Limited expertise may hurt India's ability to contain coronavirus outbreak

Foreign domestic workers wear masks to protect themselves from Severe Acute Respiratory Syndrome (SARS), in Hong Kong. Reuters
There are too many unknowns in the recent Wuhan corona virus outbreak that now threatens to become a pandemic. Scientists don’t fully know where the virus came from. They don’t know how virulent it is. Public health officials don’t know how many people have been infected. They don’t know whether the virus can be shed to the environment before the symptoms show up.

All these factors are important to how the world manages to control or limit a pandemic. Yet there is one aspect of the outbreak that is now known clearly: Chinese officials underestimated the severity of the outbreak, even downplaying the mode of infection, and this attitude had an important role in the rapid spread of the disease in the country.

As India prepares itself against the virus, a similar denial or underplaying of the crisis can have equally serious consequences.

India’s limits

India’s ability to contain an epidemic is far less than that of China. Its scientific infrastructure is less advanced and extensive, its ability to quarantine a large number of people non-existent, its hospitals ill-equipped to treat large armies of sick people. The only advantage is the knowledge of the Chinese experience, which India can use to limit the spread of the disease.

Chinese officials had maintained throughout December that there was no evidence of human-to-human transmission. But, as a study just published in the journal Lancet shows, 14 of the 41 the cases analysed had no exposure to the animal market. This suggested that the virus may not have had an origin in the animal market. It also suggested, more ominously, that the outbreak may have started as early as November.

If this is true, there may be a large number of infected people spread widely in the Chinese population, and it makes controlling the epidemic far more difficult. It also makes it difficult to calculate a key parameter in the spread of the disease: a value called R-naught, which is the number of people one sick person can infect.

The World Health Organisation (WHO) estimated the R-naught of between 1.4 and 2.5, and some scientists think it is a slight underestimate. The value is not different from the R-naught of two recent pandemics: SARS and the H1N1 pandemic of 2009.

However, an accurate value of R-naught would depend on the real number of sick people in China. If the number of sick people is high, the R-naught value would drop and is good news for all other countries. Similarly, if the majority of sick people recover the fatality rate – currently at around 3% - would also drop and the outbreak would not be considered as serious as SARS.

In between all this, there is one piece of information that is vital to control a pandemic: whether a sick person begins shedding the virus before the symptoms appear. In the SARS pandemic, patients did not spread the virus before the symptoms appeared. The study in Lancet about one family suggested that patients infected by Wuhan coronavirus could spread the infection before symptoms manifest. Epidemiologists think that such scenarios common for many viruses.

If this turns out to be the case, it will be hard for India to control the spread of the virus in the population. It becomes harder to track the source of an infection and the people a sick person came into contact with. Airport screening for symptoms becomes pointless in such cases. Chinese health minister Ma Xiaowei had said a few days ago that the virus is infectious during its incubation period, but experts think that there is not enough hard evidence.

China is likely to develop a vaccine within three months and determine its safety within another three months. Unless the virus mutates very fast, a commercial vaccine may be available by the end of the year. The next few weeks will give a clue to whether the virus is potent enough to remain in the population till then.

In any case, a pandemic illustrates India’s poor healthcare and scientific infrastructure than any other problem. Dealing with pandemics would require a multi-pronged approach, ranging from mathematical analysis to the ability to rapidly develop drugs and vaccines. India’s healthcare system is too small for such a large population. According to a study published in Lancet a year and a half ago, 1.6 million people die in India every year due to poor quality of healthcare.

India’s scientific expertise, despite its depth in pockets, is not broad enough to respond quickly in such situations. As the director of the National Institute of Virology said recently, India needs 20 times as many virologists as it has at the moment. For a country of 1.3 billion people, India has too few scientists and healthcare professionals to deal with such emergencies.

(The author is a Bengaluru-based science writer and winner of INSA's Indira Gandhi Prize for Popularization of Science, 2020.)

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