India currently has over 150 confirmed cases of COVID-19. The government has been quick to adopt a multi pronged strategy, including issuance of clear guidelines to ministries for coordinated action, imposition of travel restrictions, suspension of visas, large-scale screening and contact tracing as well as regular dissemination of information to the public. Mounting a swift response involving all stakeholders in a country of India’s scale and diversity is undoubtedly commendable. With these measures in place we can be confident that India will be able to successfully limit the spread of the disease. Meanwhile in Italy, the number of coronavirus cases and deaths continue to surge. Doctors and nurses are under increasing pressure and are calling out for help while medical supplies run out rapidly. In the US, dozens of health-care workers have fallen ill with covid-19, and more are quarantined after exposure to the virus, an expected but worrisome development as the U.S. health system braces for a surge in infections. The need of the hour is to build a resilient public health system that can prevent diseases, promote good health and respond quickly to minimise loss of life when faced with an outbreak of this magnitude.
A new virus called the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has been identified as the cause of a disease outbreak that began in China in 2019. The disease is called coronavirus disease 2019 (COVID-19).
The virus is a type of coronavirus — a family of viruses that can cause illnesses such as the common cold, severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome (MERS).
How did the outbreak start?
The source of the coronavirus is believed to be a "wet market" in Wuhan which sold both dead and live animals including fish and birds.
Such markets pose a heightened risk of viruses jumping from animals to humans because hygiene standards are difficult to maintain if live animals are being kept and butchered on site. Typically, they are also densely packed.
The animal source of the latest outbreak has not yet been identified, but the original host is thought to be bats. Bats were not sold at the Wuhan market but may have infected live chickens or other animals sold there.
Bats are host to a wide range of zoonotic virusesincluding Ebola, HIV and rabies.
Edited excerpts from the debate:
What is pandemic disease?
A pandemic is the global outbreak of a disease. There are many examples in history, the most recent being the COVID-19 pandemic, declared as such by the World Health Organization on March 12, 2020.
Pandemics are generally classified as epidemics first, which is the rapid spread of a disease across a particular region or regions.
The Zika virus outbreak that began in Brazil in 2014 and made its way across the Caribbean and Latin America was an epidemic, as was the Ebola outbreak in West Africa in 2014-2016.
The U.S. has been experiencing an opioidepidemic since 2017 because of the widespread misuse and high numbers of deaths caused by the drug, according to the S. Department of Health and Human Services.
COVID-19 began as an epidemic in China, before making its way around the world in a matter of months and becoming a pandemic.
But epidemics don't always become pandemics, and it's not always a fast or clear transition.
For example, HIV was considered an epidemic in West Africa for decades before becoming a pandemic in the late 20th century.
What is the difference between ‘epidemic’and ‘pandemic’?
Bigger and spreading.
An epidemic is an outbreak over a larger geographic area. When people in places outside of Wuhan began testing positive for infection with SARS-CoV-2 (which causes the disease known as COVID-19), epidemiologists knew the outbreak was spreading, a likely sign that containment efforts were insufficient or came too late.
This was not unexpected, given that no treatment or vaccine is yet available.
But widespread cases of COVID-19 across China meant that the Wuhan outbreak had grown to an epidemic.
In the most classical sense, once an epidemic spreads to multiple countries or regions of the world, it is considered a pandemic.
However, some epidemiologists classify a situation as a pandemic only once the disease is sustained in some of the newly affected regions through local transmission.
To illustrate, a sick traveler with COVID-19 who returns to the U.S. from China doesn’t make a pandemic, but once they infect a few family members or friends, there’s some debate.
If new local outbreaks ensue, epidemiologists will agree that efforts to control global spread have failed and refer to the emerging situation as a pandemic.
What is the role of robust public health system in dealing with a pandemic?
While all sectors of society are involved in pandemic preparedness and response, the national government is the natural leader for overall coordination and communication efforts.
In its leadership role, the central government should:
identify, appoint, and lead the coordinating body for pandemic preparedness and response; enact or modify legislation and policies required to sustain and optimize pandemic preparedness, capacity development, and response efforts across all sectors;
prioritize and guide the allocation and targeting of resources to achieve the goals as outlined in a country's Pandemic Influenza Preparedness Plan;
provide additional resources for national pandemic preparedness, capacity development, and response measures; and
consider providing resources and technical assistance to countries experiencing outbreaks of influenza with pandemic potential.
What is the situation in India?
India is ill-prepared to cope with the mysterious coronavirus, should it turn into an epidemic, because of a creaky and overburdened health infrastructure.
Public health experts believe that India is ill equipped to handle such emergencies
Current health infrastructure in India paints a dismal picture of healthcare delivery system in the country.
The virus outbreak has been classified as an epidemic by the World Health Organization (WHO) as the disease has already killed thousands of people.
India is not prepared to tackle health epidemics, particularly given its urban congestion. In fact, given the city structure and the way the settlements have grown, epidemics, once they occur, will spread at a galloping rate.
The slum clusters all around the cities, the unhygienic growth, and poor waste disposal system will only aggravate the situation.
Health infrastructure is the basic support for the delivery of public health activities, but current facilities in the country paint a dismal picture of the delivery system.
There are 23,582 government hospitals with 710,761 beds in the country, according to the National Health Profile 2018.
These comprise 19,810 hospitals in rural areas with 279,588 beds and 3,772 hospitals in urban areas with 431,173 beds.
More than 70% of India’s population lives in rural areas and there are 156,231 sub centres, 25,650 primary health centres and 5,624 community health centres to cater to their needs, according to figures from 31 March 2017.
There are a total of 2,903 blood banks, which means less than three blood banks for every 1 million population.
How about other countries?
Most countries, including India, are unprepared for outbreaks of major infectious diseases, with Asian countries facing significant risks, according to the Global Health Security Index 2019.
Thailand and South Korea were among the best-performing countries in Asia, while India was at 57th rank out of 195 countries with a score of 46.5 out of 100, the report said.
There was little evidence that countries have tested emergency capabilities to show they would be functional in a crisis, the report showed.
Fewer than 5% of countries have a national requirement to test their emergency operations centres to respond to a health emergency on an annual basis.
The private sector has emerged as a strong force in India’s healthcare service delivery. For health emergencies such as coronavirus, private hospitals have geared themselves up. However, their network in small towns and villages is poor and not many can afford private treatment, experts said.
What is the spending pattern?
As India braces for the rapid spread of the coronavirus, its health care system offers limited comfort. The country spends only 3.66 percent of its GDP on public health, while some of its smaller neighbors such as Nepal (6.29 percent) spenda much higher proportion.
Advanced economies are even further ahead: The United States, for example, spends about 17 percent of its GDP on health care; Germany and the United Kingdom spend 11.14 percent and 9.76 percent, respectively.
India has just 0.5 hospital beds for every 1,000 people living there; the World Health Organization (WHO) recommends at least five. India averages 8 doctors for every 1,000 citizens; even Italy, which has been badly hit by the coronavirus outbreak, has five times as many doctors per capita.
With 182 reported infections and four deaths so far, is India taking this advice seriously? Is the world's second-most populous country testing enough?
The jury is out on this one. India had tested some 14,175 people in 72 state-run labs - one of the lowest testing rates in the world.
The reason: the country has limited testing. So, only people who have been in touch with an infected person or those who have travelled to high-risk countries, or health workers managing patients with severe respiratory disease and developing Covid-19 symptoms are eligible for testing.
The road ahead:
India has a lower proportion of elderly than other countries, but its healthcare facilities are limited and already struggle to accommodate the large number of patients with other diseases.
This, along with our high population density, can be India’s great challenge.
In an already stretched and underfunded public healthcare system, money spent on the coronavirus leaves less for other public health problems.
The coronavirus may also be spreading in India because health officials have struggled to maintain quarantines, with people fleeing from isolation wards, complaining of filthy conditions.