Context-With multiple cities in China under a public health lockdown, global supply chains of various essential products and consumer goods are likely to be affected. This should be particularly worrisome for India, which has a roughly $93 billion total trade and about $57 billion trade imbalance with China.

Cause of worry turned into a reality

Public health experts have worried most about an animal virus-

• That gets into humans.
• Causes human-to-human transmission.
• Has high infectivity and a range of clinical severity.
• With no human immunity, no diagnostic tests, drugs or vaccines.
• An emerging virus, called the 2019 novel coronavirus (2019-nCoV), appears to be just that.
• With the World Health Organisation declaring it a Public Health Emergency of International Concern (PHEIC), this outbreak is now a pandemic.

What is coronavirus

Group of animal virus: Coronaviruses are a group of animal viruses identified by their crown-like (corona) appearance under a microscope.

SAARS connection: The 2019-nCoV belongs to this group of viruses, six of which, including the 2003 Severe Acute Respiratory Syndrome (SARS) and the 2012 Middle East Respiratory Syndrome (MERS) viruses, were earlier known to cause disease in humans.

• Genetic similarity with other viruses: Genetic sequencing of the virus from five patients showed it to be 5 per cent identical to the SARS virus.

Bats as hosts: Since the SARS outbreak in 2003, scientists have discovered a large number of SARS-related coronaviruses from their natural hosts-bats.

• Previous studies have shown some of these bat coronaviruses to have the potential to infect humans.
• Genetic sequencing showed it to human coronavirus to be over 96 per cent identical to a bat coronavirus.
• Thus, 2019-nCoV clearly originated from bats, jumped into humans either directly or through an intermediate host, and adapted itself to human-to-human transmission.
• Bats are a particularly rich reservoir for viruses with the potential to infect humans.
• Examples of these include viruses such as Hanta, Rabies, Nipah, Ebola and Marburg viruses, and others that have caused high levels of mortality and morbidity in humans.
• India has 117 species and 100 sub-species of bats, but we know little about the viruses they harbour and their disease potential.

India’s response

India’s response includes-

• Surveillance of arriving passengers at airports.
• Awareness drives in the border states.
• Designation of hospitals with isolation wards and the availability of protective gear (e.g. masks) to health workers.
• SOP: There are clear operating procedures for sample collection and its transport to the National Institute of Virology, Pune, which is the nodal testing centre.
• A self-declaration mechanism is in place and a 24×7 telephone helpline has been set up.

Two areas of concern

• 1. Promotion of untested medicines: There is mixed messaging promoting AYUSH products that are untested and of questionable efficacy.
• 2. India- a hot zone of zoonotic pathogens: India has been a “hot zone” for the emergence of new zoonotic (animal-derived) pathogens for over a decade.
• But we continue to lack the capacity to quickly identify, isolate and characterise a novel pathogen.
• Example of China: China is a good example of how investments in research and public health will allow it to take a lead on developing diagnostic tests, vaccines and drugs for this new virus. We must do the same and prepare for the future.

Disruption in global supply chains and concerns for India

• With multiple cities in China under a public health lockdown, global supply chains of various essential products and consumer goods are likely to be affected.
• This should be particularly worrisome for India, which has a roughly $93 billion total trade and about $57 billion trade imbalance with China.
• Disruption in medicine supply: The Indian pharmaceuticals industry imports about 85 per cent of its active pharmaceutical ingredients from China.
• Any disruption in this supply chain would adversely affect the availability of medicines in India, which would be required in an outbreak situation.
• Need to support local pharma. industry: India must, therefore, take steps to correct this imbalance and support the local pharmaceuticals industry in reducing its dependence on China

Possible scenarios

• Public health experts estimate that the epidemic will peak in three months.
• From here on, there are a few possible scenarios, but which of these would play out is hard to guess.
• 1^st possibility: There could be very large numbers of cases and global spread of the virus with a low CFR of 0.1-0.5 per cent, like the bad flu. Or the same with increased CFR, which would lead to significant mortality.
• 2^nd possibility: It is also possible that the outbreak spiralled in China due to a combination of factors not present elsewhere, such as population density, food habits and the Chinese New Year, which sees large population movements.
  • It is also possible that the pandemic may not sustain outside China and die out like the 2003 SARS outbreak.
• Whatever be the case, surveillance and sensible public health measures will be needed over the next few months.

Conclusion

India escaped the 2003 SARS and 2012 MERS outbreaks largely unscathed. This may still be the case with 2019-nCoV, but the laws of probability are likely to catch up soon. It would help to invest, build capacity and be ready.