CMAAO Update 11^th February on Coronavirus (2019-nCoV)

“Let’s not shake hands,” said President Xi Jinping of China

Confirmed cases: 43099; Countries 28; Deaths 1018

New cases on 11^th Feb: 2546 (6% change)

11^th Feb: 849 new serious cases (including 839 in Hubei)

Cases: 82% mild, 15% severe, 3% critical, 2% deaths

Currently infected: 38038, Mild cases: 30693 (81%), Serious or critical: 7345 (19%, mortality 15%)

Cases with outcome: 5061, Recovered or discharged: 4043

Likely deaths 1101+1018 = 2119 with the present trend and available treatment

Summary

The virus behaves like SARS (may not become endemic and end up as hit and run in six months without mutation), with 2 % case fatality (15% of admitted cases), time to death 14 days, time to pneumonia 9 days, 3-4 reproductive number R0, has its origin from bats, spreads through large droplets and predominantly from people having lower respiratory infections and hence, universal droplet and hand hygiene precautions are the answer.

More than 60 new cases of the virus have been confirmed on a ship quarantined in Japan, bringing the total to 136.

PM Modi writes to Xi Jinping, offers assistance. Indians on ship ask Modi for help.

WHO warns about "trolls and conspiracy theories"

1. On Russias Channel One, the host linked the virus to US President Donald Trump, and claimed that US intelligence agencies or pharmaceutical companies are behind it.
2. British media linked the virus to a video of a Chinese woman eating bat soup. However, it has been found that the video was shot in 2016 and was in Palau, in the western Pacific Ocean, not China.
3. A discredited scientific study linked the new coronavirus to snakes.
4. Philippines: A claim advises people to "keep your throat moist", avoid spicy food and "load up on vitamin C". The information is reported to have come from the countrys Department of Health but it does not match the advice on the DOH website or its official press releases on the outbreak.
5. A claim suggests avoiding cold or preserved food and drinks, such as ice cream and milkshakes, for "at least 90 days". ForChange, a facebook page, accompanied the post with a video of a parasite being removed from a persons lips. Altnews fact-checkers stated that the video is three months old and unrelated to the virus.
6. At first glance, several documents doing the rounds appear to suggest that experts have been aware of the virus for years. A link to a 2015 patent filed by the Pirbright Institute in Surrey, England, was shared that talks about developing a weakened version of coronavirus for potential use as a vaccine to prevent or treat respiratory diseases. Conspiracy theorist and YouTuber Jordan Sather used the fact that the Bill & Melinda Gates Foundation is a donor to both Pirbright and vaccine development and hinted that the current outbreak virus has somehow been manufactured to attract funding for the development of a vaccine. But Pirbrights patent is not for the new coronavirus. It covers the avian infectious bronchitis virus, a member of the wider coronavirus family that infects poultry.
7. Another claim: The virus was part of Chinas "covert biological weapons programme" and may have leaked from the Wuhan Institute of Virology. Many accounts promoting the theory cite two Washington Times articles which quote a former Israeli military intelligence officer for the claim. However, there is no evidence for the claim in the two articles, and the Israeli source is quoted as saying that "so far there isnt evidence or indication" to suggest there was a leak.
8. One claim links the virus to the suspension of a researcher at Canadas National Microbiology Laboratory. Virologist Dr Xiangguo Qiu, her husband and some of her students from China were removed from the lab following a possible "policy breach," reported Canadas national broadcaster CBC last year. Police told CBC News that there was "no threat to public safety".

  Dr Qiu had visited the Wuhan National Biosafety Laboratory of the Chinese Academy of Sciences twice a year for two years.

A tweet stated that Dr Qiu and her husband were a "spy team", had sent "pathogens to the Wuhan facility", and that her husband "specialized in coronavirus research". None of the the claims in the tweet are found in the two CBC reports and the terms "coronavirus" and "spy" do not appear even once in either.

9. Varying versions of a "whistleblower" video, allegedly taken by a "doctor" or a "nurse" in Hubei province, have gained million views on various social media platforms and have found mention in numerous online reports. The most popular version was uploaded to YouTube by a Korean user, and included English and Korean subtitles. The video has since been taken down.

 According to the English subtitles, the woman is a nurse in a Wuhan hospital. She does not claim to be either a nurse or a doctor in the video; however. The woman does not identify herself, and is wearing protective suit in an unknown location. The suit and mask do not match the ones worn by medical staff in Hubei. But she makes a number of unsubstantiated claims about the virus, making it unlikely for her to be a nurse or a paramedic. She also claims the virus has a "second mutation", which can infect up to 14 people. The WHO has; however, made preliminary estimates that the number of infections an individual carrying the virus can cause is 1.4 to 2.5.

10. Fact-checking website Snopes has debunked the claim that China wants to kill 20,000 coronavirus patients. The site is linked to a sex website.

 Case Definition

1. Fever (subjective or confirmed)

OR signs/symptoms of lower respiratory illness (cough or shortness of breath)

PLUS, any person (including health care workers) who has had close contact with a laboratory-confirmed novel coronavirus patient within 14 days of symptom onset.

Contact refers to: Being within nearly 6 feet (2 meters) or within the room or care area of a 2019-nCoV case for a prolonged time while not wearing recommended personal protective equipment (gowns, gloves, NIOSH-certified disposable N95 respirator, eye protection); close contact may involve caring for, living with, visiting, or sharing a health care waiting area or room with a 2019-nCoV case OR having direct contact with infectious secretions of a 2019-nCoV case (such as being coughed on) while not wearing recommended personal protective equipment.

2. Fever andsigns/symptoms of lower respiratory illness (cough or shortness of breath) PLUS a history of travel from Hubei Province, China within 14 days of symptom onset
3. Feverand signs/symptoms of lower respiratory illness (cough or shortness of breath) requiring hospitalization PLUS a history of travel from mainland China within 14 days of symptom onset.

Continue asking patients with suspected flu or diarrhea if they, or someone they have been in contact with, recently returned from coronavirus-affected area. [In US, in a confirmed case, 2019-nCoV RNA has been identified in a stool specimen collected on day 7 of the patient’s illness.]

Take Home Messages

Delhi Help line number, email, website: +91-11-23978046, ncov2019@gmaildotcom, mohfw.gov.in/node/4904

Virus: Single-strand, positive-sense RNA genome ranging from 26 to 32 kilobases in length; Beta corona virus

Family: Corona virus family. ‘Corona’ means crown or the halo around the sun. Heart is considered a crown and hence the arteries that supply oxygen to the heart are also called coronary arteries. When seen under an electron microscope, the virus appears round in shape with spikes poking out from its periphery.

Origin: Wuhan, China; December 2019

1^st case informed to the world by Dr. Li Wenliang; died on Feb 6^th

Virus is killed by sunlight, temperature, humidity. It can survive on stainless steel surface for 36 hours 9 Hong Kong report). Sunlight diminishes the virus’ ability to grow in half, so the half-life will be 2.5 minutes and in the dark it’s about 13-20m.  The virus can remain intact at 4 degrees or 10 degrees for a longer time. At 30 degrees; however, there is inactivation. The virus cannot also tolerate high humidity. SARS stopped around May and June in 2003 probably due to more sunlight and more humidity. Alive on surface: 3-12 hours

Types of Transmission: Droplet or direct (Corona); Contact from surface (Corona), aerosol or nuclei ( TB, Corona ??)

Kissing scenes banned in movies in China

Air crew exempted from breath analyser tests: Kerala

Burial:  China has banned death ceremonies, people gathering together.

Link to ACE: 2019-nCoV might be able to bind to the angiotensin-converting enzyme 2 receptor in humans.

Lockdown: 50 million people in China

Feb 10

New confirmed cases: 2,478 (2,097 in Hubei province)

New cases of suspected infections: 3,536  (1,814 in Hubei)

New serious cases: 849 (839 in Hubei)

Deaths: 108

Released from hospitals after being cured: 716 (427 in Hubei)

 26,724 people who had had close contact with infected patients were freed from medical observation.

Feb 10, The National Health Commission:

42,638 reports of confirmed cases

1,016 deaths

3,996 patients had been cured and discharged from hospital

Remained 37,626 confirmed cases (including 7,333 in serious condition) and 21,675 suspected cases.

428,438 people have been identified as having had close contact with infected patients.

187,728 are now under medical observation. 

70 confirmed infections had been reported in Hong Kong and Macao special administrative regions and Taiwan province: 42 in Hong Kong (1 death), 10 in Macao (1 had been cured and discharged from hospital) and 18 in Taiwan (1 had been cured and discharged from hospital).

Three deadly human respiratory coronaviruses: Severe acute respiratory syndrome coronavirus [SARS-CoV], Middle East respiratory syndrome coronavirus [MERS-CoV]) and 2019-nCoV: The virus is 75-80% identical to the SARS-CoV.

30^th January 2020: Emergency: It is a Public Health Emergency of International Concern  (It is mandatory to report to WHO human and animal cases).

Prior 5 PHEICs: 

26^th April 2009 Swine flu: shift toward mortality among persons less than 65 years of age; 10 August 2010, WHO announced that the H1N1 influenza virus has moved into the post-pandemic period. However, localized outbreaks of various magnitudes are likely to continue.

May 2014 Polio: resurgence of wild polio after its near-eradication; Global eradication was deemed to be at risk with small numbers of cases in Afghanistan, Pakistan, and Nigeria; In October 2019, continuing cases of wild polio in Pakistan and Afghanistan, in addition to new vaccine-derived cases in Africa and Asia; the status was reviewed and remains a PHEIC. It was extended on 11 December 2019.

August 2014 Ebola: It was the first PHEIC in a resource-poor setting.

Feb 1, 2016 Zika: link with microcephaly and Guillain–Barré syndrome. This was the first time a PHEIC was declared for a mosquito‐borne disease. This declaration was lifted on 18 November 2016.

2018–20 Kivu Ebola: A review of the PHEIC had been planned at the fifth meeting of the EC on 10 October 2019 and as of 18 October 2019, it continues to be a PHEIC.

Kerala: State public health emergency. Three primary cases have been reported in North, South and Central Kerala (Kasaragod district in north Kerala, Thrissur in central Kerala and Alappuzha in South Kerala). Four Karnataka districts bordering Kerala — Kodagu, Mangaluru, Chamarajanagar and Mysuru - have been put on high alert.

Median age: 59 years (2-74 years); Male to female ratio: 56% male

Link to Huanan Seafood Wholesale Market: 55% with onset before January 1, 2020 and 8.6% of the subsequent cases. The Chinese government has banned wildlife trade until the epidemic passes. 

Mean incubation period: 5.2 days (95% confidence interval [CI], 4.1 to 7.0), with the 95th percentile of the distribution at 12.5 days.

Epidemic doubling time: In its early stages, every 7.4 days, with a mean serial interval of 7.5 days (95% CI, 5.3 to 19)

Contagiousness or Basic reproductive number: 2.2 (95% CI, 1.4 to 3.9).  The reproduction number, referred to as R0 or “r naught” is the number of additional people that an infected person can infect. An outbreak with a reproductive number of below 1 will gradually disappear. The R0 for the common flu is 1.3 and for SARS it was 2.0.

Comorbid conditions: 71%, deaths in comorbid cases; SARS affected people in their 30 or 50 years. MERS affected people with co-morbidity. The China data indicate that it’s those with the co-morbidity that are most at risk, like seasonal influenza.

0-15 years age: Just like SARS, it mostly does not affect children 15 years of age or less

Daily deaths:  73 deaths on 5^th (15% rise), 66 on 4^th, 64 on 3^rd Feb.

Anticipation: one lac already infected.

Secondary cases: Thailand, Taiwan, Germany, Vietnam, Japan, France and the United States

Deaths outside China: Philippines on Feb 2 (44-year-old Chinese man) and 2^nd in Hong Kong (39 M, local) on February 4; both had co-morbid conditions. Both acquired infection from Wuhan.

ICU need: 20% needed ICU care with 15% of them died

Fever: In all (no fever, no corona)

Cough: 75% cases

Weakness or muscle ache: 50%

Shortness of breath: 50%

TLC: low

Liver transaminase levels: raised

Case fatality: 2% [Dr John Nicholls, University of Hong Kong] China is only reporting those who come for test; there are stricter guidelines for a case to be considered positive; actual mortality may be 0.8%-1%, like outside China

Case fatality in admitted cases: 15%

Time to death:  14 days

Time to pneumonia:  9 days

Origin: Bats

Mode of spread: Large droplets and predominately from people having lower respiratory infections

Answer: Universal droplet precautions.

Incubation period:  up to 2 weeks, according to WHO; Mean 5.5 days

Transmission: Predominantly a large droplet and contact and less frequently by means of aerosols and fomites

Once it was disclosed that SARS also spread through the fecal-oral route there was reduced emphasis on the masks and greater emphasis on disinfection and washing hands. Hong Kong has far more cleanliness (than China) and they are very aware of social hygiene. And other countries will be more aware of the social hygiene (than China). So in those countries may should see less outbreaks and spread [Dr John Nicholls]

Healthcare Workers: In Hong Kong, with SARS, there was a lot of infection of healthcare workers since they were close to patients and did invasive procedures. But now, there is not much evidence of the healthcare workers getting sick or dying (unless China is not reporting it). This may suggest that it is not being spread by close aerosol contact but more likely by the fecal-oral route or with droplets. So, it may not be as contagious within hospitals. Makeshift hospitals will help.

Lab precautions: BSL 2 or 3

Human to human contact period: Requires contact of ten minutes within six feet

Travel preferable seat: Choosing a window seat and staying there lowers the risk

Travel advisory:  Level 1 in all countries (Exercise normal safety precautions), Level 2 in all  affected countries and states including Kerala ( Exercise a high degree of caution), Level 3 in all countries with secondary cases (Reconsider your need to travel) and Level 4 in China ( Do not travel). Hong Kong has imposed 14 days quarantine on people arriving from China. The Karnataka government has ordered that anybody arriving from the 23 coronavirus affected countries must stay in isolation at home for 28 days. The home isolation requirement is irrespective of the virus symptoms.

To date, 72 countries have implemented travel restrictions.

Travel and trade restrictions: WHO says no to countries

Leave china all together: UK

Entry to India not allowed: Foreigners who went to China on or after January 15

Visas Suspended: All visas issued to Chinese nationals before February 5 (not applicable to aircrew)

Flight suspended: IndiGo and Air India have suspended all of their flights between the two countries. SpiceJet continues to fly on Delhi-Hong Kong route.

High viral load: Detection of 2019-nCoV RNA in specimens from the upper respiratory tract with low Ct values on day 4 and day 7 of illness suggests high viral loads and potential for transmissibility. [NEJM]

Risk to other Asian countries, including India: Currently, people at risk are healthcare workers caring for 2019-nCoV patients and other close contacts of 2019-nCoV patients. For the general public, unlikely to be exposed to this virus, the immediate health risk from 2019-nCoV is considered low currently.

It is less likely to have serious illness in other countries. As patients with breathlessness are unlikely to board and patients will mild illness or asymptomatic illness are less likely to transmit infections.

Zoonotic but unlikely to spread through seafood: This new coronavirus is closely related to bat coronaviruses. Bats seem to be the likely primary reservoir for the virus. While SARS-CoV was transmitted to humans from exotic animals in wet markets, MERS-CoV transmitted from camels. The ancestral hosts were probably bats; however.

The virus has been traced to snakes in China. Snakes often hunt for bats. According to reports, snakes were sold in the local seafood market in Wuhan, thus raising the likelihood that the 2019-nCoV might have moved from the host species, i.e., bats, to snakes and then to humans. It is still not understood as to how the virus could adapt to both the cold-blooded and warm-blooded hosts. 

Infectiousness to humans: This new virus seems to thrive better in primary human airway epithelial cells as compared to standard tissue-culture cells, unlike SARS-CoV or MERS-CoV. The 2019-nCoV will likely behave more like the SARS-CoV.

SARS-CoV and MERS-CoV affect the intrapulmonary epithelial cells more than the upper airway cells. Transmission thus occurs primarily from patients with recognized illness and not from patients with mild, nonspecific signs. However NEJM has reported a case of 2019-nCoV infection acquired outside of Asia wherein transmission seems to have taken place during the incubation period in the index patient but the same has been challenged now.

2019-nCoV seems to employ the same cellular receptor as SARS-CoV (human angiotensin-converting enzyme 2 [hACE2]). Transmission is expected to occur only after signs of lower respiratory tract disease develop.

SARS is high [unintelligible] kind of inducer. This means that when it infects the lower part of the lung, the body develops a very severe reaction against it and leads to lots of inflammation and scarring. In SARS, after the first 10 to 15 days, it wasn’t the virus killing the patients it was the body’s reaction. Is this virus in the MERS or SARS kind picture or is this the other type of virus which is a milder coronavirus like the NL63 or the 229? It may be the mild (unintelligible) kind of inducer. [Dr John Nicholls University of Hong Kong]

No sore throat: This new virus attacks the lungs as well, and not just the throat. Patients so far have not presented with a sore throat, because the 2019-nCoV attacks the intraepithelial cells of lung tissue.

Asymptomatic transmission: A report of a small cluster of five cases indicated transmission from asymptomatic individuals during the incubation period; all patients in this cluster had mild illness. Another person got infected while using gown, but the eyes were not covered. NEJM reported a transmission from asymptomatic case but the same has been challenged.

Mass Quarantine May Spark Irrational Fear, Anxiety, Stigma

Evacuation: US, Japan, India have evacuated their citizens trapped in China’s affected areas.  All 645 evacuees from Wuhan tested negative for the deadly infection in India. Close to 80 Indian students are still stuck in Wuhan. 70 of the 80 chose to stay behind at the time of the evacuation operation. 10 had expressed willingness to return to India but could not board as they failed the screening process at the airport.

Bangladesh scrapped plans to bring back its 171 nationals stuck In China as crew members refused to fly. State-run Biman Airlines Boeing 777-300 ER aircraft on February 1 brought back 312 Bangladesh nationals.

Legal implications in India: Section 270 in The Indian Penal Code: 270. Malignant act likely to spread infection of disease danger­ous to life.—Whoever malignantly does any act which is, and which he knows or has reason to believe to be, likely to spread the infection of any disease dangerous to life, shall be punished with imprisonment of either description for a term which may extend to two years, or with fine, or with both.

Asymptomatic: Unlike SARS, patients were symptomatic at about day 5. Some of these cases may be asymptomatic until about day 7. The first 5 days are probably asymptomatic. 

Case fatality of coronavirus 2%

Case fatality of MERS 34% (2012, killed 858 people out of the 2,494 infected)

Case fatality of SARS 10% (Nov. 2002 - Jul. 2003, originated from Beijing, spread to 29 countries, with 8,096 people infected and 774 deaths) 

Case fatality of Ebola 50%,

Case fatality of Smallpox 30-40%

Case fatality of Measles 10-15% developing countries

Case fatality of Polio 2-5% children and 15-30% adults

Case fatality of Diphtheria 5-10%

Case fatality of Whooping cough 4% infants < 1yr, 1% children < 4 years

Case fatality of Swine flu < 0.1-4 %

Case fatality of seasonal flu 0.01%.

Case fatality of current virus in Wuhan 4.9%.

Case fatality of current virus in Hubei Province 3.1%.

Case fatality of current virus in Nationwide 2.1%.

Case fatality of current virus in other provinces 0.16%.

Number of flu deaths every year: 290,000 to 650,000 (795 to 1,781 deaths per day)

Lab tests: There are two ways to detect a virus: through the genetic material DNA or RNA and to detect the protein of the virus. The rapid tests look at the protein. It takes 8-12 weeks to make commercial antibodies. Currently, for the diagnostics tests, PCR is being used which gives  a turnaround in 1-2 hours.

Treatment: No proven antiviral treatment.

With SARS, in 6 months the virus was gone and it never came back. Pharmaceutical companies may not spend millions to develop a vaccine for something which may never come back.

Evidence of E. coli: Secondary infection is most likely the cause of deaths in the Philippines and Hong Kong.

SARS Experience: A combination of lopinavir and ritonavir showed promise in lab

MERS experience: Combination of lopinavir, ritonavir and recombinant interferon beta-1b has been tried

Recreation of Virus: Scientists in Australia have reportedly developed a lab-grown version of coronavirus.

Chloroquine: had potent antiviral activity against the SARS-CoV, has been shown to have similar activity against HCoV-229E in cultured cells and against HCoV-OC43 both in cultured cells and in a mouse model.

Thai experience: Oseltamivir along with lopinavir and ritonavir, both HIV drugs.

Experimental drug: From Gilead Sciences Inc., called remdesevir (started on 6^th Feb as a trial)

Russia and China drug: Arbidol, an antiviral drug used in Russia and China for treating influenza, could be combined with Darunavir, the anti-H.I.V. drug, for treating patients with the coronavirus. (The corona virus shares some similarity to HIV virus also)

PVP-I mouthwashes and gargles are known to reduce viral load in the oral cavity and the oropharynx. PVP-I has high potency for viricidal activity against hepatitis A and influenza, MERS and SARS

DCGI Approval: The Drug Controller General of India has approved the "restricted use" of a combination of drugs (Lopinavir and ritonavir) used widely for controlling HIV infection in public health emergency for treating those affected by novel coronavirus.

Steroids: In SARS, people were put on long-term steroids ending with immunosuppression and late complications and death. The current protocol is short-term treatment.

Universal respiratory droplets precautions

Self-quarantining: 2 weeks

Adherence: Strict

Soap and water: Wash your hands often and for at least 20 seconds.

Alcohol-based hand sanitizer: if soap and water is not available

Avoid touching:  your eyes, nose, and mouth with unwashed hands.

Avoid close contact:  (3-6 feet) with people who are sick with cough or breathlessness

Stay home:  when you are sick.

Cover your cough or sneeze with a tissue, then throw the tissue in the trash.

Clean and disinfect frequently touched objects and surfaces.

Surgical Masks: For patients

N 95 Masks: For health care providers and close contacts

The world is facing a chronic shortage of gowns, masks, gloves and other protective equipment in the fight against novel coronavirus.

Ten Common Myths

1. People receiving packages from China are not at risk of contracting the new coronavirus as the virus does not survive long on objects, such as letters or packages.

2. There is no evidence that animals/pets such as dogs or cats can get infected with the new coronavirus. However, it is always in your best interests to wash your hands with soap and water after contact with pets to prevent transmission of common bacteria such as E. coli and Salmonella.

3. Pneumococcal vaccine and Haemophilus influenza type B (Hib) vaccine, do protection no against the new coronavirus.

4. Regularly rinsing the nose with saline does not protect people from infection with the new coronavirus or respiratory infections although it can hasten recovery from the common cold.

5. There is no evidence that using mouthwash protects from infection with the new coronavirus although some brands of mouthwash can eliminate certain microbes for a few minutes in the saliva in your mouth.

6. Garlic may have some antimicrobial properties, however, there is no evidence that eating garlic protects people from the new coronavirus.

7. Sesame oil does not kill the new coronavirus. Chemical disinfectants that can kill the 2019-nCoV on surfaces are bleach/chlorine-based disinfectants, either solvents, 75% ethanol, peracetic acid and chloroform. However, they have little to no impact on the virus if you put them on the skin or under your nose. It can even be dangerous to put these chemicals on your skin.

8. 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) have increased odds of becoming severely ill with the virus.  People of all ages are advised to take steps to protect themselves from the virus, for example by following good hand hygiene and good respiratory hygiene?

9. Antibiotics do not work against viruses.  Hence, antibiotics should not be used to prevent or treat new coronavirus unless you suspect bacterial co-infection.

10. To date, there is no specific medicine recommended to prevent or treat the new coronavirus (2019-nCoV).

Role of CMAAO and other Medical Associations

1. All countries should be prepared for containment, including active surveillance, early detection, isolation and case management, tracking contacts and prevention of spread of the virus and to share full data with WHO. 
2. It is a legal requirement that all countries share information with WHO under the IHR.     

3.  If 2019-nCoV is detected in an animal (information about the species, tests, and epidemiological data), it must be reported to the World Organization for Animal Health (OIE) as an emerging disease.

4.  All countries should emphasize on reducing human infection, prevention of secondary transmission and international spread.

PMO Suggestions sent

7^th January: CMAAO Alert: WHO to monitor Chinas mysterious pneumonia of unknown virus outbreak

8^th Jan: CMAAO warns Asian citizens travelling China over mystery pneumonia outbreak

10^th January: I wrote an editorial: Corona virus strain causing pneumonia in Wuhan, China, It’s a new strain of corona virus in the China pneumonia

13^th January: China Virus Outbreak Linked to Seafood Market:

15^th January: First Case of China Pneumonia Virus Found Outside China in Thailand

17^th January: WHO issues warning after mysterious Chinese corona virus spreads to Japan

17^th Jan: India at threat of Coronavirus. CMAAO urges travel advisory on coronavirus: http://www.drugtodayonline.com/medical-news/nation/10379-cmaao-urges-travel-advisory-on-coronavirus.html

 (18^th Jan: Indian govt issues travel advisory as Chinas mysterious Coronavirus spread in other countries)

18^th Jan: WHO issues warning after mysterious Chinese Coronavirus spreads to Japan [http://blogs.kkaggarwal.com/tag/who/]

18th-20th Jan: Three countries meet, also discussed Corona virus

22^nd Jan: Still not being declared to be a notifiable disease; N 95 to be included in the list of essential drugs and price-capped; Oseltamivir should also be price-capped; flights should have masks available for all passengers; not declaring flu-like symptoms while boarding or landing should be a punishable offence (23^rd Jan: India issues advisory to airports)

24^th: Inter Ministerial Committee needs to be formed on Coronavirus (PMO took a meeting on 24^th evening)

25^th Jan: Indian government should pay for Indians affected with the virus in China

  26^th Jan: Need of National Droplet Infection Control Program; Policy to ban export of face masks; policy to evacuate Indians and people of  neighboring countries from China’s affected areas; Time to collaborate on Nosode therapy (Exports of masks banned on 31^st January by Indian Government)

Action:  Feb 1^st: Ibrahim Mohamed Solih thanked India for the evacuation of seven Maldivian nationals from the coronavirus-hit Chinese city of Wuhan. India evacuated 647 people

 [On 30^th Jan, India banned gloves, PEP and masks but on 8^th lifted the ban on surgical masks/disposable masks and all gloves except NBR gloves. All other personal protection equipment, including N-95 and equipment accompanying masks and gloves shall remin banned.] 

27^th Jan: History of anti-fever drugs at airports should be taken

28^th Jan: Do research on Nosodes

29^th Jan: Closure of live markets all over the world, India should take  lead

30^th Jan: Paid flu leave, surgical mask at public places, N 95 for health care providers

31^st Jan: Respiratory hygiene advisory to schools, Pan-India task force to be made  

1^st Feb: Disaster Budget is the need of the hour

3^rd Feb: 100 crore budget for Coronavirus; Private labs to be recognized; one dedicated corona National help line; MTNL, BSNL to have a line of advisory in their bills; isolation wards to be single rooms or two beds separated with six feet distance; national insurance to cover cost of treatment;  Sea ports to have same precautions; price caps for masks, and gloves; National Droplet Control Program; clarification that import of goods is not risky And suspend AI flights to China and Hong Kong

[Feb 4 - Air India suspended flight services to Hong Kong from Friday until March 28. Earlier, Air India had cancelled its flight to Shanghai from January 31 to February 14; and 5^th Feb - The Ministry of Defence is setting up 10 new laboratories across the country, primarily to conduct research on viruses]

4^th Feb: Kerala travel advisory needed [The Union Ministry of Health and Family Welfare issued a fresh travel advisory on Monday urging people to refrain from visiting China]

5^th Feb: PM should talk about Coronavirus in Man Ki Baat or a special address

6^th Feb: Time to have makeshift bed policy to tackle deaths in Kota, Muzaffarpur and Coronavirus cases [Uttarakhand to set up two dedicated hospitals to tackle coronavirus : https://www.hindustantimes.com/india-news/uttarakhand-to-set-up-two-dedicated-hospitals-to-tackle-coronavirus/story-NYxBOw6XHTbugznTWa3CXK.html]

7^th Feb: IPC 269 should be applicable to corona virus

8^th Feb: Teleconsultation should be allowed for flu and coronavirus consultation

 Total Cases of Novel Coronavirus (2019-nCoV)