The first case of novel coronavirus, then called 2019-nCoV, was reported from Wuhan, a city in China, on the last day of 2019. In 74 days (until March 13), the disease has spread to 120 countries and infected more than 169,719 people and killed more than 6,518 people, most of them in China, followed by Italy. First coronavirus death in India was reported from Karnataka on March 12. As a matter of fact, seven out of every 10 confirmed cases outside China is from Italy, South Korea and Iran, the three countries together account for 46,921 cases and 2608 deaths.
Every day, there are reports of public events being cancelled and institutions announcing lockdowns to prevent the spread of Covid-19, the word coined for coronavirus disease by the World Health Organisation (WHO) on February 11 by when the number of deaths – 1018 – had surpassed deaths during the 2003 SARS epidemic, which killed 774 people.
On March 11, exactly a month later, the WHO declared the novel coronavirus outbreak as a pandemic. “We are deeply concerned both by the alarming levels of spread and severity and by the alarming levels of inaction,” director general Tedros Adhanom Ghebreyesus told reporters in Geneva. “We have therefore made the assessment that Covid-19 can be characterised as a pandemic.”
The coronavirus has spread around the world, halting business activities, grounding flights, closing schools and offices, and forcing postponement of sporting events. There’s a question mark over the Tokyo Summer Olympics, too.
On the day, WHO declared novel coronavirus a pandemic, Italy, the north European country worst affected outside China, announced a lockdown. It lost 168 people in 24 hours. The country has had 12,462 cases and 827 deaths, replacing South Korea as the country with the second-highest number of cases. Italian Prime Minister Giuseppe Conte told the 60 million residents of his country that they should travel only for the most urgent work or health reasons. The Vatican suspended mass until April 3 because of the emergency. Pope Francis held his weekly general audience via livestream for the first time as the Vatican implemented Italy’s drastic coronavirus lockdown measures and barred the general public from St. Peter’s Square.
After China, Europe is the worst affected. 46% of the cases outside China were reported from Europe – Italy, France, Germany and Spain. About 26% of the cases are in western Pacific region (from Japan to New Zealand) and 23% in Eastern Mediterranean. In other parts of the world, German Chancellor Angela Merkel said “up to 70% of the population was likely to be infected” as the virus spreads around the world in the absence of a cure. In the US, the New York state deployed National Guard troops for the first time during the crisis to help contain the spread of the disease from a suburb. At least 28 people have died in the US with 1,025 infected – nearly double the 550 total confirmed cases the day before. Google and Twitter, meanwhile, recommended its employees work from home if their roles permit.
In India, where 60 Covid-19 cases have been reported and one person has died, all travelers, both Indian nationals and foreigners, arriving from coronavirus-affected countries have been advised to stay under home quarantine for at least 14 days. This is more applicable on travelers from 12 high-risk countries: China, Hong Kong, South Korea, Japan, Italy, Thailand, Singapore, Iran, Malaysia, France, Spain and Germany.
The union health ministry said India has issued an advisory for this, which calls for passengers with travel history to affected high-risk countries to undergo self-imposed quarantine for a period of 14 days from the date of their arrival and their employers to facilitate work-from-home for such employees during this period.
The advisory said: “All incoming international passengers returning to India must self-monitor their health and follow the recommended “DOs and DON’Ts” since more than 100 countries across the world now have reported cases of Covid-19 and travellers to these countries, or any person having travelled abroad, might have come in contact with people affected with Covid-19 during their stay there or even while in transit at airports.”
India also suspended all visas issued on or before March 11 and on which foreigners have not yet entered India. “Regular visas [including e-visas] granted to all foreign nationals who have travel history to these countries on or after 1.2.2020 and who have not yet entered India also stands suspended,” the advisory said. However, visas of all foreigners already in India remain valid. These people have been advised to contact the nearest Foreigners Regional Registration Office/Foreigner’s Registration Officers (FRRO/FRO) through e-FRRO module for extension/conversion of visa or grant of any consular service, if required.
People travelling from, or having visited, Italy or South Korea will need a certificate of having tested negative for Covid-19 from the designated laboratories authorised by the health authorities of these countries to enter India as a temporary measure.
The Indian government also restricted entry of cruise ships at its ports. Only international cruise ships, which had planned and intimated their call to an Indian port by January 1, will be allowed entry. However, the ships will be directed to those ports that have thermal screening facility for passengers and crew. Any international cruise ship or any member of its crew or any passenger having a travel history of visiting any of the Covid-19 affected countries after February 1 will not be permitted to enter any Indian port till March 31.
Exemptions from such restrictions have been made for diplomats, United Nations’ officials and other international bodies, Overseas Citizenship of India (OCI) cardholders and air crew from the above mentioned countries on entry.
Restrictions on visas and on entry for cruise ships came into effect from 1200 GMT on March 13 at the port of departure.
Delhi declared Covid-19 an epidemic and ordered all cinema halls shut, Mumbai banned all public events, and at least four states said they were suspending regular classes in schools and colleges.
The main spread of coronavirus in India was by Italians or by people who have come from Italy, where the virus is virulent. Italian tourists account for 16 of the 44 Covid-19 cases; the driver of the group is also infected. Two from the group are undergoing treatment in Rajasthan; the remaining 14 Italian are in Medanta.
Spread of infection and Covid-19 deaths are linked to demography. Italy, with an ageing population, who tend to have chronic diseases and lower immunity than healthy people, accounted for 5% Covid-19 death rate compared to the 3.4% global average. India has a young demographic with a more robust immunity and has accounted for only one death. Covid-19, like other virus diseases, causes more severe disease among older population, with most children and young adults showing mild symptoms.
The second-highest imported cases in India are from Iran, from where four travellers have come back infected. These are mostly pilgrims, who tend to be older and have limited mobility and social exposure as compared to young adults.
Globally, efforts to contain the spread have been stepped up. The solution lies in wider testing facilities, restrictions on travelers and cancellation of public events. Experts said that India should study the responses of China, South Korea, Italy and the US. South Korea cracked down on the disease’s spread through aggressive testing. India should make sure it has enough testing kits. The second is to restrict and regulate international travel and travellers — inbound as well as outbound. India has already done this. It needs to do more, including, and controversially, a restriction on travellers from the US. The third is to cancel public events. Experts call this social distancing. In both China and South Korea, this helped reverse the trend in terms of new cases. Remember, in Italy, the initial mass exposure happened during mass at churches, when people did not know they had Covid-19.
“Limiting social contact is the only way to stop the spread of the virus and everyone returning from Italy or another affected country, including those without symptoms, must stay home quarantined for two weeks with minimal contact with their family and friends to contain the spread of the virus. And they must get tested if they have symptoms to protect their family,” Hindustan Times quoted Dr RR Gangakhedkar as saying. Gangakhedkar is head of division of epidemiology and communicable disease at Indian Council of Medical Research, India’s apex network of laboratories for testing Covid-19.
However, in India, people are hiding their travel history to avoid quarantine and testing. Doctors feel by doing this, they are hurting themselves and their families. “Some people are reluctant to report symptoms or travel history, with some even running away from isolation facilities,” said an expert. A couple and their 24-year-old son who were diagnosed with Covid-19 in Kerala on Sunday suppressed symptoms and didn’t disclose their recent travel to Italy, which led to the infection spreading to two other family members. In Jaipur, an 85-year-old man, who returned from Dubai, tested positive for Covid-19 on March 11, 10 days after his return. He went to three private hospitals with the symptoms but was never put in isolation. It was only when he went to Jaipur’s SMS Hospital that he was diagnosed with Covid-19 and put in isolation. In 10 days, he, his 78-year-old wife and 50-year-old son, must have come in contact with hundreds of people.
If we want to prevent spread of coronavirus disease in India, people must be upfront about where they have travelled from, who they were in contact with, and if they know of anyone who recently travelled to an affected country.