Are there enough testing facilities in the country? What happens when a person tests positive?

The story so far: On March 8, India’s Health Ministry said the total number of the highly contagious coronavirus disease (COVID-19) cases in the country had risen to 34. In December 2019, the World Health Organisation (WHO) had declared an outbreak of the febrile respiratory illness of unknown etiology from Wuhan, Hubei Province of China. The outbreak was epidemiologically linked to the Wuhan Seafood Wholesale Market involving the sale of seafood and live animals. Later named COVID-19, it has now spread to more than 90 countries apart from China, — there are 101,923 confirmed cases and 3,486 deaths from 94 countries, areas and territories (as on March 7, 10:00 CET). WHO has declared the outbreak as a “Public Health Emergency of International Concern.”

What do we know about the virus?

Little is known about the novel coronavirus (SARS-Cov-2), which currently has no vaccine and has the potential to cause severe illnesses and pneumonia, according to senior health officials in the Indian Council of Medical Research (ICMR). It primarily spreads through the respiratory droplets of infected people. If a person touches a surface or object that has been infected by the virus and then touches his own mouth, nose, or eyes, he may get infected. Symptoms of COVID-19 appear within two to 14 days after exposure and include fever, cough, a runny nose and difficulty in breathing.

Where is screening being done?

As preventive measures, the Health Ministry has recommended universal screening of all international flights, cancellation of biometric attendance for all ministries till March 31, advised against mass gatherings. The Indian Army is now establishing additional quarantine facilities for 1,500 personnel (total) which will be activated at locations as part of the overall effort. The tentative locations identified are at Jaisalmer (Rajasthan), Suratgarh (Rajasthan), Secunderabad (Telangana), Chennai (Tamil Nadu) and Kolkata (West Bengal).

The Ministry has also suggested augmenting isolation facilities in hospitals across India besides ensuring adequate supply of protective gear, medicines and other essential services.

What is the process?

Universal screening for coronavirus is being done at 30 airports having international operations. A total of 7,26,122 passengers have been screened so far from 7,108 flights (as on March 7).

Airlines have been instructed to make in-flight announcements about COVID-19 and all international passengers are being asked to fill the ‘Self Reporting Form’ in duplicate. Those picked out through thermal screening are sent for further tests and isolation and treatment if necessary to designated hospitals including Ram Manohar Lohia and Safdarjung Hospital (both in Delhi). The government has adopted these measures such as universal screening of passengers, filling up self-declaration forms, surveillance of those who have come in contact with infected persons to contain the spread.

What happens if a person tested has fever?

Points of entry such as airports, sea ports, borders have set up a protocol of thermal screening, which means anyone with fever will be picked out. All passengers coming into India are being screened. In case a passenger has a temperature, he is referred for further tests at designated hospitals where COVID-19 symptoms are matched, the country he comes from is looked into, exposure is checked and samples are collected for testing.

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Isolation (home/hospital) is advised for a period of 14 to 21 days when the case samples of the suspected person are sent for testing. If he tests positive, he is sent for treatment and all his contacts are then traced. The test results for COVID-19 are obtained in four to five hours. The virus has an incubation period of about 14 days. According to health officials, India is following WHO-prescribed guidelines to detect, treat and contain the virus.

How is the infection being treated?

A WHO release says: “We are dealing with a new virus and WHO is working closely with clinicians caring for patients with COVID-19, across the globe and international experts on infectious disease to better understand, in real time, the clinical presentation, natural history and treatment interventions for COVID-19.” It adds that a majority of patients with COVID-19 are adults and most patients (80%) experienced mild illness. Approximately 14% experienced severe disease and 5% were critically ill worldwide.

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In India, a senior health official said WHO-prescribed patient management guidance was being followed, which included interim clinical care guidance for hospitalised patients and home care guidance for those with a milder infection which may be treated at home in isolation when the health system is strained.

What are the challenges?

Health Minister Harsh Vardhan said, “India’s additional challenge is to contain clusters due to local transmission. We have provided the Containment Action Plan to all the States. A national level training workshop has been conducted for all the States and hospitals on COVID-19 management which will then be taken up at the district level. Senior officers of the Ministry have been deputed to States and UTs [Union Territories] to review their preparedness and provide required guidance in the containment efforts.”

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He added that the Ministry has designated the District Collector as the nodal officer for containment operations. States have been guided in terms of identifying the containment zone, buffer zone and preparation of a micro plan to ensure effective active and passive surveillance and contact tracing through inter-disciplinary teams in the areas where cases are located. A 24-hour seven day control room is operational with call centre number 011-23978046. So far, more than 9,200 calls have been attended to including 667 international calls, as per information released by the Health Ministry (March 5).

Are testing labs being strengthened?

“Early diagnosis helps in early identification and containment of the disease,” notes a senior ICMR official. As many as 52 laboratories are now operational across the country to test for COVID-19. An additional 57 laboratories have been provided with viral transport media and swabs for sample collection.

Dr. Harsh Vardhan said, “We have tried to limit COVID-19 exposure to India by suspending regular visas/e-visa granted to nationals of Italy, Iran, South Korea, Japan issued on or before March 3, 2020. Also Indian citizens are advised to refrain from travel to China, Iran, South Korea, Italy and Japan. But that isn’t enough. We are now strengthening our testing labs too.”.

As on March 6, 2020, a total of 4,058 samples from 3,404 individuals have been tested by the labs. The Minister said, “This includes testing of 1,308 samples from 654 individuals evacuated from Wuhan, China and quarantined at the Indo-Tibetan Border Police and Manesar Camps and tested twice on days 0 and 14. Subsequently, another 236 individuals evacuated from Wuhan and Diamond Princess Ship, Japan on February 27, 2020 was tested on day 0. Repeat testing will be done on day 14.”

When should a person get tested?

Giving details of who should be considered for COVID-19 testing, the Minister said this would include people who are symptomatic (that is if they have fever, sore throat, running nose, dyspnea, etc), especially individuals who have returned from affected countries (China, Hong Kong, Japan, South Korea, Singapore, Iran, Italy etc.), or have had close contact with confirmed positive cases of COVID-19. The types of samples being taken include throat and nasal swabs.

Is India ready with lab requirements, medicines?

An ICMR release said testing laboratories have been supplied with the primers, probes, PCR reagents, positive and negative controls, and standard operating procedure (SOP) by the National Institute of Virology (NIV), Pune. Further, NIV is also undertaking quality control activities. It maintains an inventory of reagents for itself and testing labs. Currently, NIV has sufficient reagents for facilitating testing in the entire network, the release pointed out.

Chemicals and Fertilizers Minister D.V. Sadananda Gowda said India has sufficient stocks of active pharmaceutical ingredients — the raw materials needed to make medicines — to last the next three months. The statement comes amid reports of disrupted supply chains for active pharmaceutical ingredients (APIs) from China due to the outbreak. He said, “The export ban on 26 APIs for common medicines was imposed to ensure that there is no domestic shortage due to the coronavirus outbreak.”

What are health officials advising?

Health officials said hands must be regularly and thoroughly cleaned with an alcohol-based hand rub or soap and water. A distance of at least 1 metre (3 feet) must be maintained from a person coughing or sneezing. If a person has fever, cough and experiences difficulty breathing, medical attention must be sought. The officials said there is no need to panic and start buying masks.