New Delhi: In December, several pneumonia cases were reported to the World Health Organization (WHO) from the Chinese city of Wuhan. What would eventually become known as simply ‘coronavirus’ was identified as a novel strain in the coronavirus family, which included viruses that caused the deadly SARS in 2002 and MERS in 2012.
On 7 January, Chinese health authorities confirmed that there is a coronavirus outbreak in the country. In under a month, it has killed over 100 people and infected more than 6,000. The number of infected cases doubled overnight just this week.
Videos from China posted on social media show infected people collapsing on the roads and hospitals dangerously packed with people waiting to get screened.
Terrifying videos of Contagion-like scenes appear to show people infected with coronavirus being taken in boxes and tubes, while doctors collapse in the middle of a hospital.
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In India, the Narendra Modi government has been on edge after four suspected cases surfaced in Delhi, Rajasthan and Bihar. On Thursday, the government confirmed its first case of coronavirus in Kerala. The patient is a student of Wuhan University, which is located in the epicentre of the outbreak in China.
ThePrint details what the virus is, the new strain’s characteristics, and how the Modi government is monitoring its movement in India.
The many strains of coronavirus
Coronaviruses were first discovered in the 1960s, belonging to the family of viruses called coronaviridae. They consist of a single-strand of the largest ribonucleic acid (RNA) — a macromolecule that converts the genetic information encoded by DNA into proteins — among viruses. Each virus has spike-like structures called peplomers. Under a microscope, this makes the virus resemble sketches of the sun.
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The name coronavirus is derived from this reference to the gas-like plasma visible around the sun during solar eclipses.
The newly discovered strain is designated as 2019-nCoV and commonly referred to with the placeholder term ‘novel strain’. Before the new strain was identified, there were six other coronavirus strains — including Severe Acute Respiratory Syndrome (SARS) and Middle East Respiratory Syndrome (MERS).
Among humans, three other strains of coronavirus continuously circulate and cause pneumonia, bronchitis, respiratory tract infections, and even common cold.
Coronaviruses are zoonotic — they get transmitted from humans to animals and vice versa. SARS and MERS, for example, were transmitted from horseshoe bats to humans through an intermediary animal — civet cats and dromedary camels, respectively.
These viruses are transmitted when they enter a cell and deposit the RNA genome into the cell’s fluid, called cytoplasm, which holds all the cell material. In here, a protein called ‘replicase’ enables the RNA to replicate itself, all within the respiratory tract, and spread through the body.
How the new strain is different
Coronaviruses thrive in the winter and are transmitted by airborne droplets. Typical incubation period for a cold-causing coronavirus strain is three days. For the novel strain, this period is anywhere between two and 10 days.
What sets the new strain apart is its ability to spread even during the incubation period before the appearance of any symptoms. This immediately increases its risk of spreading, making it much harder to contain.
When symptoms do appear, they include dry cough, fever, and breathing difficulties, but this could quickly escalate to a fatal condition. The virus also infects children, but the symptoms are typically very mild.
On Tuesday, an expert at China’s National Health Commission said one week was sufficient for a recovery from mild coronavirus symptoms.
There have been at least 47 confirmed cases of infection outside China, in 15 countries, including India’s neighbours Nepal and Sri Lanka, and Thailand, Singapore, Taiwan, Cambodia, Vietnam, Malaysia, South Korea, Japan, France, Germany, Canada, and US.
There have been no deaths yet outside of China.
There is currently no preventive vaccine or cure for the virus. A breakthrough was achieved this week when scientists in Australia became the first to grow the virus from an infected patient. This is expected to aid in drug discovery, diagnosis, and treatment by acting as a “control material” against which antibodies can be built and vaccines tested.
Surveillance and detection in India
On Monday, Cabinet Secretary Rajiv Gauba reviewed the preventive measures on the coronavirus outbreak with secretaries in the ministries of health, external affairs, civil aviation, labour, defence, information and broadcast and the National Disaster Management Authority.
Over 35,000 people have undergone thermal screening in India and a list has been floated to the health ministries of various states of the people who recently travelled to China.
The state governments and the national health missions in the states are working as per the outbreak protocol under the Integrated Disease Surveillance Programme (IDSP) and the technical advice provided by WHO.
Manoj Kumar, Director, National Health Mission, Bihar, said the authorities have screened the family members of a 29-year-old researcher who recently returned from Tianjin in China. The researcher, who is from Chhapra, has been kept in an isolation ward in Patna Medical College and Hospital.
“We are testing all those. We have screened three of her family members along with her co-passenger on the flight she had travelled in. Seven districts of Bihar are on alert and we have asked the officials to look out for those who might have symptoms,” Kumar told ThePrint.
Nepal-bordering Bihar districts Sitamarhi, Kishanganj, Supaul, Madhubani, West Champaran, East Champaran and Araria are currently under surveillance. Nepal has reported a case of the novel virus.
Extensive monitoring is also being done in Rajasthan, where one patient is kept in isolation at the SMS Medical College in Jaipur.
According to Rajasthan Health Secretary Rohit Kumar, nearly 500 people have been screened real-time so far after the suspected case in the state.
Though health experts have expressed their confidence over the outbreak protocols in place, they highlight the need for collaboration between the private and public sectors in order to contain the disease successfully.
“Our biggest problem is our private sector because patients tend to not go to the government sector for something like this. And many times private-sector doctors dismiss such cases till it is too late,” said N. Devadasan, a former WHO employee and technical adviser to the Health Systems Transformation Platform.
Citing the example of the successful containment of the Nipah virus in Kerala in 2018, he said good clinical systems are required for quick identification and response. The Nipah virus is widely considered to have been successfully contained due to a strong health network in the country as well as effective and quick communication from officials enabling instant dissemination of information.
‘Focus all efforts’
On Tuesday, WHO director general Tedros Adhanom Ghebreyesus met Chinese President Xi Jinping to discuss the next steps to contain the outbreak. The meeting came even as Poonam Khetrapal Singh, Regional Director, WHO South-East Asia Region, continued her meetings with India’s Health Minister Harsh Vardhan and ministry officials.
Despite fears over the virus, WHO has not yet declared it a global health emergency. It has, however, rated the virus’ risk as ‘high’. WHO South-East Asia has urged countries in the region to remain vigilant and strengthen readiness to rapidly detect any case of importation of the virus and prevent its spread.
“It is time to focus all efforts on readiness guided by whatever is known about the new coronavirus,” Singh said in a statement Monday.
This report has been updated to include India’s first coronavirus case in Kerala.
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