India reports first case of novel coronavirus
doi:10.1038/nindia.2020.15 Published online 30 January 2020
Indian authorities have reported the first confirmed case of the novel coronavirus in the southern state of Kerala.The country's ministry of health and family welfare announced Thursday (30 January 2019) that an Indian student who recently returned from the Wuhan University in China has tested positive for the virus.
The patient is stable and is being monitored in a hospital in Kerala, the ministry said in a release.
Priya Abraham, director of India's central facility the National Institute of Virology in Pune said that of the 49 samples they had received till now, this one from a woman in Thrissur district of Kerala was positive. NIV has been receiving about 10 samples every day in the past week and is equipped to turn around results for coronavirus in a day, she said.
Three other patients, suspected of carrying the virus were isolated in New Delhi's Ram Manohar Lohia hospital earlier but they have tested negative. Some other suspected cases were isolated in Rajasthan and Bihar states. More than 800 people who have returned from China to Kerala after the outbreak in Wuhan were being observed either in hospital isolation wards or under home quarantine. The ministry has advised a 14-day isolation period for people who may have recently traveled to China.
Two cases of the novel coronavirus (2019 nCoV) have also been reported from neighbouring Nepal and Sri Lanka.
India mounted vigil on the virus, which causes severe respiratory illness, following its outbreak in neighbouring China in December 2019. Besides a travel advisory, the health ministry has issued guidelines for the clinical management of severe acute respiratory illness (SARI) in suspected or confirmed cases of the virus. India's health minister Harsh Vardhan said 20 airports across the country had installed thermal screening facilities for everyone with a recent travel history to China.
Earlier this week, India reviewed its national preventive measures huddling secretaries from the ministries of health, external affairs, civil aviation, labour, defence, information and broadcast and the National Disaster Management Authority.
Public health experts, however, feel that India may not be sufficiently equipped to tackle a health emergency, should it arise.
“Since the virus can infect during the pre-clinical phase when there are no symptoms, simply revving up surveillance at entry points to the country may not be enough," says K. Srinath Reddy, President of the public-private initiative Public Health Foundation of India. Health services have to be prepared to quickly identify cases and segregate them, he says.
He also points out that the capability to manage an outbreak differs across India's states and between urban and rural populations. “There should be a strong emphasis on risk communication to educate the community about prevention and personal care, while reassuring people to dispel panic," he adds. The government needs to invest more in health systems to handle emergency risk communication.
Meanwhile, India's cabinet secretary Rajiv Gauba reviewed the emerging situation during the day and suggested heightened outreach in rural areas as well as villages bordering Nepal. The government would also put up check-posts in key tourist locations for better surveillance.
The sheer volume of airline traffic that India handles could be another challenge in such emerging global outbreaks, says Indrani Gupta, Professor and Head of the Health Policy Research Unit at the Institute of Economic Growth in Delhi.
The coronavirus spreads asymptomatically and takes time to manifest, raising the probability of missing cases, she points out. "While the government is taking all precautions, a few missed cases can rapidly escalate the problem," Gupta says. India's over-stretched health system, where a substantial number of people seek care from the private sector, surveillance and monitoring also puts immense pressure on the health sector.
The Global Health Security Index 2019, in which India ranked 57 among 195 countries, underlines that national health security is fundamentally weak around the world. No country is fully prepared for epidemics or pandemics and every country has important gaps to address.
Clinician scientist Gagandeep Kang, who was part of the collaborative effort that developed an indigenous rotavirus vaccine, says an inter-connected world makes it challenging to limit the spread of respiratory viruses even with new age screening procedures. Kang, a professor in the Division of Gastrointestinal Sciences, Christian Medical College, Vellore, suggests creating a responsive system that provides widely available standard diagnostic tests. "Once potentially exposed individuals are identified, we must lower the risk of their transmitting infection through quarantine, cohorting and infection control practices."
As the first confirmed case was detected, India pressed into service six more laboratories in Karnataka, Delhi and Kerala states for testing suspected cases. Six more in Kolkata, Secunderabad, Lucknow, Jaipur, Nagpur and Chennai were expected to start working by 31 January 2019.