, hospital beds, ventilators, etc will hamstring out efforts to respond to the epidemic," he said.

Dr Babu also expressed his concerns over the lack of a "robust surveillance system" in India. "Our response will be as good as our surveillance."

Weak health system

India, Pakistan and Bangladesh together account for 1.7 billion people, making South Asia the most-populated part of the world. All have weak health systems.

Containing the outbreak in Southeast Asia is also emerging as a serious concern for global health authorities.

Five of the 11 countries in both of these regions have confirmed COVID-19 cases – Thailand, 43; India, 31; Indonesia, two; and Sri Lanka and Nepal, one each.

On Wednesday, Dr Poonam Khetrapal Singh, Regional Director, WHO Southeast Asia region, said more cases were likely.

"More cases can be expected. Rapidly identifying these cases, isolating them and following their contacts are important initiatives to help limit person-to-person transmission. The speed of our response is critical, which is only possible if we are prepared," she said in a statement released on Wednesday.

The coronavirus spreads from person to person in close proximity, similar to other respiratory illnesses, such as the flu.

WHO has asked countries in Southeast Asia region to strengthen preparedness for "all possible scenarios and ensure early containment measures."

Contain local transmission

As the Indian government moves to contain local transmission of the deadly virus, regular and e-visas granted to nationals from Italy, Iran, South Korea and Japan have been suspended.

Passengers arriving via flights from 12 countries - Italy, Iran, China, Hong Kong, Japan, South Korea, Thailand, Singapore, Nepal, Indonesia, Vietnam and Malaysia - have to undergo compulsory screening at 21 airports across the country.

coronavirus-how-to-stay-safe

The Indian health ministry has directed state governments to identify isolation facilities, and strengthen laboratory diagnosis facilities, as the South Asian country braces for a further surge in cases.

The government said it is confident of measures being taken to control the epidemic. "Health authorities will check and sensitise every household within a three-km radius of the house of the infected person ..." Vardhan, the health minister, said.

Using the approach, the government was able to trace people who had come into contact with the infected Delhi patient.

No Holi celebrations

The Gurgaon patient, an employee of an e-commerce firm, is stable and the company has shut down its office to undertake a sanitisation process.

The Indian health minister added that all patients who tested positive were currently stable.

Meanwhile, Prime Minister Narendra Modi and several other political leaders have tweeted that they would not participate in celebrations for Holi - a spring festival of colours - as "social distancing" is one of the preventive measures advised by health experts.

On Tuesday, WHO issued a warning that severe disruption to the global supply of personal protective equipment (PPE) – caused by rising demand, panic buying, hoarding and misuse – is putting lives at risk.

The shortages of medical supplies like gloves, medical masks, respirators, goggles, face shields, gowns, and aprons are leaving doctors, nurses and other frontline workers dangerously ill-equipped.

"Without secure supply chains, the risk to healthcare workers around the world is real. Industry and governments must act quickly to boost supply, ease export restrictions and put measures in place to stop speculation and hoarding. We can’t stop COVID-19 without protecting health workers first," said WHO Director-General Dr Tedros Adhanom Ghebreyesus.

The WHO has supplied nearly 300,000 pieces of PPE such as caps, goggles, surgical masks, gloves and gowns to South Asian nations, and nearly 200,000 more pieces are being procured.

Meanwhile, as a precautionary measure, the Indian government on Tuesday banned the export of 26 active pharmaceuticals ingredients (APIs) or basic chemicals, including paracetamol, antibiotics and some vitamins, due to the spread of coronavirus.

It also sought to allay fears of scarcity, saying the present stock of APIs may be sufficient for two or three months to manufacture formulations.

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