SME Times News Bureau | 10 Apr, 2020
Given that many parts of India are witnessing large number of cases of
Covid-19, experts have expressed their views on community transmission,
but speaking exclusively to IANS, Poonam Khetrapal Singh, Regional
Director of the World Health Organization's South-East Asia region, said
that currently cases in India have been traceable so there is no
community transmission.
Dr Khetrapal Singh spoke on variety of
topics related to the novel coronavirus, India's response of containing
the disease, testing strategy and lockdown.
Excerpts of the interview...
What has WHO discovered about
this new virus behaviour and character? What kind of trends or data are
coming about this novel virus? Any findings or conclusion about its
aetiology so far?
Poonam Khetrapal Singh: Based on currently available data, the
main driver of COVID-19 transmission is people who have symptoms.
Preliminary data suggests that people may be more contagious around the
time of symptom onset as compared to later on in the disease. Detailed
exposure histories are being taken to better understand the
pre-symptomatic phase of infection and how transmission may have
occurred in these few instances. While there are some reports of
laboratory-confirmed cases who are truly asymptomatic, to date there has
been no documented asymptomatic transmission. This does not exclude the
possibility that it may occur. Transmission from an asymptomatic person
is very rare with other coronaviruses, such as Middle East Respiratory
Syndrome coronavirus (MERS-CoV). Persons who are symptomatic spread
viruses more readily through coughing or exhaling. WHO is regularly
monitoring all emerging evidence about this critical topic. About the
source, increasing evidence demonstrates the link between the COVID-19
and other similar known coronaviruses circulating in bats, and more
specifically those of the Rhinolophus bat sub-species. At this stage, it
is not possible to determine precisely how humans in China were
initially infected with SARS-CoV-2. The route of transmission to humans
at the start of this event remains unclear. The current most likely
hypothesis is that an intermediary host animal has played a role in the
transmission - this could be a domestic animal, a wild animal, or a
domesticated wild animal and, as of yet, has not been identified. WHO
continues to collaborate with experts, countries and other partners to
identify gaps and research priorities for the control of COVID-19,
caused by the SARS-CoV-2, including the identification of the source of
SARS-CoV-2. Current information suggests that the virus can cause mild,
flu-like symptoms as well as more severe disease. Patients have a range
of symptoms: fever (83-98 per cent), cough (68 per cent) and shortness
of breath (19-35 per cent). About 40 per cent of cases seem to have mild
disease, 40 per cent of cases have moderate disease (defined as
radiology-confirmed pneumonia), about 14 per cent appear to progress to
severe disease, and some 5 per cent are critical. Risk factors for
severe disease are older age and comorbidities. This is a new disease
and our understanding is changing rapidly. WHO continues to analyze
information on both current and any new cases, as this is critical to
enhancing our understanding of severity.
A post is
doing rounds on social media, defining the time frame of survival of the
virus on different kind of surfaces (like aerosols for up to three
hours, up to four hours on copper, up to 24 hours on cardboard and up to
two to three days on plastic and stainless steel) How true it is?
Poonam Khetrapal Singh: The virus that causes COVID-19 is mainly transmitted through droplets
generated when an infected person coughs, sneezes, or speaks. These
droplets are too heavy to hang in the air. They quickly fall on floors
or surfaces. You can be infected by breathing in the virus if you are
within 1 meter of a person who has COVID-19, or by touching a
contaminated surface and then touching your eyes, nose or mouth before
washing your hands. Surfaces can be contaminated with the virus. Studies
conducted on SARS-CoV and MERS-CoV indicate that coronaviruses can
persist on different surfaces for up to a few days depending on a
combination of parameters such as temperature, humidity and light. Thus,
frequent hand washing and cleaning of surfaces has been always
recommended by WHO.
Has WHO done any finding on this SARS-CoV-2 relation, response or reaction with (High and Low) temperature?
Poonam Khetrapal Singh: There is no robust evidence yet to such hypotheses. It is important
that people practice hand hygiene regularly with soap and water; clean
surfaces regularly with disinfectant - for example kitchen benches and
work desks; cover their cough and sneeze; take extra precautions to
avoid crowded areas if you are over 60, or if you have an underlying
condition such as cardiovascular disease, diabetes, chronic respiratory
disease, and cancer; if you are sick, stay at home, and eat and sleep
separately from your family, use different utensils and cutlery to eat;
and if you develop shortness of breath, call your doctor and seek care
immediately.
How far is the world still from finding therapeutic cure for COVID-19?
Poonam Khetrapal Singh: No pharmaceutical products have yet been shown to be safe and effective
for the treatment of COVID-19. However, a number of medicines have been
suggested as potential investigational therapies, many of which are now
being studied in clinical trials, including the Solidarity trial
co-sponsored by WHO and participating countries. So far, 74 countries
have either joined the Solidarity trial or are in the process of joining
and more than 200 patients had been randomly assigned to one of the
study arms. Each new patient who joins the trial gets us one step closer
to knowing which drugs work. There are multiple randomized clinical
trials investigating the safety and efficacy of anti-virals and steroids
ongoing worldwide.
Although health authorities have
not said that it is a 'community transmission' stage in India. Do you
think the same?
Poonam Khetrapal Singh: : Community transmission in any country is
confirmed when the source of infection is unclear. In other words, when
transmission in a given area - is extensive, in multiple locations,
without reported travel history to areas reporting community
transmission and without epidemiological links to known cases. Currently
cases in India have been traceable. However, whatever the stage, the
key action points are - engage with people; find, isolate, test and
treat and trace every contact; ready your hospitals; and protect and
train health workers. That's the only way to combat COVID19.
Do you think India is conducting less tests even as WHO Director General said "testing testing and testing?
Poonam Khetrapal Singh: On testing, India's response has been proportionate to the need and the
transmission scenario of COVID-19. The country has, on an ongoing
basis, been ramping up its capacities with currently 152 public sector
laboratories and 49 accredited private lab chains testing all
symptomatic individuals who have undertaken international travel in the
last 14 days; all symptomatic contacts of laboratory confirmed cases;
all symptomatic health care workers; all hospitalized patients with
Severe Acute Respiratory Illness and asymptomatic direct and high-risk
contacts of a confirmed case. Besides all influenza like cases in
hotspot areas are being tested. India has been calibrating its testing
strategy as per the changing situation, taking into account scope, need
and capacity.
Question 7: Looking at the number of cases, do you
think India is amid an outbreak? Or do see that the disease is still
contained very well here? Do you think India has taken the decision of
lockdown very late, despite early warning from WHO?
Poonam Khetrapal Singh: India has so far managed to keep cases relatively low by rolling out
quick and aggressive response. India has an advantage as the
country-initiated response early and had an opportunity to learn from
other countries that are ahead in terms of cases and applying different
strategies in responding to the ongoing pandemic. The most effective way
to control an outbreak is to detect disease early, isolate, treat,
trace contacts, and promote social distancing measures. A lockdown helps
in conducting these well but is not the solution by itself in curbing
the epidemic.
Is India getting any help in procuring PPE from WHO funds? Or do you think it's doing very well on its own?
Poonam Khetrapal Singh: India's response is nationally funded. WHO has provided some PPEs and
primers and probes from its stockpile, and is also facilitating supplies
through the global pandemic supply chain. WHO's work with the Ministry
of Health and Family Welfare and state governments on various
preparedness and response measures include strengthening surveillance
and contact tracing; laboratory and research protocols; risk
communications; hospital preparedness; training on infection prevention
and control and cluster containment plan.
How do you
think India is responding to the evolving situation as compared to
other countries in the South Asian region?
Poonam Khetrapal Singh: WHO has been
recommending all countries to scale up emergency response mechanism to
A1) engage with people, 2) Find, isolate, test and treat every case and
trace every contact; 3) ready hospitals; and 4) protect and train health
workers.India's response to COVID-19 has been pre-emptive, pro-active
and graded with high-level political commitment. India's efforts, that
are led by the highest political leadership, is very much in line with
WHO recommended actions such as coordination, planning, and monitoring;
community engagement; surveillance, rapid response teams and case
investigation, points of entry, national laboratories; infection
prevention and control; case management; and operational support and
logistics. This needs to continue/be ensured at all levels.