Corona virus update

Corona virus update and compiled information

I have been getting a lot of calls from many investor friends from the industry who were anxious in the wake of the ongoing Corona virus crisis. Having qualifications in the subjects of public health and that I am a qualified doctor probably makes them get in touch with me. I thought of compiling important information which was otherwise scattered across the web into a single concise page for quick reading. I hope this mitigates a lot of queries many have regarding Corona virus, specially in Indian context.

V.IMP: India Official national update site (Please visit https://www.mohfw.gov.in for latest updates):

• Total number of passengers screened at airport (9th Mar) : 9,41,717 
• Total number of Confirmed COVID 2019 cases across India * : 43 (27 National, 16 foreign nationals) (includingforeign nationals, as on 08.03.2020 at 10 AM)
• As per MOHFW site (https://www.mohfw.gov.in) , regions with confirmed cases are Delhi, Haryana, Kerala, Rajasthan, Telengana, Uttar Pradesh, Ladakh, J&K & Tamil Nadu
• Mumbai & Maharashtra have no official cases notified yet as of 9th March 2020

Official helpline numbers India: 

+91-11-23978046

The Helpline Email ID for corona-virus : ncov2019@gmail.com

WHO India official update site:

https://www.who.int/india/emergencies/novel-coronavirus-2019

Official WHO India Page:

https://www.who.int/india/

Appreciation from WHO: 

"The Government of India has demonstrated strong commitment for preparedness and response to COVID-19, which is being led by the Prime Minister’s office and coordinated by the Ministry of Health & Family Welfare (MoHFW)"- Dr Henk Bekedam, WHO Country Representative to India

WHO on their website for India continues to mention that the "Prime Minister's Office, MoHFW and Cabinet Secretary are closely monitoring the situation of COVID-19. States were also asked to identify possible quarantine facilities, to augment isolation wards and for active engagement of district collectors in cluster management at district, block and village levels. Passengers (foreign and Indian) arriving directly or indirectly from China, Hong Kong, Indonesia, Iran, Italy, Japan, Macau, Malaysia, Nepal, Singapore, South Korea, Taiwan, Thailand and Vietnam are screened at point of entry. Indian citizens are advised to refrain from travel to China, Iran, Italy, Republic of Korea and advised to avoid non-essential travel to other COVID-19 affected countries".

This endorsement by WHO is a sigh of relief that the Indian government is doing its best to mitigate the situation.

India Travel & Visa Advisory: https://www.mohfw.gov.in/DraftTraveladvisorytotravelersUpdated06032020.pdf

https://boi.gov.in/content/advisory-travel-and-visa-restrictions-related-covid-19

Indian Mass Gathering Advisory: 

https://www.mohfw.gov.in/advisoryformassgathering.pdf

Official Indian Ministry poster:

https://www.mohfw.gov.in/Poster_Corona_ad_Eng.pdf

Indian Ministry Biometrics attendance advisory:

https://www.mohfw.gov.in/advisoryforbiometricattendance.pdf

2019-Novel CoV Testing Laboratories:

https://dhr.gov.in/sites/default/files/COVID-19%20Testing%20Laboratories.pdf

Guidance Document For State Nodal VRDL 9To give an overview on how state nodal officers react)

https://dhr.gov.in/sites/default/files/GuidanceDocument%20For%20StateNodal%20VRDL.pdf

All research updates from Indian official site: 

https://dhr.gov.in/whatsnew/2019-novel-corona-virus

Official PMO Tweet with poster:

https://twitter.com/narendramodi/status/1234762662413660165?s=20

About the Virus:

With the current information available, it is suggested that the route of human-to-human transmission of 2019-nCoV is either via respiratory droplets or contact. Any person who is in close contact (within 1 meter/3Feet) with someone who has respiratory symptoms like sneezing, coughing, etc is at risk of being exposed to potentially infective respiratory droplets. 

"Coronaviruses (CoV) are a large family of viruses that cause illness ranging from the common cold to more severe diseases such as Middle East Respiratory Syndrome (MERS-CoV) and Severe Acute Respiratory Syndrome (SARS-CoV). A novel coronavirus (nCoV) is a new strain that has not been previously identified in humans.  Coronaviruses are zoonotic, meaning they are transmitted between animals and people.  Several known coronaviruses are circulating in animals that have not yet infected humans" - This is concerning as strange food habbits like eating bats or live animals among various populations pose a threat in future for similar outbreaks if such habbits are not contained by the governments. 

Various studies and scientific papers published on such habits were published prior to the corona virus outbreak:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6466186/

https://www.sciencedirect.com/science/article/pii/S2590053619300308

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3168224/

https://www.mdpi.com/journal/viruses/special_issues/viruses_bats_2019

Higher risks:

Early information out of China, where COVID-19 first started, shows that certain populations are at higher risk of getting very sick and include:

• Older adults
• People who have serious chronic medical conditions like:
• Heart disease
• Diabetes
• Lung disease

Incubation Period:

The “incubation period” which is the time between getting exposed to the COVID19 virus and beginning to have symptoms of the disease. Most estimates of the incubation period range from 1-14 days & mostly around five days.

Common signs of infection & recommendations:

https://www.who.int/health-topics/coronavirus

Common signs of infection include respiratory symptoms, fever, cough, shortness of breath and breathing difficulties. In more severe cases, infection can cause pneumonia, severe acute respiratory syndrome, kidney failure and even death. 

WHO General advisory:

https://www.who.int/emergencies/diseases/novel-coronavirus-2019/advice-for-public

1. Wash your hands frequently

2. Maintain social distancing

Maintain at least 1 metre (3 feet) distance between yourself and anyone who is coughing or sneezing. Work from home should be encouraged where feasible and intercity travel must be avoided as far as possible to avoid intermingling at airports as hubs of infection from unkown sources of infections from various foreign trvelers who may avoid detection due to incubation periods.

3. Avoid touching eyes, nose and mouth

4. Practice respiratory hygiene

Make sure good respiratory hygiene is followed which includes covering mouth and nose with your bent elbow or tissue when you cough or sneeze. Then dispose of the used tissue immediately in lined dustbins.

5. If you have fever, cough and difficulty breathing, seek medical care early

Stay home if you feel unwell. If you have a fever, cough and difficulty breathing, seek medical attention and call in advance. Follow the directions of your local health authority.

6. Stay informed and follow advice given by your healthcare provider

More WHO FAQ on Corona virus:

https://www.who.int/news-room/q-a-detail/q-a-coronaviruses

Indian Ministry advise on mass gatherings: 

Mass gathering is ill-advised, I suggest all Holi gatherings and other group celebrations like birthday gatherings etc should be avoided: https://www.mohfw.gov.in/advisoryformassgathering.pdf

Lab Test:

According to recommendations by the World Health Organization. the diagnosis of COVID-19 must be confirmed by RT-PCR or gene sequencing for respiratory or blood specimens, as the key indicator for hospitalisation.  The samples may include a awb from throat or nose, a nasal aspirate, tracheal aspirate or a sputum test.

Confirmation of test:

Confirmation takes 12-24 hours as the test includes polymerase chain reaction (PCR) and a more sensitive form called reverse-transcription polymerase chain reaction (RTPCR). Various labs in India have been set up in government labs or in collaboration with private centres. All these labs are work under the guidance of National Institute of Virology (NIV), Pune. 

WHO Advice on use of masks:

https://www.who.int/docs/default-source/documents/advice-on-the-use-of-masks-2019-ncov.pdf | https://www.who.int/emergencies/diseases/novel-coronavirus-2019/advice-for-public/when-and-how-to-use-masks

Wearing a medical mask is one of the prevention measures to limit spread of certain respiratory diseases, including 2019- nCoV, in affected areas. However, the use of a mask alone is insufficient to provide the adequate level of protection and other equally relevant measures should be adopted. If you are healthy, you only need to wear a mask if you are taking care of a person with suspected 2019-nCoV infection. If masks are to be used, this measure must be combined with hand hygiene and other IPC measures to prevent the human-to- human transmission of 2019-nCov. WHO has developed guidance for home care and health care settings on infection prevention and control (IPC) strategies for use when infection with 2019-nCoV is suspected. 

Wearing medical masks when not indicated may cause unnecessary cost, procurement burden and create a false sense of security that can lead to neglecting other essential measures such as hand hygiene practices.

Replace the mask with a new one as soon as it is damp and do not re-use single-use masks.

To remove the mask: remove it from behind (do not touch the front of mask); discard immediately in a closed bin; clean hands with alcohol-based hand rub or soap and water. 

Cloth masks are not recommended under any circumstance. 

Economic Impact and care: Several industry colleagues asked me on the economic impact of the corona virus how it compares to SARS/MERS, I have compiled some information on that as follows:

Economic impact and historic comparison with SARS/MERS https://www.weforum.org/agenda/2020/02/comparing-outbreaks-coronavirus-mers-sars-health-epidemic/Coronavirus has spread much more quickly than SARS or MERS, but…..The latest data suggests that it's less deadly than either SARS or MERS (The latest statistics indicate a fatality rate of about 2.2%, but disease experts say the actual rate may be higher or lower as there are likely more unconfirmed cases.
The SARS virus killed about 10% of all infected individuals, while the MERS outbreak identified in 2012 had a fatality rate of around 35%

International alarm over the coronavirus that emerged in Wuhan, China, in December is driven by its rapid spread and the fact that infectious disease experts cannot yet know how deadly or contagious it is.

Within weeks, the virus has infected more people than Severe Acute Respiratory Syndrome (SARS) did in months. On Jan. 30, the World Health Organization declared the outbreak a global emergency. 

When compared to the new virus, the spread of SARS took much longer to gain momentum. Middle East Respiratory Syndrome (MERS) that first emerged in Saudi Arabia in 2012, took eight years to infect almost 2,500 people. SO i feel, due to the uniqueness of the world today, that its is immensely digitally connected as compared to 2003 of SARS, the learnings and execution of good effective practices from one part of the world is extremely quick into another part of the world. 

The speed of spreading information (Possible in the presently digitally connected word) is the key to eventual success in dealing with the Corona virus.

Various News articles cite parallels of coronavirus outbreak with the SARS crisis of 2002/2003 where 800 people dies in about 17 countries. But in 2003 the markets were breaking out of difficult recession. But the coronavirus outbreak has not leached that epidemic level of SARS, Ebola, Bird Flu in terms of fatality percentage and the mitigation now is is much more mature and quicker.

Economic papers on SARS:

https://www.ncbi.nlm.nih.gov/books/NBK92473/

https://www.cnbc.com/2020/02/11/coronavirus-4-charts-show-how-sars-hit-chinas-economy-in-2003.html

https://www.bloomberg.com/news/articles/2020-01-31/the-coronavirus-is-more-dangerous-for-the-economy-than-sars

https://www.cnbc.com/2020/02/06/coronavirus-the-hit-to-the-global-economy-will-be-worse-than-sars.html

https://economictimes.indiatimes.com/news/economy/finance/coronavirus-fall-to-have-minimal-impact-on-indias-gdp-report/articleshow/74471188.cms

Many industry leaders citied previous epidemic related economic turmoil to be a result of panic more tan the virus.- So if the panic is curtailed, enough confidence building measures promoted, regular updates on mitigation shared by countries to its citizens, the corona virus impact can soon be mitigated without much affect on the markets.

Sequioa also had some advise for investors Facing challenges as a result of the virus outbreak,including efforts to address drop in business activity, sSupply chain disruptions, curtailment of travel and canceled meetings. It also suggest to have enough cash runway to withstand a few poor quarters with contingency plans. preapring for fundraising crunch, opportunities to create innovative & creative business models, revision in sales forecast, improving marketing efforts and change in customer acquisition strategies, to evaluate headcount critically, and reavaluating capitl spends. https://medium.com/sequoia-capital/coronavirus-the-black-swan-of-2020-7c72bdeb9753 

Important caution:

https://www.who.int/emergencies/diseases/novel-coronavirus-2019/advice-for-public/myth-busters

1. Cold weather and snow CANNOT kill the new coronavirus.
2. Taking a hot bath does not prevent the new coronavirus disease
3. The new coronavirus cannot be transmitted through goods manufactured in China or any country reporting COVID-19 cases.
4. The new coronavirus CANNOT be transmitted through mosquito bites.
5. Hand dryers are not effective in killing the new coronavirus?
6. Ultraviolet disinfection lamp should not be used as it can cause irritation
7. Thermal scanners are effective in detecting people who have developed a fever (i.e. have a higher than normal body temperature) because of infection with the new coronavirus, however, they cannot detect people who are infected but are not yet sick with fever. This is because it takes between 2 and 10 days before people who are infected become sick and develop a fever.
8. Spraying alcohol or chlorine all over your body will not kill viruses that have already entered your body. 
9. At present, there is no evidence that companion animals/pets such as dogs or cats can be infected with the new coronavirus
10. Vaccines against pneumonia, such as pneumococcal vaccine and Haemophilus influenza type B (Hib) vaccine, do not provide protection against the new coronavirus.
11. The virus is so new and different that it needs its own vaccine. Researchers are trying to develop a vaccine against 2019-nCoV, and WHO is supporting their efforts.
12. There is no evidence that regularly rinsing the nose with saline has protected people from infection with the new coronavirus. 
13. Garlic is a healthy food that may have some antimicrobial properties. However, there is no evidence from the current outbreak that eating garlic has protected people from the new coronavirus.
14. People of all ages can be infected by the new coronavirus (2019-nCoV). Older people, and people with pre-existing medical conditions (such as asthma, diabetes, heart disease) appear to be more vulnerable to becoming severely ill with the virus. 
15. Antibiotics do not work against viruses, only bacteria. The new coronavirus (2019-nCoV) is a virus and, therefore, antibiotics should not be used as a means of prevention or treatment.
16. To date, there is no specific medicine recommended to prevent or treat the new coronavirus (2019-nCoV). 

Warm Weather effect:

Various professionals suggest that warm weather has a mitigating effect in spreading the virus.

As per one news report, "Souren Panja, Head, Critical Care, RTIICS concurs with Aggarwal. The typical Indian weather is certainly a deterrent, he believes. According to him, "The geographical spread of nCoV suggests that it has so far been restricted to cooler climates." According to Arindam Biswas, and internal medicine consultant, three factors determine a virus' spread — the "agent or the virus itself, the host and the environment". While the agent and the host are present everywhere, India didn't give the virus an ideal weather condition, he thinks. https://time.com/5790880/coronavirus-warm-weather-summer/

Reasons citied by professionals is that that warm, humid weather can make it harder for respiratory droplets to spread viruses. The UV light from sunshine also helps reduce viral transmission according to some.

“The droplets that carry viruses do not stay suspended in humid air as long, and the warmer temperatures lead to more rapid virus degradation,” says Elizabeth McGraw, director of the Center for Infectious Disease Dynamics at Pennsylvania State University"

"Human activity also changes in summer months, says Thomas Bollyky, the director of the Global Health Program at the Washington D.C.-based Council on Foreign Relations. People spend less time indoors—where they tend to be in closer contact with each other, making it easier for the virus to spread—in the summer.

Warm weather affect Study: https://journals.plos.org/plospathogens/article?id=10.1371/journal.ppat.0030151

Additional reading:

Realtime counters by third party sites:

https://www.worldometers.info/coronavirus/

CDC:

https://www.cdc.gov/coronavirus/2019-ncov/index.html

Cruise Ship travel advisory:

https://wwwnc.cdc.gov/travel/page/covid-19-cruise-ship

European CDC:

https://www.ecdc.europa.eu/en/novel-coronavirus-china/questions-answers

NHS:

https://www.nhs.uk/conditions/coronavirus-covid-19/

Third party Latest updates:

https://economictimes.indiatimes.com/news/politics-and-nation/coronavirus-news-live-updates-death-toll-march-9/liveblog/74545182.cms

WHO Global Guidance:
https://www.who.int/emergencies/diseases/novel-coronavirus-2019/technical-guidance/critical-preparedness-readiness-and-response-actions-for-covid-19

WHO has defined four transmission scenarios for COVID-19:1. Countries with no cases (No cases);2. Countries with 1 or more cases, imported or locally detected (Sporadic cases);3. Countries experiencing cases clusters in time, geographic location and/or common exposure (Clusters of cases);4. Countries experiencing larger outbreaks of local transmission (Community transmission).

Update on Covid- 19 & travel advisory as shared by Maharashtra officials (Mostly relevant to travellers to Maharashtra & International airport at Mumbai:

All travellers who have symptoms of fever, sore throat, cough, cold and difficulty in breathing within 14 days of landing , and who have a positive history of travelling  to  affected Countries  ( China, Hong Kong, Thailand, Singapore, South Korea, Japan, Vietnam, Nepal, Malaysia, Indonesia, Iran and Italy  or any other affected country) have to be sent to  identified isolation facility and sample should be referred to designated lab.

Isolation facilities have been setup at Kasturaba Hospital Mumbai and Naidu Hospital,Pune. Along with these all Government Medical Colleges and District hospitals are also equipped with isolation facility.

For Asymptomatic travellers with a positive travel history  home isolation for 14 days from day of landing is advised. 

They should observe social distancing.

Local health authority will follow up all such travellers telephonically for their health status. If during this period any one develops above mentioned symptoms he/she will be admitted to nearby isolation facility and will be tested for corona. All travellers coming from COVID 19 affected countries must be , encouraged for self reporting to local health authority *on development of symptoms. 

Every traveller should follow the do's and don'ts ( preventive measures ) i.e. frequent hand washing , cough etiquettes, avoiding crowded places.  

COVID 19 Diagnostic Facility is available at following labs in Maharashtra -    1) National Institute of Virology, Pune   2) Kasturba Central Laboratory Mumbai   3) Indira Gandhi Medical College, Nagpur 

For any queries contact - State Control Room - 020 - 2612 7394,Toll Free number 104Dr.Pramod Padwal MOH Mira Bhayander Municipal Corporation 8422811236 Dr.Nandkishor Lahane IDSP Mira Bhayander Municipal Corporation 8422811240Dr. Pradip Awate State Surveillance Officer 9423337556Dr. Amol Mankar State Epidemiologist 9766732163For Mumbai, Dr Yashashree Keni 9833867979For Pune Corporation, Dr. Sanjiv Vavare, 9689931541For Pune division, Dr. Sanjay Deshmukh, Deputy Director, 9422033439For Nagpur division, Dr Sanjay Jaiswal Deputy Director 9422150677For Akola division, Dr. Farukhi Deputy Director 9423422570For Aurangabad division,Dr. Lale Deputy Director 9421958419For Thane division, Dr Mrs Rathod Deputy Director 8928284072For Latur division, Dr.Male 9404042297For Kolhapur division,Dr. Borase Deputy Director,9422791259For Nashik division, Dr. Pattanshetti Deputy Director, 9422653695

  

India denies entry to cruise ships on virus fears

India has banned all foreign cruise ships from its ports because of the coronavirus, with one European vessel turned away from Mangalore in the south at the weekend, officials said Monday. 
Cruise ships are seen as fertile breeding ground for the deadly virus, with more than 700 cases and six linked deaths from the Diamond Princess held off Japan last month. (AFP)

China opens Disney Resort

The Maharashtra Food and Drug Administration (FDA) has ordered chemists to sell coronavirus Covid-19 kits only on doctors’ prescription. The government received complaints that chemists are selling the kits and masks at higher prices than the MRP.

Official Press release page of Govt of India

All: https://pib.gov.in/AllRelease.aspx

Corona:https://pib.gov.in/PressReleseDetail.aspx?PRID=1605744

Recommended actions as suggested by WHO:

Highest priority 
Enhance whole-of-society coordination mechanisms to support preparedness and response, including the health, transport, travel, trade, finance, security and other sectors. Involve public health Emergency Operations Centres and other emergency response systems early. Sensitize the public to their active role in the response. Engage with key partners to develop national and sub-national preparedness and response plans. Build on existing plans such as influenza pandemic preparedness plan. Enhance hospital and community preparedness plans; ensure that space, staffing, and supplies are adequate for a surge in patient care needs. 
Secondary priorityEstablish metrics and monitoring evaluation systems to assess effectiveness of measures. Document lessons learned to inform on-going and future preparedness and response activities. Prepare for regulatory approval, market authorization and post-market surveillance of COVID-19 products (e.g. laboratory diagnostics, therapeutics, vaccines), when available. 

(https://www.who.int/docs/default-source/coronaviruse/20200307-responding-to-covid-19-communitytransmission-final.pdf?sfvrsn=ec5fa30a_5):

Beware: Scam Alert:

https://www.who.int/about/communications/cyber-security

Criminals are disguising themselves as WHO or Indian official to steal money or sensitive information.  If you are contacted by a person or organization that appears to be from WHO, verify their authenticity before responding.

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