The Surat plague was badly handled, but India dealt with the Nipah crisis well; institutionalising the lessons is critical.
China’s coronavirus crisis is an opportunity for India to ensure epidemic preparedness. Apart from the lack of healthcare capacity to deal with the crisis—this, after its 2002 SARS outbreak killed over 700 people—China’s response to the outbreak might end up being a factor contributing to the rise in death toll. The country’s primary healthcare system being ill-equipped to handle the outbreak has meant that its hospitals are buckling under pressure.
Three 1,000 bed hospitals are being built at breakneck speed, but this is quite late in the day. Recently, eight hospitals in Hubei province, whose capital, Wuhan, is ground-zero, put out a call for basic transmission-prevention articles—N95 masks, surgical gowns, and goggles.
New York Times reports medical workers had to resort to jugaad substitutes. Moreover, three major Chinese drug firms have announced they lack the capacity to generate the requisite number of test-kits. China has made considerable investment in public healthcare since 2002, but, clearly, it hadn’t prepared enough. Although, there is more transparent information flow from the country regarding the novel coronavirus 2019 (nCoV-2019) than there was at the time of SARS.
The early sharing of information, including the viral genome sequence, will help other countries develop protocols for early response. But, Chinese authorities ignored earlier scientific warnings on the increased possibility of such outbreaks. Wuhan Institute of Virology researchers tracing coronaviruses since 2002 had warned of their zoonotic links, and that some of these are singularly suited to transmission to humans.
In the absence of any specific treatment, patients are reportedly being administered a host of antivirals, including that for HIV, and traditional Chinese medicine. Given how fast viruses can mutate, even developing resistance, this could prove a recipe for tragedy. And, while the lockdown of nearly 56 million Chinese could help contain the virus geographically, the transport restrictions could also severely affect mobilisation of crucial healthcare infrastructure, potentially pushing up the death toll.
India must learn from all this. The country rose to the Nipah challenge in 2018 after initially faltering, as there was exemplary coordination between local, state and national authorities—the lack of this caused the Surat plague to reach the proportions it did. However, Nipah was a fledgling challenge compared with what China is facing. To prevent nCoV from reaching its shores or, at least, contain it there if it does, India needs to make sure its entry points—airports and ports—are fortified with screening, and quarantining facilities. Heat scanners that can detect fever, a symptom of infection, at airports are a great start, but the first-line of medical intervention needs to be beefed up.
Apart from making sure diagnostics and treatment facilities are bolstered, fighting or preventing an epidemic will require significant public awareness, on methods of transmission, handling of patients and everything in between.
The frontline of the fight against communicable diseases is vaccination, and India must engage with vaccine research in a concentrated manner, more so since every warning of the climate change ramifications for India talk of a spurt in tropical, communicable diseases.