The first coronavirus case in India was reported on January 30 in Thrissur district of Kerala. (Photo: PTI)

On March 10, India reported six new cases of COVID-19 from Maharashtra and Karnataka--two states that had so far remained untouched by the coronavirus outbreak in India. With this, the overall number of COVID-19 cases in India touched 50. Of these 50 cases, three have been cured and discharged while the remaining are active cases.

Four of the six COVID-19 cases that were reported on March 10 were detected in Bengaluru, and two in Pune. All these patients had a travel history to the US or Dubai--two locations where coronavirus cases have been on a rise.

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The 50th COVID-19 case in India was reported 41 days after the first case was reported in Kerala on January 30. The first patient was a student studying at a university in Wuhan, China (the epicentre of the global coronavirus outbreak) and was spending her vacation at her home in Thrissur district.

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In a span of four days, two more people tested positive for COVID-19 in Kerala. They too were students who had returned from China on vacation.

With the number of confirmed COVID-19 cases in India crossing 50, we take a look at the first 50 cases to understand the geographical spread of coronavirus outbreak in India and the possible manner in which these patients contracted the viral infection.

Geographical spread: 50 cases, 12 states & 18 cities

As on March 10, 13 states and Union territories in India had reported at least one COVID-19 case--Kerala, Tamil Nadu, Telangana, Karnataka, Maharashtra, Uttar Pradesh, Delhi, Haryana, Rajasthan, Punjab, J&K and Ladakh. A further breakdown of the spread shows that the first 50 cases were reported from 19 cities/districts.

The map below depicts the geographical spread of the coronavirus outbreak in India.

The storymap below gives a gist of the cases reported in each city/district and whether the patient(s) had any travel history to a coronavirus-hit country or whether they contracted COVID-19 locally.

Transmission: The travel history of COVID-19 cases

Our analysis of the first 50 COVID-19 cases shows that a majority of them had a travel history to a country that was already affected by the coronavirus outbreak. Analysing statements issued by the Union Health Ministry, we found that 39 of the first 50 COVID-19 cases in India had a foreign travel history, while 11 cases contracted the infection through local transmission i.e. in India.

Most of the cases (23) had a travel history to Italy. This included the 16 Italian nationals who tested positive in Jaipur.

Besides this, four COVID-19 cases had a travel history to Iran and an equal number to the US; three cases had a travel history to China and an equal number to Dubai; one patient had travelled to Oman and one to Thailand and Singapore.

Meanwhile, the 11 cases that contracted the viral infection in India included:

Six cases in Agra (who had come in touch with a Delhi patient);

Two cases in Kerala (who had come in touch with their three family members who had returned from Italy);

One case in Jaipur (the driver hired by the Italian group);

One case in Delhi (a woman who got infected after coming in contact with a patient at a Gurgaon IT firm);

One case in Meerut (who came in touch with the six people tested positive in Agra).

This situation demands caution.

Of the 11 cases of local transmission, 10 were where the patients came in contact with somebody who had travelled abroad. In other words, these patients are the ones who fell ill without having visited any coronavirus-hit country.

Meanwhile, the 11th patient reportedly contracted COVID-19 even though he did not come in contact with anyone who had travelled abroad. This suggests that India has already reached the second stage of infection when the transmission takes place from secondary patients to tertiary patient.

It will be important to see if such cases continue to get reported in the coming weeks.

Timeline of 1st 50 cases

Jan 30: India's first COVID-19 case reported in Kerala's Thrissur district. The patient, a student in Wuhan, China, was home for vacation. She was immediately put in isolation at General Hospital, Thrissur.

Feb 2: Second COVID-19 case reported in Kerala. This time it is in Alappuzha district and the patient too was a student who had returned home from China for vacation. The patient is admitted to Alappuzha Medical College.

Feb 3: Kerala reports third COVID-19 case and the government immediately declared a state emergency. The case was reported in Kasaragod district and the patient was put in isolation at the district hospital. More than 3,400 people who were suspected to have come in contact with the three patients were put in quarantines to contain the coronavirus outbreak.

March 2: After a nearly month-long gap, two new cases are reported-one each in Delhi and Hyderabad. The patient in Delhi had a travel history to Italy and the one in Hyderabad had a travel history to Dubai. The total number of COVID-19 cases now is 5.

March 3: India reports its sixth COVID-19 case. The patient, an Italian national on a trip to India, was detected in Jaipur and was immediately kept in isolation.

March 4: With 22 new cases in a day, this was the worst day for India with regards to the coronavirus outbreak. The 22 cases included the wife of the Italian tourist who tested positive on March 3, and 14 other members of the tourist group they were part of. All group members were Italians.

Besides them, an Indian driver who was hired by the group also tests positive for COVID-19.

Six COVID-19 cases were also reported in Agra. All of them were people who had been exposed to the Delhi patient detected on March 2.

March 5: An employee with a tech firm in Gurgaon tests positive for COVID-19. He had a travel history to Italy. Another case is reported in the Delhi-NCR (in Ghaziabad); the patient had a travel history to Iran.

March 6: One new case reported in Delhi. The patient, a resident of Uttam Nagar, had a travel history to Thailand and Malaysia. With this, the overall number of COVID-19 cases in India climbs to 31.

March 7: Two COVID-19 cases were reported in Ladakh and one in Chennai, Tamil Nadu. The patients in Ladakh had a travel history to Iran and the one in Chennai had a travel history to Oman.

March 8: Kerala sees fresh COVID-19 cases with five people testing positive in Pathanamthitta district. All five cases were from the same family, three of which had a travel history to Italy and two contracted the infection in India.

March 9: India's coronavirus cases mounted further with five new cases being reported in the country. These cases were reported from Jammu, Ernakulam (Kerala), Delhi, Uttar Pradesh and Hoshiarpur (Punjab).

Of the five cases, the patient in Delhi did not have any travel history outside India. Health officials said she contracted the viral infection from the techie who tested positive in Gurgaon on March 5.

The three-year-old girl in Ernakulam and the patient in Punjab had a travel history to Italy; the patient in Jammu (a 63-year-old woman) had a travel history to Iran.

News agency PTI in a report said the case in Uttar Pradesh was detected in Meerut and he had come in contact with the six people who tested positive in Agra on March 4.

March 10: Six new cases reported in India -- two in Maharashtra (Pune) and four in Karnataka (Bengaluru) -- taking the total number to 50. Three of the four patients in Bengaluru had a travel history from to the US and Dubai and the fourth had a travel history to the US via Heathrow in London.

The two patients in Pune had a travel history to Dubai.

Precautions you can take

As per WHO, you should observe the following precautions:

Avoid close contact with people suffering from acute respiratory infections

Wash hands frequently, especially if there is a direct contact will ill people or exposure to their environment

Avoid close contact with live or dead farm and wild animals

If you have symptoms of acute respiratory infection, you should practice cough etiquette (maintain distance, cover cough and sneezes with disposable tissues or clothing and wash hands).

If you are visiting a live animal market, a wet market or any animal product market, practice general hygiene like regular hand washing with soap and potable water after touching animals and animal products.

Avoid touching eyes, nose or mouth with hands and avoid any contact with sick animals or spoiled animal products.

Avoid consuming raw or undercooked animal products and handle raw meat and milk with care.

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