No community transmission in India yet, says WHO regional head

Dr Poonam Khetrapal Singh, Regional Director of the WHO's South-East Asia region spoke on variety of topics related to the novel coronavirus, India's response of containing the disease, testing strategy and lockdown

No community transmission in India yet, says WHO regional head

NEW DELHI : 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 to IANS Dr Poonam Khetrapal Singh, Regional Director of the World Health Organisation'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. Here are the excerpts of her 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?

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%), cough (68%) and shortness of breath (19-35%). About 40% of cases seem to have mild disease, 40% of cases have moderate disease (defined as radiology-confirmed pneumonia), about 14% appear to progress to severe disease, and some 5% 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?

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?

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?

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?

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?

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.

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?

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?

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?

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.