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   2020| February & March  | Volume 151 | Issue 2  
    Online since April 28, 2020

 
 
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PROTOCOL
Lopinavir/ritonavir combination therapy amongst symptomatic coronavirus disease 2019 patients in India: Protocol for restricted public health emergency use
Tarun Bhatnagar, Manoj V Murhekar, Manish Soneja, Nivedita Gupta, Sidhartha Giri, Naveet Wig, Raman Gangakhedkar
February & March 2020, 151(2):184-189
DOI:10.4103/ijmr.IJMR_502_20  PMID:32362644
As of February 29, 2020, more than 85,000 cases of coronavirus disease 2019 (COVID-19) have been reported from China and 53 other countries with 2,924 deaths. On January 30, 2020, the first laboratory-confirmed case of COVID was reported from Kerala, India. In view of the earlier evidence about effectiveness of repurposed lopinavir/ritonavir against severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome (MERS) coronavirus (CoV), as well as preliminary docking studies conducted by the ICMR-National Institute of Virology, Pune, the Central Drugs Standard Control Organization approved the restricted public health use of lopinavir/ritonavir combination amongst symptomatic COVID-19 patients detected in the country. Hospitalized adult patients with laboratory-confirmed SARS-CoV-2 infection with any one of the following criteria will be eligible to receive lopinavir/ritonavir for 14 days after obtaining written informed consent: (i) respiratory distress with respiratory rate ≥22/min or SpO2of <94 per cent; (ii) lung parenchymal infiltrates on chest X-ray; (iii) hypotension defined as systolic blood pressure <90 mmHg or need for vasopressor/inotropic medication; (iv) new-onset organ dysfunction; and (v) high-risk groups - age >60 yr, diabetes mellitus, renal failure, chronic lung disease and immunocompromised persons. Patients will be monitored to document clinical (hospital length of stay and mortality at 14, 28 and 90 days), laboratory (presence of viral RNA in serial throat swab samples) and safety (adverse events and serious adverse events) outcomes. Treatment outcomes amongst initial cases would be useful in providing guidance about the clinical management of patients with COVID-19. If found useful in managing initial SARS-CoV-2-infected patients, further evaluation using a randomized control trial design is warranted to guide future therapeutic use of this combination.
  11 5,504 934
ORIGINAL ARTICLES
Prudent public health intervention strategies to control the coronavirus disease 2019 transmission in India: A mathematical model-based approach
Sandip Mandal, Tarun Bhatnagar, Nimalan Arinaminpathy, Anup Agarwal, Amartya Chowdhury, Manoj Murhekar, Raman R Gangakhedkar, Swarup Sarkar
February & March 2020, 151(2):190-199
DOI:10.4103/ijmr.IJMR_504_20  PMID:32362645
Background & objectives: Coronavirus disease 2019 (COVID-19) has raised urgent questions about containment and mitigation, particularly in countries where the virus has not yet established human-to-human transmission. The objectives of this study were to find out if it was possible to prevent, or delay, the local outbreaks of COVID-19 through restrictions on travel from abroad and if the virus has already established in-country transmission, to what extent would its impact be mitigated through quarantine of symptomatic patients? Methods: These questions were addressed in the context of India, using simple mathematical models of infectious disease transmission. While there remained important uncertainties in the natural history of COVID-19, using hypothetical epidemic curves, some key findings were illustrated that appeared insensitive to model assumptions, as well as highlighting critical data gaps. Results: It was assumed that symptomatic quarantine would identify and quarantine 50 per cent of symptomatic individuals within three days of developing symptoms. In an optimistic scenario of the basic reproduction number (R0) being 1.5, and asymptomatic infections lacking any infectiousness, such measures would reduce the cumulative incidence by 62 per cent. In the pessimistic scenario of R0=4, and asymptomatic infections being half as infectious as symptomatic, this projected impact falls to two per cent. Interpretation & conclusions: Port-of-entry-based entry screening of travellers with suggestive clinical features and from COVID-19-affected countries, would achieve modest delays in the introduction of the virus into the community. Acting alone, however, such measures would be insufficient to delay the outbreak by weeks or longer. Once the virus establishes transmission within the community, quarantine of symptomatics may have a meaningful impact on disease burden. Model projections are subject to substantial uncertainty and can be further refined as more is understood about the natural history of infection of this novel virus. As a public health measure, health system and community preparedness would be critical to control any impending spread of COVID-19 in the country.
  10 6,083 1,336
REVIEW ARTICLES
The 2019 novel coronavirus disease (COVID-19) pandemic: A review of the current evidence
Pranab Chatterjee, Nazia Nagi, Anup Agarwal, Bhabatosh Das, Sayantan Banerjee, Swarup Sarkar, Nivedita Gupta, Raman R Gangakhedkar
February & March 2020, 151(2):147-159
DOI:10.4103/ijmr.IJMR_519_20  PMID:32362642
A novel coronavirus (nCoV) spillover event, with its epicenter in Wuhan, People's Republic of China, has emerged as a public health emergency of international concern. This began as an outbreak in December 2019, and till February 28, 2020, there have been 83,704 confirmed cases of novel coronavirus disease 2019 (COVID-19) globally, with 2,859 deaths, resulting in an overall case fatality rate of 3.41 per cent (95% confidence interval 3.29-3.54%). By this time (February 28, 2020) 58 countries or territories and one international conveyance (Diamond Princess Cruise Ship) were affected. As a part of the global response to manage and contain the pandemic, major emphasis was placed on generating research intelligence to guide evidence-based responses to contain the virus, which was named severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), owing to its genetic similarities with the SARS virus. This review summarizes the emerging evidence which can help guide the public health response, particularly in India. Key areas have been identified in which research needs to be conducted to generate critical intelligence for advising prevention and control efforts. The emergence of SARS-CoV-2 has once again exposed the weaknesses of global health systems preparedness, ability to respond to an infectious threat, the rapidity of transmission of infections across international borders and the ineffectiveness of knee-jerk policy responses to emerging/re-emerging infectious disease threats. The review concludes with the key learning points from the ongoing efforts to prevent and contain COVID-19 and identifies the need to invest in health systems, community-led response mechanisms and the need for preparedness and global health security.
  8 21,684 4,023
ORIGINAL ARTICLES
Full-genome sequences of the first two SARS-CoV-2 viruses from India
Pragya D Yadav, Varsha A Potdar, Manohar Lal Choudhary, Dimpal A Nyayanit, Megha Agrawal, Santosh M Jadhav, Triparna D Majumdar, Anita Shete-Aich, Atanu Basu, Priya Abraham, Sarah S Cherian
February & March 2020, 151(2):200-209
DOI:10.4103/ijmr.IJMR_663_20  PMID:32242873
Background & objectives: Since December 2019, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has globally affected 195 countries. In India, suspected cases were screened for SARS-CoV-2 as per the advisory of the Ministry of Health and Family Welfare. The objective of this study was to characterize SARS-CoV-2 sequences from three identified positive cases as on February 29, 2020. Methods: Throat swab/nasal swab specimens for a total of 881 suspected cases were screened by E gene and confirmed by RdRp (1), RdRp (2) and N gene real-time reverse transcription-polymerase chain reactions and next-generation sequencing. Phylogenetic analysis, molecular characterization and prediction of B- and T-cell epitopes for Indian SARS-CoV-2 sequences were undertaken. Results: Three cases with a travel history from Wuhan, China, were confirmed positive for SARS-CoV-2. Almost complete (29,851 nucleotides) genomes of case 1, case 3 and a fragmented genome for case 2 were obtained. The sequences of Indian SARS-CoV-2 though not identical showed high (~99.98%) identity with Wuhan seafood market pneumonia virus (accession number: NC 045512). Phylogenetic analysis showed that the Indian sequences belonged to different clusters. Predicted linear B-cell epitopes were found to be concentrated in the S1 domain of spike protein, and a conformational epitope was identified in the receptor-binding domain. The predicted T-cell epitopes showed broad human leucocyte antigen allele coverage of A and B supertypes predominant in the Indian population. Interpretation & conclusions: The two SARS-CoV-2 sequences obtained from India represent two different introductions into the country. The genetic heterogeneity is as noted globally. The identified B- and T-cell epitopes may be considered suitable for future experiments towards the design of vaccines and diagnostics. Continuous monitoring and analysis of the sequences of new cases from India and the other affected countries would be vital to understand the genetic evolution and rates of substitution of the SARS-CoV-2.
  7 13,860 4,349
CORRESPONDENCES
Transmission electron microscopy imaging of SARS-CoV-2
Sharda Prasad, Varsha Potdar, Sarah Cherian, Priya Abraham, Atanu Basu, ICMR-NIV NIC Team
February & March 2020, 151(2):241-243
DOI:10.4103/ijmr.IJMR_577_20  PMID:32362648
  6 3,323 727
POLICY GUIDELINES
Guidance for building a dedicated health facility to contain the spread of the 2019 novel coronavirus outbreak
Anup Agarwal, Nazia Nagi, Pranab Chatterjee, Swarup Sarkar, Devendra Mourya, Rima Rakeshkumar Sahay, Rajesh Bhatia
February & March 2020, 151(2):177-183
DOI:10.4103/ijmr.IJMR_518_20  PMID:32362643
Preparedness for the ongoing coronavirus disease 2019 (COVID-19) and its spread in India calls for setting up of adequately equipped and dedicated health facilities to manage sick patients while protecting healthcare workers and the environment. In the wake of other emerging dangerous pathogens in recent times, such as Ebola, Nipah and Zika, it is important that such facilities are kept ready during the inter-epidemic period for training of health professionals and for managing cases of multi-drug resistant and difficult-to-treat pathogens. While endemic potential of such critically ill patients is not yet known, the health system should have surge capacity for such critical care units and preferably each tertiary government hospital should have at least one such facility. This article describes elements of design of such unit (e.g., space, infection control, waste disposal, safety of healthcare workers, partners to be involved in design and plan) which can be adapted to the context of either a new construction or makeshift construction on top of an existing structure. In view of a potential epidemic of COVID-19, specific requirements to handle it are also given.
  6 3,875 833
REVIEW ARTICLES
Biorisk assessment for infrastructure & biosafety requirements for the laboratories providing coronavirus SARS-CoV-2/(COVID-19) diagnosis
Devendra T Mourya, Gajanan Sapkal, Pragya D Yadav, Sujeet Kumar M Belani, Anita Shete, Nivedita Gupta
February & March 2020, 151(2):172-176
DOI:10.4103/ijmr.IJMR_763_20  PMID:32242878
Novel coronavirus infection [coronavirus disease 2019 (COVID-19)] has spread to more than 203 countries of various regions including Africa, America, Europe, South East Asia and Western Pacific. The WHO had declared COVID-19 as the global public health emergency and subsequently as pandemic because of its worldwide spread. It is now one of the top-priority pathogens to be dealt with, because of high transmissibility, severe illness and associated mortality, wide geographical spread, lack of control measures with knowledge gaps in veterinary and human epidemiology, immunity and pathogenesis. The quick detection of cases and isolating them has become critical to contain it. To meet the increasing demand of the diagnostic services, it is necessary to enhance and expand laboratory capabilities since existing laboratories cannot meet the emerging demand. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a BSL-2 (Biosafety Level 2) agent and needs to be handled in biosafety cabinet using standard precautions. This review highlights minimum requirements for the diagnostic laboratories opting testing of material for the diagnosis of COVID-19 and associated biorisk to the individuals and to the community.
  2 5,030 1,509
CORRESPONDENCES
First isolation of SARS-CoV-2 from clinical samples in India
Prasad Sarkale, Savita Patil, Pragya D Yadav, Dimpal A Nyayanit, Gajanan Sapkal, Shrikant Baradkar, Rajen Lakra, Anita Shete-Aich, Sharda Prasad, Atanu Basu, Lalit Dar, Veena Vipat, Sidhartha Giri, Varsha Potdar, Manohar Lal Choudhary, Ira Praharaj, Amita Jain, Bharati Malhotra, Pranita Gawande, Kaumudi Kalele, Nivedita Gupta, Sarah S Cherian, Priya Abraham
February & March 2020, 151(2):244-250
DOI:10.4103/ijmr.IJMR_1029_20  PMID:32362649
  1 2,696 615
ORIGINAL ARTICLES
Detection of coronaviruses in Pteropus & Rousettus species of bats from different States of India
Pragya D Yadav, Anita Shete-Aich, Dimpal A Nyayanit, Prachi Pardeshi, Triparna Majumdar, R Balasubramanian, Padinjaremattathil Thankappan Ullas, Sreelekshmy Mohandas, Hitesh Dighe, Pradeep Sawant, Savita Patil, Dilip Patil, MD Gokhale, Basavaraj Mathapati, AB Sudeep, Sreekant Baradkar, Abhimanyu Kumar, Rutuja Kharde, Malvika Salve, Yash Joshi, Nivedita Gupta, Devendra T Mourya
February & March 2020, 151(2):226-235
DOI:10.4103/ijmr.IJMR_795_20  PMID:32317409
Background & objectives: Bats are considered to be the natural reservoir for many viruses, of which some are potential human pathogens. In India, an association of Pteropus medius bats with the Nipah virus was reported in the past. It is suspected that the recently emerged severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) also has its association with bats. To assess the presence of CoVs in bats, we performed identification and characterization of bat CoV (BtCoV) in P. medius and Rousettus species from representative States in India, collected during 2018 and 2019. Methods: Representative rectal swab (RS) and throat swab specimens of Pteropus and Rousettus spp. bats were screened for CoVs using a pan-CoV reverse transcription-polymerase chain reaction (RT-PCR) targeting the RNA-dependent RNA polymerase (RdRp) gene. A single-step RT-PCR was performed on the RNA extracted from the bat specimens. Next-generation sequencing (NGS) was performed on a few representative bat specimens that were tested positive. Phylogenetic analysis was carried out on the partial sequences of RdRp gene sequences retrieved from both the bat species and complete viral genomes recovered from Rousettus spp. Results: Bat samples from the seven States were screened, and the RS specimens of eight Rousettus spp. and 21 Pteropus spp. were found positive for CoV RdRp gene. Among these, by Sanger sequencing, partial RdRp sequences could be retrieved from three Rousettus and eight Pteropus bat specimens. Phylogenetic analysis of the partial RdRp region demonstrated distinct subclustering of the BtCoV sequences retrieved from these Rousettus and Pteropus spp. bats. NGS led to the recovery of four sequences covering approximately 94.3 per cent of the whole genome of the BtCoVs from Rousettus bats. Three BtCoV sequences had 93.69 per cent identity to CoV BtRt-BetaCoV/GX2018. The fourth BtCoV sequence was 96.8 per cent identical to BtCoV HKU9-1. Interpretation & conclusions: This study was a step towards understanding the CoV circulation in Indian bats. Detection of potentially pathogenic CoVs in Indian bats stresses the need for enhanced screening for novel viruses in them. One Health approach with collaborative activities by the animal health and human health sectors in these surveillance activities shall be of use to public health. This would help in the development of diagnostic assays for novel viruses with outbreak potential and be useful in disease interventions. Proactive surveillance remains crucial for identifying the emerging novel viruses with epidemic potential and measures for risk mitigation.
  1 3,140 1,332
PERSPECTIVES
Public engagement is key for containing COVID-19 pandemic
Rajesh Bhatia
February & March 2020, 151(2):118-120
DOI:10.4103/ijmr.IJMR_780_20  PMID:32242877
  1 3,168 1,753
COVID-19: Impact on health of people & wealth of nations
Prakash N Tandon
February & March 2020, 151(2):121-123
DOI:10.4103/ijmr.IJMR_664_20  PMID:32202260
  1 5,576 4,299
Ethics preparedness for infectious disease outbreaks research in India: A case for novel coronavirus disease 2019
Roli Mathur
February & March 2020, 151(2):124-131
DOI:10.4103/ijmr.IJMR_463_20  PMID:32362641
  1 1,791 573
Need for integrated surveillance at human-animal interface for rapid detection & response to emerging coronavirus infections using One Health approach
Rajesh Bhatia
February & March 2020, 151(2):132-135
DOI:10.4103/ijmr.IJMR_623_20  PMID:32202259
  1 1,044 279
REVIEW ARTICLES
Perspectives for repurposing drugs for the coronavirus disease 2019
Sarah S Cherian, Megha Agrawal, Atanu Basu, Priya Abraham, Raman R Gangakhedkar, Balram Bhargava
February & March 2020, 151(2):160-171
DOI:10.4103/ijmr.IJMR_585_20  PMID:32317408
The newly emerged 2019 novel coronavirus (CoV), named as severe acute respiratory syndrome CoV-2 (SARS-CoV-2), like SARS-CoV (now, SARS-CoV-1) and Middle East respiratory syndrome CoV (MERS-CoV), has been associated with high infection rates with over 36,405 deaths. In the absence of approved marketed drugs against coronaviruses, the treatment and management of this novel CoV disease (COVID-19) worldwide is a challenge. Drug repurposing that has emerged as an effective drug discovery approach from earlier approved drugs could reduce the time and cost compared to de novo drug discovery. Direct virus-targeted antiviral agents target specific nucleic acid or proteins of the virus while host-based antivirals target either the host innate immune responses or the cellular machineries that are crucial for viral infection. Both the approaches necessarily interfere with viral pathogenesis. Here we summarize the present status of both virus-based and host-based drug repurposing perspectives for coronaviruses in general and the SARS-CoV-2 in particular.
  1 4,371 1,825
CORRESPONDENCES
Development of in vitro transcribed RNA as positive control for laboratory diagnosis of SARS-CoV-2 in India
Manohar Lal Choudhary, Veena Vipat, Sheetal Jadhav, Atanu Basu, Sarah Cherian, Priya Abraham, Varsha A Potdar
February & March 2020, 151(2):251-254
DOI:10.4103/ijmr.IJMR_671_20  PMID:32242876
  - 2,971 2,514
Genomic analysis of SARS-CoV-2 strains among Indians returning from Italy, Iran & China, & Italian tourists in India
Varsha Potdar, Sarah S Cherian, Gururaj Rao Deshpande, Padinjaremattathil Thankappan Ullas, Pragya D Yadav, Manohar Lal Choudhary, Rohan Gughe, Veena Vipat, Sheetal Jadhav, Savita Patil, Dimpal Nyayanit, Triparna Majumdar, Atul Walimbe, Shivshankar Gaikwad, Hitesh Dighe, Anita Shete-Aich, Sreelekshmy Mohandas, Deepika Chowdhury, Gajanan Sapkal, Atanu Basu, Nivedita Gupta, Raman R Gangakhedkar, Sidhartha Giri, Lalit Dar, Amita Jain, Bharati Malhotra, Priya Abraham, NIC Team
February & March 2020, 151(2):255-260
DOI:10.4103/ijmr.IJMR_1058_20  PMID:32362650
  - 1,872 805
EDITORIAL
Time to revisit national response to pandemics
Rajesh Bhatia, Priya Abraham
February & March 2020, 151(2):111-113
DOI:10.4103/ijmr.IJMR_846_20  PMID:32317407
  - 2,265 2,774
ORIGINAL ARTICLES
Severe acute respiratory illness surveillance for coronavirus disease 2019, India, 2020
Nivedita Gupta, Ira Praharaj, Tarun Bhatnagar, Jeromie Wesley Vivian Thangaraj, Sidhartha Giri, Himanshu Chauhan, Sanket Kulkarni, Manoj Murhekar, Sujeet Singh, Raman R Gangakhedkar, Balram Bhargava, ICMR COVID Team
February & March 2020, 151(2):236-240
DOI:10.4103/ijmr.IJMR_1035_20  PMID:32362647
Background & objectives: Sentinel surveillance among severe acute respiratory illness (SARI) patients can help identify the spread and extent of transmission of coronavirus disease 2019 (COVID-19). SARI surveillance was initiated in the early phase of the COVID-19 outbreak in India. We describe here the positivity for COVID-19 among SARI patients and their characteristics. Methods: SARI patients admitted at 41 sentinel sites from February 15, 2020 onwards were tested for COVID-19 by real-time reverse transcription-polymerase chain reaction, targeting E and RdRp genes of SARS-CoV-2. Data were extracted from Virus Research and Diagnostic Laboratory Network for analysis. Results: A total of 104 (1.8%) of the 5,911 SARI patients tested were positive for COVID-19. These cases were reported from 52 districts in 20 States/Union Territories. The COVID-19 positivity was higher among males and patients aged above 50 years. In all, 40 (39.2%) COVID-19 cases did not report any history of contact with a known case or international travel. Interpretation & conclusions: COVID-19 containment activities need to be targeted in districts reporting COVID-19 cases among SARI patients. Intensifying sentinel surveillance for COVID-19 among SARI patients may be an efficient tool to effectively use resources towards containment and mitigation efforts.
  - 4,763 943
Strategic planning to augment the testing capacity for COVID-19 in India
Nivedita Gupta, Tarun Bhatnagar, Kiran Rade, Manoj Murhekar, Raman R Gangakhedkar, Anu Nagar, ICMR COVID Team
February & March 2020, 151(2):210-215
DOI:10.4103/ijmr.IJMR_1166_20  PMID:32362646
Background & objectives: Nearly 5,500 tests for coronavirus disease 2019 (COVID-19) had been conducted on March 31, 2020 across the Indian Council of Medical Research (ICMR)-approved public and private laboratories in India. Given the need to rapidly increase testing coverage, we undertook an exercise to explore and quantify interventions to increase the daily real-time reverse transcription-polymerase chain reaction (qRT-PCR)-based testing capacity over the next few months. The objective of this exercise was to prepare a potential plan to scale-up COVID-19 testing in India in the public sector. Methods: Potential increase in daily testing capacity of the existing public laboratories was calculated across the three base scenarios of shifts (9, 16 and 24 h). Additional testing capacity was added for each shift scenario based on interventions ranging from procurement of additional qRT-PCR machines, leveraging spare capacity on available qRT-PCR machines not drafted into COVID-19 testing, to in-laboratory process optimization efforts. Results: Moving to a 24 h working model in the existing approved laboratories can enhance the daily testing capacity to 40,464 tests/day. The capacity can be further bolstered by leveraging qRT-PCR and nucleic acid amplification test (NAAT)-based machines available with the Multidisciplinary Research Units (MRUs), National AIDS Control Organisation (NACO) and National Tuberculosis Elimination Programme (NTEP). Using combination/multiplex kits, and provision of automated RNA extraction platforms at all laboratories could also optimize run time and contribute to capacity increase by 1.5-2 times. Interpretation & conclusions: Adopting these interventions could help increase public sector's daily testing capacity to nearly 100,000-120,000 tests/day. It is important to note that utilization of the scaled-up testing capacity will require deployment of additional workforce, procurement of corresponding commodities for testing and scale-up of sample collection and transportation efforts.
  - 2,406 604
Laboratory preparedness for SARS-CoV-2 testing in India: Harnessing a network of Virus Research & Diagnostic Laboratories
Nivedita Gupta, Varsha Potdar, Ira Praharaj, Sidhartha Giri, Gajanan Sapkal, Pragya Yadav, Manohar Lal Choudhary, Lalit Dar, AP Sugunan, Harmanmeet Kaur, Ashok Munivenkatappa, Jayanthi Shastri, Krishnasamy Kaveri, Shanta Dutta, Bharti Malhotra, Amita Jain, Kammilli Nagamani, GB Shantala, Sharmila Raut, MM Vegad, Ajanta Sharma, Aashish Choudhary, Megha Brijwal, Anukumar Balakrishnan, Jayaswamy Manjunatha, Manish Pathak, Sivasubramanian Srinivasan, Hasina Banu, Himanshu Sharma, Parul Jain, Pakalpati Sunita, R Ambica, Babita Fageria, Disha Patel, Gitika Rajbongshi, Neetu Vijay, Jitendra Narayan, Neeraj Aggarwal, Anu Nagar, Raman R Gangakhedkar, Priya Abraham
February & March 2020, 151(2):216-225
DOI:10.4103/ijmr.IJMR_594_20  PMID:32242875
Background & objectives: An outbreak of respiratory illness of unknown aetiology was reported from Hubei province of Wuhan, People's Republic of China, in December 2019. The outbreak was attributed to a novel coronavirus (CoV), named as severe acute respiratory syndrome (SARS)-CoV-2 and the disease as COVID-19. Within one month, cases were reported from 25 countries. In view of the novel viral strain with reported high morbidity, establishing early countrywide diagnosis to detect imported cases became critical. Here we describe the role of a countrywide network of VRDLs in early diagnosis of COVID-19. Methods: The Indian Council of Medical Research (ICMR)-National Institute of Virology (NIV), Pune, established screening as well as confirmatory assays for SARS-CoV-2. A total of 13 VRDLs were provided with the E gene screening real-time reverse transcription-polymerase chain reaction (rRT-PCR) assay. VRDLs were selected on the basis of their presence near an international airport/seaport and their past performance. The case definition for testing included all individuals with travel history to Wuhan and symptomatic individuals with travel history to other parts of China. This was later expanded to include symptomatic individuals returning from Singapore, Japan, Hong Kong, Thailand and South Korea. Results: Within a week of standardization of the test at NIV, all VRDLs could initiate testing for SARS-CoV-2. Till February 29, 2020, a total of 2,913 samples were tested. This included both 654 individuals quarantined in the two camps and others fitting within the case definition. The quarantined individuals were tested twice - at days 0 and 14. All tested negative on both occasions. Only three individuals belonging to different districts in Kerala were found to be positive. Interpretation & conclusions: Sudden emergence of SARS-CoV-2 and its potential to cause a pandemic posed an unsurmountable challenge to the public health system of India. However, concerted efforts of various arms of the Government of India resulted in a well-coordinated action at each level. India has successfully demonstrated its ability to establish quick diagnosis of SARS-CoV-2 at NIV, Pune, and the testing VRDLs.
  - 4,225 2,289
PERSPECTIVES
The research community must meet the coronavirus disease 2019 challenge
Poonam Khetrapal Singh
February & March 2020, 151(2):116-117
DOI:10.4103/ijmr.IJMR_832_20  PMID:32270770
  - 1,326 1,445
COVID-19 in India: Moving from containment to mitigation
George M Varghese, Rebecca John
February & March 2020, 151(2):136-139
DOI:10.4103/ijmr.IJMR_860_20  PMID:32317412
  - 2,747 1,502
Responding to COVID-19 pandemic: Why a strong health system is required
Tanzin Dikid, Sushma Chaudhary, Kapil Goel, Preeti Padda, Rajesh Sahu, Tripurari Kumar, SK Jain, SK Singh, Jai Prakash Narain
February & March 2020, 151(2):140-145
DOI:10.4103/ijmr.IJMR_761_20  PMID:32317411
  - 1,645 1,003
VIEW POINT
Tracking the impact of interventions against COVID-19 in absence of extensive testing
Ganesan Karthikeyan
February & March 2020, 151(2):114-115
DOI:10.4103/ijmr.IJMR_864_20  PMID:32317405
  - 2,356 2,272
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