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International Journal of Research and Review
Vol.7; Issue: 3; March 2020
Website: www.ijrrjournal.com
Review Article E-ISSN: 2349-9788; P-ISSN: 2454-2237
Novel Coronavirus (COVID-19) in India: Current
Scenario
Varsha Kachroo
Resident, Dept. of Medicine, Govt. Medical College, Jammu.
ABSTRACT INTRODUCTION
The Novel Corona Virus (Covid-19)
Covid-19, just few days back, was foreign earlier known only as the Wuhan virus,
to us and now spreading its routes well in expanded its circle in South Korea, Japan,
India. Starting with one case and now with Italy, Iran and finally spreading its routes to
800+ cases, the virus is trending right now India. It is given the name novel because it
in almost every part of the country. The is a never seen before mutation of animal
irony is not much is known about this novel coronavirus. As of now, a certain source of
virus, hence mortality and morbidity across the outbreak is unknown. It is believed that
the globe is on a peak. The Ministry of the virus might be linked with a wet market
Health and Family Welfare, Government of (with seafood and live animals) from
India and ICMR (Indian Council of Medical Wuhan that was not complying with health
Research) has formulated guidelines, and safety regulations. The Wuhan wet
advisories for social distancing protocol, market has since been closed down
diagnosis, management, do’s and don’ts and indefinitely. [1] The Covid-19 is very similar
other reliable material. The topic of Novel in symptomatology to other viral respiratory
Corona virus is huge to cover it entirely in infections. Cases vary from mild forms to
every aspect on a single page, and so is its severe ones that can lead to serious medical
impact across the world. But the basic conditions or even death. It is believed that
things and protocols remain same symptoms may appear in 2 to 14 days, as
everywhere. This review briefly covers the the incubation period for the novel
introduction, possible mode of transmission, coronavirus has not yet been confirmed. [1]
definitions, some basic advices, diagnosis, As it is novel virus specific modes of
treatment and management protocol being transmission is not known. [1] Originally
followed right now in India; however emerged as animal source but now
subjected to change in due course of time as spreading from person to person. There has
is the number of cases and mortality. The been speculation about the virus spreading
health care personnel are doing their job while the carrier (infected person) is not
perfectly and so is the Government, but showing any symptoms, but that has not
what is important for everyone being a been confirmed as a scientific fact. [1]
citizen of India is to maintain social Currently symptoms reported are cough,
distancing and follow advisories strictly acute onset of fever and difficulty in
from time to time so that we can make way breathing. Out of all the cases that have
for our own lives and lives of our dear ones. been confirmed, up to 20% have been
deemed to be severe. [1] Complications that
Keywords: Covid-19, coronavirus, India may arise as a result of being infected are
pneumonia, sepsis, septic shock and ARDS
(acute respiratory distress syndrome). [1]
Suspicion should arise with the above
International Journal of Research and Review (ijrrjournal.com) 435
Vol.7; Issue: 3; March 2020
Varsha Kachroo. Novel coronavirus (COVID-19) in India: current scenario
mentioned symptoms and recent travel 2. A person with acute respiratory illness of
history to countries being affected by any degree of severity who, within 14 days
Covid19 or now more crudely travel to any before onset of illness, had any of the
foreign country. following exposures:
a) Close physical contact (defined
Definitions and Triage: [2] below)with a confirmed case of COVID -
Currently in India, following definitions are 19 infection, while that patient was
used to define and triage patient with symptomatic; or
infection. b) A healthcare facility in a country where
hospital-associated COVID - 19 infections
SARI (Severe Acute Respiratory have been reported;
Infection) : An ARI with history of fever or
measured temperature ≥38 °C and cough; CLOSE CONTACT DEFINITION: [2]
onset within the last ~10 days; and requiring Health care associated exposure,
hospitalization. including providing direct care for
COVID-19 patients, working with
Current case definition: [2] health care workers infected with
1. SARI in a person, with history of fever COVID-19, visiting patients or staying
and cough requiring admission to hospital, in the same close environment of a
with no other etiology that fully explains the COVID - 19 patients.
clinical presentation (testing should be Working together in close proximity or
according to local guidance for management sharing the same classroom environment
of community-acquired pneumonia. with a COVID - 19 patient
Examples of other etiologies include Travelling together with COVID - 19
Streptococcus pneumoniae, Haemophilus patient in any kind of conveyance.
influenza type B, Legionella pneumophila, Living in the same household as a
other recognized primary bacterial COVID - 19 patients
pneumonias, influenza viruses, and
Respiratory syncytial virus. Clinicians CASE CLASSIFICATION: [2]
should also be alert to the possibility of Suspect Case:
atypical presentations in patients who are A. Patients with severe acute respiratory
immunocompromised); infection (fever, cough, and requiring
admission to hospital), AND with no other
AND any of the following: etiology that fully explains the clinical
a) A history of international travel in 14 presentation AND at least one of the
days prior to symptom onset; or following:
b) the disease occurs in a health care worker a history of travel to or residence in the
who has been working in an environment city of Wuhan, Hubei Province, China in
where patients with SARI are being cared the 14 days prior to symptom onset, or
for, without regard to place of residence or Patient is a health care worker who has
history of travel; or been working in an environment where
c) the person develops an unusual or severe acute respiratory infections of
unexpected clinical course, especially unknown etiology are being cared for.
sudden deterioration despite appropriate B. Patients with any acute respiratory illness
treatment, without regard to place of AND at least one of the following:
residence or history of travel, even if close contact with a confirmed or
another etiology has been identified that probable case of 2019-nCoV in the 14
fully explains the clinical presentation days prior to illness onset, or
visiting or working in a live animal
market in Wuhan, Hubei Province,
International Journal of Research and Review (ijrrjournal.com) 436
Vol.7; Issue: 3; March 2020
Varsha Kachroo. Novel coronavirus (COVID-19) in India: current scenario China in the 14 days prior to symptom Mild ARDS: 200 mmHg
Varsha Kachroo. Novel coronavirus (COVID-19) in India: current scenario
has suspended all tourist visas, as a majority am to 9 pm as advised by Prime Minister
of cases were linked to other countries. [4] Narender Modi. [6] He urged all Indians to
The Govt. has also issued lockdown of 75 stay at home for the next few weeks and if
districts across the country where confirmed possible work from home. [7] The formation
COVID-19 cases have been reported till 31 of the COVID-19 Economic Response Task
March. [5] Force was announced during the live
Janta Curfew was observed on 22nd address to the nation. [8]
March 2020 in the wake of pandemic from 7
Image1: Distribution of cases across various states and UTs of India
Source: Ministry of Health and Family Welfare
International Journal of Research and Review (ijrrjournal.com) 438
Vol.7; Issue: 3; March 2020
Varsha Kachroo. Novel coronavirus (COVID-19) in India: current scenario
Image 2: Statewise distribution of Covid19 in India as on 26 th March 2020
Source: Wikipedia. [9]
Common Prevention Measures: [1] cooking; before eating and setting the
Clean your hands frequently, either by table; after sneezing or coughing and
washing them with soap and water (for last but not least, wash your hands
at least 20 seconds) or using an alcohol- frequently as possible when you are sick
based (with at least60% alcohol) hand or caring for the sick.
sanitizer (when the hands are not visibly Cover your mouth and nose with your
dirty). elbow if you want to sneeze/cough or,
To protect yourself and others, you preferably, do it in a tissue. Dispose of
should always wash your hands: after the tissue immediately in a closed bin.
using the toilet; after handling pets or Avoid touching your eyes, nose, and
their waste; before, during and after mouth with your hands. They have
International Journal of Research and Review (ijrrjournal.com) 439
Vol.7; Issue: 3; March 2020Varsha Kachroo. Novel coronavirus (COVID-19) in India: current scenario
mucous membranes that can act as some of them concluding that they are
pathways for particles, and our hands ten times dirtier than a toilet seat. Try to
are the primary carrier of those harmful also maintain your children’s phones or
particles. smart devices as clean as possible.
Avoid being in direct contact with Don’t spit in public. It’s not just rude,
people that sneeze or cough. Try to but it can spread harmful particles.
maintain a distance of about 6 feet (that Explain to your child why he/she should
is how far the particles can travel) not engage in public spitting. Do it in a
between you and them. Teach your kids tissue that you can safely dispose of.
to recognize these symptoms and act If you are sick, stay at home as much as
accordingly. This goes the other way possible. The same goes for a sick
too, stay away from crowded places and family member, encourage them to stay
avoid contact with people if you are inside and care for them if possible. It
experiencing these symptoms. In other decreases the viral load and the risk of
words, maintain social distancing. spreading, and it’s making your
Frequently wipe your phone (especially community a safer space for others.
the screen) with an alcohol based
disinfectant. There are many studies that
show just how dirty our phones are, with
WHO NEEDS TO WEAR A MASK? [10]
Source: Ministry of Health and Family Welfare; Awareness Material: When to wear a mask?
International Journal of Research and Review (ijrrjournal.com) 440
Vol.7; Issue: 3; March 2020Varsha Kachroo. Novel coronavirus (COVID-19) in India: current scenario
DO’S AND DON’TS: [11]
Source: Ministry of Health and Family Welfare; Do’s and Don’ts
DIAGNOSIS: [2] sample does not exclude the diagnosis, and
Collect blood cultures for bacteria additional URT and LRT samples are
that cause pneumonia and sepsis, ideally recommended. Sputum induction should be
before antimicrobial therapy. DO NOT avoided due to increased risk of increasing
delay antimicrobial therapy to collect blood aerosol transmission.
cultures Collect specimens of In hospitalized patients with confirmed
nasopharyngeal and oropharyngeal swab for COVID - 19 infection, repeat URT samples
RT - PCR. Clinicians may also collect LRT should be collected to demonstrate viral
(Lower Respiratory Tract) samples when clearance. The frequency of specimen
these are readily available (for example, in collection will depend on local
mechanically ventilated patients). Use circumstances but should be done at least
appropriate PPE for specimen collection every 2 to 4 days until there are two
(droplet and contact precautions for URT consecutive negative results (of URT
specimens; airborne precautions for LRT samples) in a clinically recovered patient at
specimens). When collecting URT samples, least 24 hours apart.
use viral swabs (sterile Dacron or rayon, not
cotton) and viral transport media. Do not CURRENT TESTING STRATEGY: [12]
sample the nostrils or tonsils. In a patient i. All asymptomatic people who have
with suspected COVID - 19, especially with undertaken International travel:
pneumonia or severe illness, a single URT
International Journal of Research and Review (ijrrjournal.com) 441
Vol.7; Issue: 3; March 2020Varsha Kachroo. Novel coronavirus (COVID-19) in India: current scenario
They should stay in home quarantine They should be tested only if they
fo|l4 days. become symptomatic (fever,
They should be tested only ii they breathing etc.).
become symptomatic (fever, cough lf test result is positive, then they
difficulty in breathing etc.). should be isolated and treated
lf test result is positive, then they protocol.
should be isolated and treated iii. Health care workers managing
protocol. respiratory distress / Severe Acute
ii. All contacts of laboratory confirmed Respiratory Illness should be tested if
positive cases: they are symptomatic.
They should stay in home quarantine
for 14 days.
DISCHARGE PROTOCOL: [13]
Source: Ministry of Health Family Welfare; Corona Discharge Policy
TREATMENT: [2] patients and other patients. Instruct all
IMPLEMENTATION OF patients to cover nose and mouth during
APPROPRIATE IPC (INFECTION coughing or sneezing with tissue or flexed
PREVENTION AND CONTROL) elbow for others. Perform hand hygiene
MEASURES: after contact with respiratory secretions.
At triage:
Give suspect patient a triple layer Droplet Precautions:
surgical mask and direct patient to separate Droplet precautions prevent large
area, an isolation room if available. Keep at droplet transmission of respiratory viruses.
least 1meter distance between suspected Use a triple layer surgical mask if working
International Journal of Research and Review (ijrrjournal.com) 442
Vol.7; Issue: 3; March 2020Varsha Kachroo. Novel coronavirus (COVID-19) in India: current scenario
within 1-2 metres of the patient. Place ventilated single rooms when performing
patients in single rooms, or group together aerosol-generating procedures, meaning
those with the same etiological diagnosis. If negative pressure rooms with minimum of
an etiological diagnosis is not possible, 12 air changes per hour or at least 160
group patients with similar clinical litres/second/patient in facilities with natural
diagnosis and based on epidemiological risk ventilation. Avoid the presence of
factors, with a spatial separation. When unnecessary individuals in the room. Care
providing care in close contact with a for the patient in the same type of room
patient with respiratory symptoms (e.g. after mechanical ventilation commences.
coughing or sneezing), use eye protection
(face-mask or goggles), because sprays of Management of hypoxemic respiratory
secretions may occur. Limit patient failure and ARDS
movement within the institution and ensure Recognize severe hypoxemic
that patients wear triple layer surgical masks respiratory failure when a patient with
when outside their rooms. respiratory distress is failing standard
oxygen therapy. Patients may continue to
Contact precautions: have increased work of breathing or
Droplet and contact precautions hypoxemia even when oxygen is delivered
prevent direct or indirect transmission from via a face mask with reservoir bag (flow
contact with contaminated surfaces or rates of 10-15 L/min, which is typically the
equipment (i.e. contact with contaminated minimum flow required to maintain bag
oxygen tubing/interfaces). Use Personal inflation; FiO2 0.60-0.95). Hypoxemic
Protective Equipment (PPE) (triple layer respiratory failure in ARDS commonly
surgical mask, eye protection, gloves and results from intrapulmonary ventilation-
gown) when entering room and remove PPE perfusion mismatch or shunt and usually
when leaving. If possible, use either requires mechanical ventilation.
disposable or dedicated equipment (e.g.
stethoscopes, blood pressure cuffs and High – flow nasal catheter oxygenation or
thermometers). If equipment needs to be non – invasive mechanical ventilation:
shared among patients, clean and disinfect When respiratory distress and/or hypoxemia
between each patient use. Ensure that health of the patient cannot be alleviated after
care workers refrain from touching their receiving standard oxygen therapy, high -
eyes, nose, and mouth with potentially flow nasal cannula oxygen therapy or non -
contaminated gloved or ungloved hands. invasive ventilation can be considered. If
Avoid contaminating environmental conditions do not improve or even get worse
surfaces that are not directly related to within a short time (1-2 hours), tracheal
patient care (e.g. door handles and light intubation and invasive mechanical
switches). Ensure adequate room ventilation should be used in a timely
ventilation. Avoid movement of patients or manner. Compared to standard oxygen
transport. Perform hand hygiene. therapy, HFNO reduces the need for
intubation. Patients with hypercapnia
Airborne Precautions (exacerbation of obstructive lung disease,
Ensure that healthcare workers cardiogenic pulmonary oedema),
performing aerosol-generating procedures hemodynamic instability, multi-organ
(i.e. open suctioning of respiratory tract, failure, or abnormal mental status should
intubation, bronchoscopy, cardiopulmonary generally not receive HFNO, although
resuscitation) use PPE, including gloves, emerging data suggest that HFNO may be
long-sleeved gowns, eye protection, and fit- safe in patients with mild-moderate and
tested particulate respirators (N95). non-worsening hypercapnia25. Patients
Whenever possible, use adequately receiving HFNO should be in a monitored
International Journal of Research and Review (ijrrjournal.com) 443
Vol.7; Issue: 3; March 2020Varsha Kachroo. Novel coronavirus (COVID-19) in India: current scenario setting and cared for by experienced neuromuscular blockade by continuous personnel capable of endotracheal infusion should not be routinely used. intubation in case the patient acutely In settings with access to expertise in deteriorates or does not improve after a extracorporeal life support (ECLS), consider short trial (about 1 hr). Implement referral of patients with refractory mechanical ventilation using lower tidal hypoxemia despite lung protective volumes (4-8 ml/kg predicted body weight, ventilation. ECLS should only be offered in PBW) and lower inspiratory pressures expert centres with a sufficient case volume (plateau pressure 25% practice guideline. In patients with moderate from baseline or urine output of
Varsha Kachroo. Novel coronavirus (COVID-19) in India: current scenario
Reduction of GCS by 2 or more April or May 2020. Studies also are
Any other organ dysfunction underway in the United States, including at
several Harvard-affiliated hospitals. It is
iv. High Risk Groups: hard to predict when the drug could be
Age> 60 yrs approved for use and produced in large
Diabetes Mellitus, Renal Failure, amounts, assuming the clinical trials
Chronic Lung disease indicate that it is effective and safe. [18]
Immunocompromised persons
PROPHYLAXIS: [19]
Dosage: The National Task Force for
Lopinavir/ Ritonavir (200 mg/ 50 mg) – 2 COVID-19 constituted by Indian Council of
tablets twice daily. For patients unable to Medical Research recommends the use of
take medications by mouth: Lopinavir hydroxychloroquine for prophylaxis of
400mg/ Ritonavir 100 mg – 5ml suspension SARS-CoV-2 infection for high risk
twice daily for population. The Advisory provides for
14 days or for 7 days after becoming placing the following high risk population
asymptomatic under chemoprophylaxis with
hydroxychloroquine;
POSSIBLE ROLE OF REMDESIVIR: Asymptomatic healthcare workers
Remdesivir is a novel antiviral drug in the involved in the care of suspected or
class of nucleotide analogs. It was confirmed cases of COVID-19.
developed for use against Ebola virus Asymptomatic household contacts of
disease and Marburg viral infections. [14] laboratory confirmed cases.
Mechanism of Action: It is a prodrug that Possible Mechanism: It is a weak base
interferes with action of viral polymerases known to elevate the pH of intracellular
and evades proofreading by viral organelles, essential for membrane fusion.
exoribonuclease, causing a decrease in viral [20]
HCQ also inhibited the entry step as well
RNA production as the post entry stages of SARS- CoV-2
Remdesivir was developed to treat infection Since acidification is crucial for
several other severe viral diseases, including endosome maturation and function, it was
the disease caused by Ebola virus. Also in summarised that endosome maturation
late January 2020, remdesivir was might be blocked at intermediate stages of
administered to the first U.S. patient endocytosis, resulting in failure of further
confirmed to be infected by SARS-CoV-2 transport of virions to the ultimate releasing
after he progressed to pneumonia. While no site. Clinical investigation found that high
broad conclusions can be made based on the concentrations of cytokines were detected in
single treatment, the patient's condition the plasma of critically ill patients infected
improved dramatically the next day, [15] and with SARS-CoV-2, suggesting that cytokine
he was eventually discharged. [16] WHO storm was associated with disease severity.
had announced the launch of a large four- [21]
Other than its direct antiviral activity,
arm pragmatic clinical trial (SOLIDARITY HCQ is a safe and successful anti-
trial) that includes one group of patients inflammatory agent that has been used
treated with remdesivir. [17] extensively in autoimmune diseases and can
Two large randomized clinical trials significantly decrease the production of
are underway in China. The two trials will cytokines and, in particular, pro-
enroll over 700 patients, and are likely to inflammatory factors. Therefore, in COVID-
definitively answer the question of whether 19 patients, HCQ may also contribute to
the drug is effective in treating COVID-19. attenuating the inflammatory response. [22]
The results of those studies are expected in
International Journal of Research and Review (ijrrjournal.com) 445
Vol.7; Issue: 3; March 2020Varsha Kachroo. Novel coronavirus (COVID-19) in India: current scenario
WHAT NEEDS TO BE DONE? https://www.thehindu.com/news/national/co
Government and doctors and ronavirus-india-locks-down-80-districts-to-
paramedics are working to the best of their contain-virus-spread/article31134567.ece
services. People should follow and adhere to 6. Bureau, Our. "PM Modi calls for 'Janata
Govt. advisories strictly. Indians should take curfew' on March 22 from 7 AM-9
PM". Businessline;19 March 2020.
lessons from China and Italy that what 7. Modi appeals for self-imposed janata
havoc this novel virus can create. The need curfew on Sunday". Business standard; 19
of the hour is social distancing and as I am March 2020.
writing this article Govt has already put 8. Covid 19 Economic Task Force:
many districts under lock down keeping in Government forms Covid-19 economic
view the rise in the number of cases and response task force, says PM Modi". The
keeping the condition in the phase 2 of the Times of India; 20 March 2020
outbreak. The citizens should understand 9. Coronavirus outbreak in India.Available
their responsibility positively that it is not from:
for others or for Govt., it is for their selves https://commons.wikimedia.org/wiki/File:C
and for their families. What goes the future OVID-19_Outbreak_Cases_in_India.svg
10. Who needs Mask. Available from:
of COVID-19 in India is not known but one https://www.mohfw.gov.in/pdf/Mask-
thing is for sure if we follow social Eng.pdf
distancing protocol and advisories strictly, 11. Do’s and Dont’s in Covid19.Available
we can make way for lives of ours and our from:
dear ones and can prevent the coming https://www.mohfw.gov.in/awareness.html
cyclone hovering over India right now. 12. Revised Strategy of Covid-19 testing in
India. Available from:
STAY SAFE. STAY AT HOME https://www.mohfw.gov.in/pdf/ICMRrevise
dtestingstrategyforCOVID.pdf
REFERENCES 13. Discharge policy of nCov Cases. Available
1. Bradley M. The Essential Guide to The from:
Wuhan Virus (Symptoms, Transmission and https://www.mohfw.gov.in/pdf/Corona%20
Prevention). Corona Virus ; 2020 Discharge-Policy.pdf
2. Guidelines on Clinical Management of 14. Warren TK, Jordan R, Lo MK, Ray AS,
COVID-19. Available from: Mackman RL, Soloveva V, et al.
https://www.mohfw.gov.in/pdf/Guidelineso "Therapeutic efficacy of the small molecule
nClinicalManagementofCOVID1912020.pd GS-5734 against Ebola virus in rhesus
3. Sinha A. One COVID-19 positive infects monkeys". Nature 2016; 531 (7594): 381–5
1.7 in India, lower than in hot zones. 15. Holshue ML, DeBolt C, Lindquist S, Lofy
The Indian Express; 23 March KH, Wiesman J, Bruce H, et al.
2020.Available from: (Washington State 2019-nCoV Case
https://indianexpress.com/article/coronaviru Investigation Team)."First Case of 2019
s/coronavirus-india-infection-rate-china- Novel Coronavirus in the United
6321154/ States". The N Eng J of Med 2020; 382(10) :
4. Sanyal A."India Suspends All Tourist Visas 929-36
Till April 15 Over Coronavirus: 10 16. Harmon A. "Inside the Race to Contain
Facts". NDTV.com. Retrieved 12 America's First Coronavirus Case". The
March2020. Available from: New York Times Feb 2020
https://www.ndtv.com/india- 17. "UN health chief announces global
news/coronavirus-impact-visas-to-india- 'solidarity trial' to jumpstart search for
suspended-till-april-15-2193382 COVID-19 treatment". UN News. March
5. Hebbar, Nistula. Coronoavirus: Union 2020
government announces lockdown in 75 18. Ellerin T, Farid H, Komaroff A, Krakower
districts till March 31.The Hindu; 22 March D, Lewine HE, Marques L, et al. As
2020.Available from: coronavirus spreads, many questions and
answers. Coronavirus Resource Centre.
Harvard Health Publishing. Available from:
International Journal of Research and Review (ijrrjournal.com) 446
Vol.7; Issue: 3; March 2020Varsha Kachroo. Novel coronavirus (COVID-19) in India: current scenario
https://www.health.harvard.edu/diseases- 21. Huang, C. et al. Clinical features of patients
and-conditions/coronavirus-resource-center infected with 2019 novel coronavirus in
19. Advisory on the use of hydroxychloroquine Wuhan, China. Lancet 2020 ; 395:497–506
for the prophylaxis of SARS-nCoV 22. Liu J, Cao R, Xu M, Wang X, Zhang H, Hu
infection. Available from: H et al. Hydroxychloroquine, a less toxic
https://www.mohfw.gov.in/pdf/Advisoryont derivative of chloroquine is effective in
heuseofHydroxychloroquinasprophylaxisfor SARS-CoV2 infection in vitro. Cell Discov
SARSCoV2infection.pdf 2020; 6(16).
20. Mauthe, M. et al. Chloroquine inhibits
autophagic flux by decreasing How to cite this article: Kachroo V. Novel
autophagosome -lysosome fusion. coronavirus (COVID-19) in India: current
Autophagy 2018 ;14:1435–55. scenario. International Journal of Research and
Review. 2020; 7(3): 435-447.
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