Lessons to learn from Chinese COVID-2019 outbreak:
(a) Complete assessment of virus genome and disclosure. Dr. Maria Van Der Kerkhove from the WHO emphasized that one of the primary reasons for quick diagnosis of coronavirus diagnoses was because the Chinese government had published a full genome-mapping of the new variant within few days of the initial outbreak, making diagnosis easier.9 This is possible partially because China has invested in academic golden generation of doctoral candidates in the biological sciences over the past 15-20 years. China has large academic talent-pool in the life-sciences, especially in molecular biology, microbiology and biochemistry. India too can use a large talent pool of doctors, research labs, pharmaceutical companies if a similar situation arises.
Chinese government had built 2 specialized hospitals for the treatment of coronavirus in just one week. The swift action, scale and rapidity of the Chinese government’s infrastructure development response to the crisis is astonishing.
(b) Responding in massive ways. Since the beginning, the Chinese top government officials involved themselves, and large number of meeting attended by many government officials were conducted to set the intention for action clear. There was a relentless and focussed determination by the government.
(c) Information dissemination. Wuhan regional government’s response and dissemination of information was swift and “state of the art,” The Wuhan government’s public website had declared a red alert extremely early, they were regularly updating impressive quantity of new information in their daily updates, the same was being published since December 31st 2019/January 2020.
(d) Staggering response to development of hospital and healthcare facilities in short time. Chinese government had built 2 specialized hospitals for the treatment of coronavirus in just one week. The swift action, scale and rapidity of the Chinese government’s infrastructure development response to the crisis is astonishing. If India faces a similar situation, the government should plan to convert stadiums, public grounds and buildings into hospitals, and quarantine large sections of infected population by combining Military and private resources.
(e) Preparation of rapid response and contingency plans under Cabinet Committee of Security or Ministry of Defence. While it is common for Ministry of Defence to have contingency plans ready for all possible scenario, it is evident that in China, the Health Ministry also had ready-made and well devised contingency-plans for almost every imaginable public health emergency.
(f) Strict Implementation of quarantine In the race to curb the spread of the new strain of coronavirus the Chinese authorities have indefinitely barred 50 million people from traveling and advised them to stay home to contain the rapidly spreading virus, known as 2019-nCoV. China’s containment measures could theoretically prevent infected people from introducing the virus elsewhere in the country or the world, experts say. But the lockdown orders were likely put into effect too late and could lead to food and medicine shortages that worsen the outbreak and cause mistrust against government. Streets and stores in the usually bustling city of Wuhan, the seventh-most populous in China, are largely deserted. This would be harsh but necessary step to contain the spread of a deadly disease. Quarantine, would involve segregating infected people from those who are healthy. A cordon was implemented in West Africa in 2014 during an Ebola outbreak, prompting cries that it was inhumane to trap people in an infected area while waiting for a fatal disease to run its course.10
The expertise and the involvement of the research lab and the health care professionals should be sought at the earliest stage of detection of the Biological agent.
Necessary components of a biological-warfare contingency plan. The national action plan when a biological weapon is used should incorporate lessons learnt in the past and from similar instances like COIVD-2019 epidemic happening abroad. Depending on the scenario the following lessons can be drawn :-
• Involvement of top politico-military brass. To be able to involve top level of government, health and security agencies at an early stage to identify and contain the spread, by obtaining political and military support.
• Synergising abilities of Healthcare, Bio-Research labs. Converging abilities of indigenous health care facilities and health care workers across the national boundaries. The Indian Council of Medical Research (ICMR) has established first Bio-Safety Level-4 (BSL-4) laboratory in the premise of Microbial Containment Complex (MCC), National Institute of Virology, Pune with support of Department of Science and Technology (DST), New Delhi. Maximum Containment Laboratory [BSL-4] at MCC, Pune has been planned and designed following internationally accepted guidelines of WHO, Geneva and CDC, Atlanta. The expertise and the involvement of the research lab and the health care professionals should be sought at the earliest stage of detection of the Biological agent.
• Identification. To be able to quickly identify sick people and quickly develop an estimate and spread of the epidemic caused by a bio-weapon.
• Quarantine. To quarantine the sick and provide them the treatment. This includes quarantine at airport, seaport, railway stations, bus stations. Primarily to prevent migration from infested area to non-infested area.
• Study International precedents. To immediately assess available data, to learn what standard of care approaches were adopted in other parts of world or in previous incidents of occurrences like in China in similar cases of epidemic. Studying standards of care, therapies, medicines, equipment and detection kit required.
• Safe working environment. Creating safe working environment for healthcare workers and community. List down standard handling practices to prevent transmission, and spread. This should involve quick production and distribution of individual protection equipment.
Ensure continuous and uninterrupted funding and resources for quarantine, medical treatment and research including quick dispersal and smooth flow of logistics across the spread area of the endemic.
• Standardisation procedure to minimise wastages. To laydown standards to optimise use of health care equipment, medical resources i.e. to use minimum and limited resources for maximum benefit.
• Identify industry partners. To lay down guidelines to augment resources if the condition so requires. This would involve identifying industry partners both nationally and internationally. Create international partners. Involve WHO and world bodies at early stage.
• Research. To undertake research, understand the Bio-weapon/ disease in its full spectrum, to understand transmission dynamics, identify animal hosts, identify risk groups, conditions that make disease more severe and effectiveness of medical interventions.
• Master protocols Rapidly developing master protocols for clinical trials will accelerate the potential to assess what works and what does not, improve collaboration and comparison across different studies, streamline ethics review and optimise the evaluation of new investigational drugs, vaccines and diagnostics.
• Sharing of information. The research information on virus materials, clinical samples and data must be immediately and rapidly shared for immediate public health purposes, including information on any successful medical intervention.
• Funding. Ensure continuous and uninterrupted funding and resources for quarantine, medical treatment and research including quick dispersal and smooth flow of logistics across the spread area of the endemic.
• Communication. Use means of mass communication to communicate with public and spread awareness about – distribution and availability of Individual Protection Equipment, use of common anti-sceptics, sanitation measures and steps for avoidance.
Threat of a biological warfare is a reality. Many powerful nations continue to be involved in developing various high-risk strains of pathogens in their Bio-safety research laboratories. India’s has a difficult and high-risk neighbourhood, which has hostile intent and little adherence to international norms.
In case of such epidemic occurring in India, we must seek aid of own Bio-research labs, large pool of doctors and pharmaceutical companies to come out with solution.
There can never be an absolute defence from asymmetric warfare like use of biological weapons.
While we must have contingency plans prepared, the best way to defend against a weapon is to have a weapon of similar capability. Deterrence is created by capability to respond with equal force and letting your adversary know about your capability. India must synergise its medical and healthcare abilities and have contingency plans and course of action ready.
In case of such epidemic occurring in India, we must seek aid of own Bio-research labs, large pool of doctors and pharmaceutical companies to come out with solution. In case, of such epidemic occurring in any part of the world, India must become part of solution provider, so as to earn goodwill and contain the threat where it exists. Doing so, will have learning value and build national abilities to respond to such bio-weapon threats and synergise public and private abilities.
The government in case of such epidemic, should be able to take hard decision of quarantining large areas and population for larger interest of the country. It must be able to provide logistics and ration in such scenario of quarantine. India needs a contingency plan and responsible state actors with a plan of action ready.
Timely action is critical and can save lot of life and help bring the epidemic in control. Enactment of laws delegating roles and responsibilities in such epidemic scenario may be a required step forward in peacetime.
1 https://www.who.int/docs/default-source/coronaviruse/ situation-reports/20200214-sitrep-25-covid-19.pdf?sfvrsn=61dda7d_2
7 https://en.wikipedia.org/wiki/Severe_acute_respiratory_ syndrome
8 https://www.theguardian.com/global/commentisfree/2020/jan/ 23/china-coronavirus-sars-cover-up-beijing-disease-dissent