1. Coronavirus testing in India, elsewhere

Relevant for GS Prelims & Mains Paper III; Science & Technology

On Friday, the Indian Council of Medical Research (ICMR) announced that it would start testing influenza patients without any travel history or contact with novel coronavirus disease (COVID-19) for signs of community transmission, terming it “inevitable”. Last week itself, the Health Ministry had announced that India had recorded its first cases of community transmission, though officials later clarified it had meant “local transmission in the community”.

Various countries have adopted various models for addressing community transmission, or for preventing it. India’s decision also raises the question: will the larger number of tests open up testing at private facilities?

What is community transmission?

It is one of the levels of transmission defined by the World Health Organization (WHO). Simply put, community transmission means that a virus is circulating in the community and can affect people with no history of travel to affected areas or of contact with an infected person. That is what ICMR is trying to find out by testing over 1,000 samples from people suffering from influenza-like symptoms but with no history of such travel or contact. India’s current emphasis on social distancing and discouragement of public gatherings, too, is aimed at checking community transmission.

Once community transmission begins, it is more difficult to trace contacts. One unknown source of infection can wreak havoc — one woman in South Korea, who refused to take the test, has been found to have ended up infecting over 160 people.

What is known about the level of transmission in India?

So far, most of the cases in India have had a history of travel abroad — for example, the Kerala and Delhi patients — or have contracted the disease from somebody around them — for example, the Italian tourist in Jaipur who ended up infecting 17 in the group including their Indian driver. On the other hand, some of the cases in Agra had neither any history of foreign travel nor had they come directly in contact with an infected person.

Here’s where you can get tested for coronavirus in India

In a statement last week, the Health Ministry had said: “Since, in addition to COVID 19 cases related to travel, some cases of community transmission have also been observed, it has been decided to involve district collectors and States have been asked to form rapid response teams as the district, block and village levels.” Later, joint secretary Lav Agarwal clarified that this means local transmission at community level.

Local transmission, another level defined by WHO, happens through direct contact with an infected person within the country. In Agra, after two people with travel history to Italy infected their families, door-to-door searches were undertaken within a 3-km radius.

Another level is imported transmission, for which the protocol is vigilance at the borders and airports, such as thermal screening and quarantine if required, like India began early on. India has also suspended visas to foreign nationals and the facility of visa-free travel to OCI card-holders.

So, does India’s latest move mean opening up testing to the private sector?

While the government is working with private hospitals to develop standard operating procedures for treatment and isolation of patients, there is no move yet for the testing process to be opened up for the private sector.

The possibility of profiteering is one concern. The primary reason for the government seeking to retain its control on the testing regime, however, is fear of wider exposure. “It is not a question of technology; allowing the private sector would mean possible patients will be going to such a large number of places where adherence to infection control norms would be crucial to prevent spread of infections. Designated laboratories mean that we streamline everything, including the exposure of the medical staff and laboratory technicians,” said a senior official of the National Centre for Disease Control.

For now, the tests ICMR is doing are free for patients. Were they to pay, the two tests have would cost them about Rs 5.000. So, even if the government did open it up to private laboratories, it would mean not everyone would be able to afford the test. Rather than open up testing to the private sector and risk exposing more people, India has chosen to wait a bit longer for test reports while the patient is in isolation.

How does India’s model for testing for the virus — and combating it — compare with those of other countries?

Among the countries where community transmission seems to have begun are China (over 80,000 cases), Italy (over 21,000) and South Korea (8,000). For the time being, India has chosen to follow the Italian model of lockdown, rather than the South Korean model of free testing.

Italy, the epicentre of the outbreak in Europe, has imposed a nationwide lockdown, especially given its ageing population. Stores and restaurants have been closed and restrictions put on individual movement. Spain too has announced plans to lock down its citizens, while France has shut down several places. Cases are still climbing in these countries.

South Korea, meanwhile, has been testing lakhs of people and tracking potential carriers — like detectives, according to a Reuters report — by using cell phone and satellite technology. Mass free testing and treatment, and identification of transmission sources, have brought down daily new cases, from 909 on February 29 to less than 100 on March 15.

For India, massive free testing in a country of 135 crore would need humongous resources. India currently has reagents for about 1 lakh tests, has done a little over 6,000 tests so far, and is in the process of procuring 2 lakh more test kits. But if mass testing were to be done, all this would be a drop in the ocean.

Coronavirus testing: What are countries besides these doing?

China adopted a graded approach, and the number of new cases are gradually declining. It has locked down Hubei, the epicentre, for 50 days now. Elsewhere, it enforced social distancing measures during the crucial phase of the Chinese New Year.

“As part of these social distancing policies, the Chinese Government encouraged people to stay at home; discouraged mass gatherings; cancelled or postponed large public events; and closed schools, universities, government offices, libraries, museums, and factories. Only limited segments of urban public transport systems remained operational and all cross-province bus routes were taken out of service,” The Lancet wrote earlier this month.

The US has partnered with a Google subsidiary to develop a website which will help determine whether a test is warranted.

What else is in India’s strategy to tackle COVID-19?

India is relying on social distancing and cluster containment. According to the containment plan developed by the Health Minister: “The cluster containment strategy would be to contain the disease within a defined geographic area by early detection, breaking the chain of transmission and thus preventing its spread to new areas. This would include geographic quarantine, social distancing measures, enhanced active surveillance, testing all suspected cases, isolation of cases, home quarantine of contacts, social mobilization to follow preventive public health measures.”

Quarantine and isolation help by breaking the chain of transmission. More than 43,000 persons are now under community surveillance by the Integrated Disease Surveillance Programme, and contact tracing is still on.

Source: The Indian Express

2. Why social distancing is important to tackle coronavirus

Relevant for GS Prelims & Mains Paper III; Science & Technology

OVER THE last two days, a number of states in India have enforced measures aimed at reducing public gatherings. This is called “social distancing”. With 100,000 reported cases of COVID-19 in 100 countries, starting with the outbreak in Wuhan in China 10 weeks ago, researchers have analysed trends in the spread have made a case for social distancing as a mitigation and containment strategy.

How does social distancing work?

To stem the speed of the coronavirus spread so that healthcare systems can handle the influx, experts are advising people to avoid mass gatherings. Offices, schools, concerts, conferences, sports events, weddings, and the like have been shut or cancelled around the world, including in a number of Indian states. An advisory by the US Centers for Disease Control recommends social distancing measures such as: reducing the frequency of large gatherings and limiting the number of attendees; limiting inter-school interactions; and considering distance or e-learning in some settings (which could be interpreted as serving the same purpose as working from home).

What is the objective of such restrictions?

Compared to deadlier diseases such as bird flu, or H5N1, coronavirus is not as fatal —which ironically also makes it more difficult to contain. With milder symptoms, the infected are more likely to be active and still spreading the virus. For example, more than half the cases aboard a cruise ship that has docked in California did not exhibit any symptoms.

In a briefing on March 11, World Health Organization (WHO) officials said, “Action must be taken to prevent transmission at the community level to reduce the epidemic to manageable clusters.” The main question for governments is how do you reduce the impact of the virus by flattening the trajectory of cases from a sharp bell curve to an elongated speed-bump-like curve. This is being called “flattening the curve”. How does ‘flattening the curve’ help?

A slow growth in patients can be handled by healthcare systems much more than a sharp rise. In effect, the goal is to postpone the spread over time.

As a report in The Atlantic stated: “A pandemic is like a slow-motion hurricane that will hit the entire world. If the same amount of rain and wind is to hit us in any scenario, better to have it come over the course of a day than an hour. People will suffer either way, but spreading the damage out will allow as many people as possible to care for one another.”

Limiting community transmission is the best way to flatten the curve.

What was the curve like in China?

The numbers show that the virus spread within Hubei exponentially but plateaued in other provinces. Just as Chinese provinces outside of Hubei effectively stemmed the spread in February, three other countries —South Korea, Italy, and Iran — were not able to flatten the curve.

On December 30, active case finding began in Wuhan. Around January 21, the number of cases started to jump intensely to roughly 550 infections and 17 deaths. Wuhan city’s lockdown was two days later. The next day, another 15 Chinese cities were shut down, eventually cordoning off 100 million people. In Chinese regions outside Hubei, new cases plateaued from February 9 onwards. All of these regions could have exploded exponentially, but tapered off.

Where else did the curve grow and eventually flatten?

As reported in the March 11 WHO briefing, 93% of cases are from four countries, making it “an uneven epidemic at the global level.” Countries are using varying testing and diagnostic systems, making comparisons tentative.

It is clear, however, that new cases began to grow in South Korea, Italy, Iran by the end of February, surpassing all Chinese regions other than Hubei.

On the other hand, countries close to China — Japan, Taiwan, Singapore, Thailand — as well as Hong Kong saw growth in case numbers plateau. Some say it’s because many of these countries learnt from the 2003 SARS epidemic. The WHO singled out Singapore as a “good example of an all-of-government approach.”

South Korea is an outlier. Experts say the country contained the virus within the first 30 patients, but on February 17 the 31st one spread it to thousands of people and symptoms showed themselves too late for authorities to check the outbreak. By now, South Korea’s case growth has shown decline, while Italy and Iran have quickly surpassed it.

Why are Europe and the United States now concerned?

The growth in European countries and the United States since the beginning of March resembles the initial curves of Italy and Hubei during their respective growth phases, leaving officials wondering if they will follow the same trajectory. Experts say that if countries take measures similar to Singapore and Taiwan, they may be able to avoid that fate.

New cases have shot up in France, Germany, Spain, US, Switzerland, and the UK. Between March 5 and 6, there were a number of countries that doubled their case numbers. In order of highest daily growth rate, they were Belgium, Switzerland, the UAE, Netherlands, France, Austria, Malaysia, Sweden, Greece, USA, Spain, UK and Norway.

Source: The Indian Express

3. Dominion over territory: On UTs and Lieutenant Governors

Relevant for GS Prelims & mains Paper II; Polity & Governance

The verdict by a Division Bench of the Madras High Court on the respective roles of the elected regime in Puducherry and the Administrator appointed by the President underscores both the inherent potential for conflict in the governance scheme for Union Territories and the manner in which it can be resolved.

The Bench has done well to say that its role is not to lay down who has residual control — whether it is the Council of Ministers or the Administrator — but to stress the existing legal framework under which their powers are defined. The Bench has set aside a single judge’s 2019 order that the Lieutenant-Governor should not interfere in the day-to-day administration of Puducherry. To this extent, it is a shot in the arm for L-G Kiran Bedi, but it also contains a note of caution against the Centre going beyond its constitutional limitations. An interesting facet of the case is that both last year’s judgment by Justice R. Mahadevan, and the one overruling it by a Bench comprising Chief Justice A.P. Sahi and Justice Subramonium Prasad, rely on the exposition of the law by the Supreme Court in relation to the National Capital Territory of Delhi. The apex court had emphasised on the need for constitutional morality and constitutional trust among high dignitaries, implying that Lt. Governors and Chief Ministers must work in unison as far as possible. In the event of an unresolved difference of opinion, the L-G should refer it to the President for a decision.

The main ground on which the single judge’s verdict has been set aside is that it was based on an inappropriate parallel sought to be drawn between a ‘Union Territory’ and a ‘State’. If the matter goes on appeal to the Supreme Court, it may be worth examining whether the single judge relied solely on this parallel. Much of his verdict drew upon the spirit of the Supreme Court’s views on the conflict between the Chief Minister and L-G of Delhi. Whether the precedent on the limits of the Delhi L-G’s powers would apply to the Puducherry Administrator was a question that was raised even then. After all, it is acknowledged that the status of NCT is sui generis.

However, the elements of conflict and discord are common to Union Territories with elected legislatures. Hence, the principle that constitutional functionaries should avoid daily clashes, with the Centre using its primacy to resolve disputes, does commend itself. In that sense, the single judge was not wrong in holding that the Administrator is bound by the “aid and advice” clause, and that the power to refer any matter to the President should not mean “every matter”. The main issue remains whether the notion of representative government should get greater credence even in a territory designated as belonging to the Union.

Source: The Hindu

4. Coronavirus | How does soap use help in tackling COVID-19?

Relevant for GS Prelims & Mains Paper III; Science & Technology

Ever since the novel coronavirus (SARS-CoV-2) outbreak began in China in end-December 2019, various measures have been mentioned to reduce the risk of infection. Guidelines by the World Health Organization specify that one of the ways to reduce the risk of infection is by regularly and thoroughly cleaning one’s hands with an alcohol-based hand rub or washing them with soap and water. Regular washing becomes important as the virus tends to be viable from hours to more than a day on different surfaces that are regularly touched with hands.

How does washing with soap help get rid of the coronavirus?

The grime on our hands contains innumerable viruses and bacteria. Washing with water without using soap helps reduce the amount of microbes but does not remove most of the virus and bacteria completely. Using soap, therefore, becomes far more effective in removing microbes.

Viruses such as coronavirus, influenza-causing viruses, Ebola, Zika have their genetic material encased in a layer of fat called the lipid envelop. Soap molecules are pin-shaped with a head that is water-loving (hydrophilic) and a tail that is oil-loving (oleophilic). Being oleophilic, the tail portion of the molecule tends to have an affinity for and ‘competes’ with the lipids in the virus envelope. Since the chemical bonds holding the virus together are not very strong, the long oleophilic tail gets inserted into the envelope and tends to have a ‘crowbar’ effect that breaks the lipid envelope of the virus. The tail also competes with the bond that binds the RNA and the lipid envelop thus dissolving the virus into its components which are then removed by water.

Do all viruses have the lipid layer?

No, certain viruses do not have the lipid envelop and are called the non-enveloped viruses. Rotavirus which causes severe diarrhoea, poliovirus, adenovirus that cause pneumonia and even human papillomavirus (HPV) do not contain the lipid envelop.

The oil-loving tail of the soap molecule also disrupts the bond that binds dirt and non-enveloped viruses to the hand. The dirt and viruses are surrounded by several tails making them remain as suspended particles. Rinsing with water washes away the suspended particles leading to clean hands.

How do alcohol-based hand sanitisers help get rid of coronavirus?

Like soap, the alcohol present in hand sanitisers dissolve the lipid envelop, thus inactivating the virus. In addition, the alcohol also tends to change the shape or denature the mushroom-shaped protein structures that stick out of the lipid envelop. The mushroom-shaped protein structures help the virus to bind to special structures found on human cells and enter the cells. To be effective, the sanitisers should contain at least 60% alcohol.

Unlike soap lather, the alcohol does not come in contact with all parts of the hand. So care needs to be taken to use sufficient amount of sanitiser to increase the coverage. Unlike water, alcohol run does not remove the dead viruses from the hand. While a sanitiser can quickly reduce the number of microbes, it does not get rid of all types of germs, and is “not as effective when hands are visibly dirty or greasy”.

Should healthy people who are not taking care of COVID-19 patients use a mask?

Medical masks help prevent the spread of coronavirus infection. If worn properly, masks may be effective in preventing transmission of coronavirus. An article published in the Journal of the American Medical Association (JAMA) says there is no evidence to suggest that masks worn by healthy individuals can help prevent infection.

But a 2010 study says: “Mask wearing was associated with reduced secondary transmission and should be encouraged during outbreak situations.”

Even the World Health Organization (WHO) says wearing a medical mask is “one of the prevention measures to limit spread of certain respiratory diseases, including novel coronavirus (SARS-CoV-2), in affected areas”.

Transmission through droplets from coughing and sneezing is one of the major routes of virus spread. When worn correctly, a mask can reduce the risk of inhaling droplets containing the virus.

With many studies showing that people infected with novel coronavirus transmit the virus even before symptoms show up, it may be prudent to wear a mask especially when the virus is spreading in the community.

In a country like India, maintaining at least one metre distance can be a challenge, especially when there is no way of knowing who is infected till such time the person starts showing visible symptoms.

What other precautions should be taken when a mask is used?

WHO cautions that using a mask alone will be insufficient to provide an “adequate level of protection”. It should be combined with hand hygiene to prevent human-to-human transmission. Wearing medical masks can give a person a “false sense of security that can lead to neglecting other essential measures such as hand hygiene practices”. So if an individual decides to wear a mask, care must be taken to regularly wash hands with soap or alcohol rub, and avoid touching the face with hands.

Incorrect mask wearing might otherwise reduce the effectiveness in cutting the risk of transmission. It should be discarded once it gets wet or dirty, and care should be taken to safely dispose of used masks. The same mask should not used for more than a couple of hours.

Source: The Hindu

Q. What is the significance of Industrial Corridors in India? Identifying industrial corridors, explain their main characteristics. (2018, 15 marks, 250 words)

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