Is India ready to tackle a pandemic like Coronavirus?

The average overall global health security score, based on 140 norms, was only 40.2 out of 100. India scored 46.5 – placing it at 57 in the ranking. In the Southeast Asia region, even Thailand and Indonesia performed better than India with scores of 73.2 and 56.6, respectively.

An optimist would take heart from the manner in which Kerala responded to the outbreak of another deadly virus in Kerala. That state’s handling of the Nipah outbreak in Kerala two years back offers lessons for other states in the areas of coordination among responders, proper communication of risk and ensuring timely interventions.

Weeks before the presence of Nipah in Kozhikode district was reported in the media in May 2018, the virus had been identified by the healthcare system there. But that response would surprise few familiar with Kerala’s robust public health network and readiness.

Official figures reveal the dismal state of India’s healthcare infrastructure. There are only 23,582 government hospitals with 710,761 beds in the country, according to the National Health Profile 2018. These include 19,810 hospitals in rural areas with 279,588 beds and 3,772 hospitals in urban areas with 431,173 beds.

There are a total of 2,900 blood banks, which means less than three blood banks for every 1 million population. With more than 70 percent of India’s population living in rural areas, healthcare delivery will be an uphill task, particularly in case of a disease outbreak.

Since there is no cure in sight for coronavirus and an outbreak can quickly turn uncontrollable, clinicians in India stress the importance of preventive measures.

For its part, the Union health ministry said it is fully aware of the situation on the ground and Cabinet Secretary Rajiv Gauba is reportedly reviewing the country’s preparedness to deal with the virus amid mounting global concern over the increasing number of cases in China.

Wuhan and 12 other Chinese cities have already been completely sealed by the authorities to stop the virus from spreading. The death toll has climbed to 80 with 2,744 confirmed cases. Over 250 to 300 Indian students are remaining stuck in Wuhan, according to media reports.

Minister of Health and Family Welfare Harsh Vardhan has held a review meeting this week and the government is planning to expand passenger screening to 20 airports. At present, thermal screening of passengers coming from China is being done at the seven big airports, including Mumbai, Delhi, Kolkata, Bengaluru, Chennai, and Kochi.

The government also plans to test the virus at 10 laboratories across the country. Currently, only the National Institute of Virology in Pune is conducting the tests. Four new laboratories — the Indian Council of Medical Research’s viral research and diagnostics lab network — at Alapuzha, Bengaluru, Hyderabad, and Mumbai are activated for testing samples.

Sudarshan Ballal, a nephrologist and director of Manipal Institute of Nephrology and Urology, said he doesn’t think India can expect cures soon, but almost all doctors practising in the country are familiar with respiratory viruses, whether it be Severe Acute Respiratory Syndrome (SARS), Middle East respiratory syndrome (MERS), or the regular H1N1.

“It is true that coronavirus is a lot more deadly. Firstly, it is a new virus, which means there is no innate immunity in people who have not been exposed to it in the past. Secondly, the disease can be transmitted even before the symptoms manifest, which means one may not know that the person sitting next to you has the infection,” he said.

Sandeep Budhiraja of Max Healthcare also emphasised the need for strict monitoring and preventive measures. “A few days back, the thought process was that it may not be highly infectious since the infection would get passed only after the symptoms start. However, now that has been proven to be wrong, and the transmission is likely much before the symptoms start. That is a big worry,” he observed.

Some hospitals in the country have already introduced a screening programme as a precautionary step. “Since this is a novel strain of the Coronavirus, there is no herd immunity against it. Moreover, it is a contagious virus affecting the respiratory system which spreads by the droplet method. We have created a screening programme for all patients with Influenza-like illness (ILI). These patients are screened in the Emergency, then examined by Internal Medicine Consultant and categorised into A, B1, B2 and C. If there is a history of travel to China or South East Asia within the last 14 days, the patient will be admitted to the isolation room. Tests will be conducted and treatment will be started,” Dr Ashutosh Shukla, Senior Consultant-Internal Medicine at Artemis Hospitals in Gurugram, said.

The kind of coronavirus that is spreading now, called NCoV, is common in non-human animals. However, these viruses are zoonotic, which means they can spread from animals to humans sometimes and since they are antibiotic resistant, clinicians don't know how to tackle them.

This is a major concern for medical practitioners and researchers here. “Anti-microbial resistance has serious implications for a country like India where misuse of “last-resort” antibiotics for common health conditions is rampant,” a patient advocacy group representative pointed out.

Many microorganisms such as bacteria and fungi have an exceptional capacity to survive in adverse surroundings. Antibiotic resistance arises when such bacteria, referred to as ‘superbugs’, evolve mechanisms to resist the effects of multiple antibiotics targeted to destroy them. When superbugs develop resistance to a particular antibiotic used to treat infections such as diarrhea or tuberculosis, the drug therapy becomes ineffective.

Medical practitioners say the situation in the country is especially alarming, stacked against this grim vantage. A study conducted in the intensive care units of 20 tertiary care hospitals showed that 7 percent of critically ill patients are resistant to antibiotics. Drug resistance to first-line antibiotics also results in 58,000 neonatal deaths each year.