Coronavirus spread from people without symptoms is rare, says WHO

New Delhi, Apr 14: The World Health Organization on Tuesday lauded "India's tough and timely actions" against the coronavirus spread as Prime Minister Narendra Modi announced the extension of current lockdown till May 3.

"It may be early to talk about results in numbers, but a six-week nationwide lockdown to facilitate effective physical distancing, coupled with the expansion of core public health measures such as detection, isolation and tracing contact of coronavirus positive people, would go a long way in arresting the virus spread," said WHO's South-East Asia Regional Director, Dr Poonam Khetrapal Singh.

"Despite huge and multiple challenges, India has been demonstrating unwavering commitment in its fight against the pandemic," she said.

"In these testing times, the action lies as much with the communities as with the authorities and the health workforce," she added.

"It is indeed time for each and every one to contribute their best and together to beat the virus," Dr Singh said.

Modi on Tuesday said the implementation of the lockdown will be strictly ensured in coming days to ensure that the virus does not spread to new areas

The prime minister said a detailed guideline on the implementation of the new lockdown will be announced on Wednesday.

According the Union Health Ministry figures, a total of 339 people have died of COVIOD-19 till date in the country, while the number of infected cases has soared to 10,363 on Tuesday.

A PTI tally of figures reported by various states as on Monday evening, however, showed at least 346 deaths.

There has been a lag in the Union Health Ministry figures, compared to the number of deaths announced by different states, which officials attribute to procedural delays in assigning the cases to individual states.

May 30: Warning of the tightrope walk ahead as governments battle the coronavirus crisis, Nobel laureate Peter Charles Doherty has expressed concern about densely populated countries such as India relaxing lockdown norms while also describing a complete shutdown as “an economic and social impossibility”.

The Australian immunologist, who cautioned that the number of COVID-19 cases will rise in the coming days, said the earliest time frame for an effective vaccine “going into large numbers of people” is nine to 12 months.

"If all goes well with testing, we could know if some of the candidate vaccines are both safe and effective as early as September/October. Then, rolling a vaccine out will depend on the type of product and how quickly it can be made, put in vials and so forth," Doherty told PTI in an email interview from Melbourne.

The novel coronavirus, he added, does not change fast like influenza and, from what is known so far, “the same vaccine should work everywhere”.

Doherty, who is with the Department of Microbiology and Immunology at the Doherty Institute, University of Melbourne, won the Nobel Prize for Medicine in 1996 for his discovery of how the body’s immune system distinguishes virus-infected cells from normal ones.

Discussing the lockdown, he said, "If it was purely a matter of hard science, everywhere should stay locked down. But that’s pretty much an economic and social impossibility.”

The expectation, he said, is the numbers will rise and limiting spread will depend on people acting responsibly and the capacity for rapid response and extensive contact testing.

“And in a densely populated country like India I think that it will be very difficult," the scientist said.

Several countries, including India, began relaxing lockdown norms in mid-May despite the WHO’s warning about a second wave. India’s lockdown began on March 25 and has since been extended. The fourth phase ends on Sunday.

Asked whether there are any alternatives to a lockdown, the 79-year-old said, "There is no other option other than closing borders. South Korea, for example, conducted massive, intensive testing and contact tracing in a wealthy country with a very disciplined population. Otherwise, not till we have effective vaccines."

He added that he personally doesn’t see the point of closing borders for people coming in if there’s already a high incidence of disease in the community, “unless it’s to avoid the need to care for them and use scarce hospital beds".

According to Doherty, the coronavirus "is a new virus which has come straight out of nature".

“It (the virus) has moved so rapidly across the world because of people travelling on international planes as well as tourist ships," he added.

The immunologist also warned against the use of hydroxychloroquine to treat COVID-19, and said current and planned trials of the anti-malaria drug should be stopped.

“My understanding is that the use of the drug in severe disease is definitely contra-indicated, but it’s not yet clear whether, if taken under medical supervision, it could have some useful effect if taken early on, or as a preventive. Those trials just haven’t been done properly," Doherty noted.

The Indian Council of Medical Research (ICMR) has backed the use of hydroxychloroquine as a preventive against COVID-19 even after the WHO suspended clinical trials of the drug citing safety concerns.

Asked whether plasma therapy can be an effective treatment for COVID-19, Doherty said, "We lack good properly controlled trials but, especially if the plasma has been tested for antibody levels and there’s evidence of good activity, it could be helpful. If I had the disease and was offered plasma therapy I would certainly accept, but I would not take hydroxychloroquine."

Doherty is also very optimistic about herd immunity developing against the SARS-CoV-2 infection.

"We think that (herd immunity) will cut in and have an obvious effect when, say, 60 per cent of people have been infected. Best hope is to boost herd immunity with a vaccine," he stated.

Herd immunity is a form of indirect protection from infectious disease that occurs when a large percentage of a population has become immune to an infection, whether through vaccination or previous infections.

The number of COVID-19 cases have crossed 5.9 million and the fatalities 3,65,000, according to the Johns Hopkins University on Saturday. 

In India, the death toll has risen to 4,971 and the number of cases to 1,73,763, according to the Union Health Ministry on Saturday.

Several states, including Bihar, Uttar Pradesh, Madhya Pradesh, Jharkhand and Chhattisgarh, have reported a rise in number since lockdown norms were relaxed in early May and migrant workers reached home.

In Uttar Pradesh, for instance, the number of infections rose from around 3,000 on May 4 to 6,532 on May 26. Similarly, Bihar’s numbers increased from around 500 to over 2,700 in the period.

Washington, Mar 29: The number of known coronavirus US cases soared well past 115,000, with more than 1,900 dead, as President Donald Trump said on Saturday he was considering imposing a quarantine on the hard hit New York region.

American healthcare workers in the trenches of the pandemic are appealing for more protective gear and equipment to treat a surge in patients that is already pushing hospitals to their limits in virus hot spots such as New York City, New Orleans and Detroit.

Trump told reporters he could order a quarantine on three states, New York, New Jersey and Connecticut, which between them have recorded at least 64,000 infections and 895 deaths.

He also appeared to soften his previous comments calling for the US economy to be swiftly reopened. Asked whether he thought the United States would restart by Easter Sunday, April 12, Trump replied, "We'll see, what happens."

New York Governor Andrew Cuomo said he had no details on any possible quarantine order for his state, telling a briefing: "I don't even know what that means. I don't know how that would be legally enforceable, and from a medical point of view I don't know what you would be accomplishing."

He said New York was postponing its presidential primary election to June 23, from April 28.

As the crisis deepened, nurses at Jacobi Medical Center in New York's borough of the Bronx protested outside the hospital on Saturday, saying supervisors asked them to reuse personal protective equipment, including masks. Some held signs with slogans including "Protect our lives so we can save yours."

"The masks are supposed to be one-time use," one nurse said, according to videos posted online. "Now, all of a sudden the CDC (Centers for Disease Control and Prevention) is saying that it's fine for us to reuse them. These choices are being made not based on science. They're being made based on need."

One resident at New York Presbyterian Hospital said they were issued with just one mask.

"This is your mask forever. You can bring it home with you. Here's how you can clean your mask," said the resident, who asked not to be named because he was not authorized to speak to the media. "It's not the people who are making these decisions that go into the patients' rooms."

Doctors are also especially concerned about a shortage of ventilators, machines that help patients breathe and are widely needed for those suffering from COVID-19, the pneumonia-like respiratory ailment caused by the highly contagious novel coronavirus.

Hospitals have also sounded the alarm about scarcities of drugs, oxygen tanks and trained staff.

By Saturday afternoon, the US number of cases stood at 115,842 with at least 1,929 deaths, according to a Reuters tally. The United States has had the most recorded cases of any country since its count of infections eclipsed those of China and Italy on Thursday.

BLACK MARKET
As shortages of key medical supplies abounded, desperate physicians and nurses were forced to take matters into their own hands.

New York-area doctors say they have had to recycle some protective gear, or even resort to bootleg suppliers.

Dr. Alexander Salerno of Salerno Medical Associates in northern New Jersey described going through a "broker" to pay $17,000 for masks and other protective equipment that should have cost about $2,500, and picking them up at an abandoned warehouse.

"You don't get any names. You get just phone numbers to text," Salerno said. "And so you agree to a term. You wire the money to a bank account. They give you a time and an address to come to."

Nurses at Mount Sinai Hospital in New York said they were locking away or hiding N95 respirator masks, surgical masks and other supplies that are prone to pilfering if left unattended.

"Masks disappear," nurse Diana Torres said. "We hide it all in drawers in front of the nurses' station."

One nurse at Westchester Medical Center, in the suburbs of the city, said colleagues have begun absconding with scarce supplies without asking, prompting better-stocked teams to lock masks, gloves and gowns in drawers and closets.

An emergency room doctor in Michigan, an emerging epicenter of the pandemic, said he was wearing one paper face mask for an entire shift due to a shortage and that hospitals in the Detroit area would soon run out of ventilators.

"We have hospital systems here in the Detroit area in Michigan who are getting to the end of their supply of ventilators and have to start telling families that they can't save their loved ones because they don't have enough equipment," the physician, Dr. Rob Davidson, said in a video posted on Twitter.

Sophia Thomas, a nurse practitioner at DePaul Community Health Center in New Orleans, where Mardi Gras celebrations late last month fueled an outbreak in Louisiana's largest city, said the numbers of coronavirus patients "have been staggering."

In the nation's second-largest city, Los Angeles Mayor Eric Garcetti said spiking cases were putting Southern California on track to match New York City's infection figures in the next week.