Test, test, test. Test every suspected case; if they test positive, isolate them and find out who they have been in contact with two days before they developed symptoms and test those people, too.

WHO is calling on nations to carry out more tests for coronavirus as health officials say there has been a rapid escalation of COVID-19 cases over the past week.  Testing, isolation and contact tracing are the key responses amidst the coronavirus pandemic.

As per WHO, more cases and deaths have now been reported throughout the rest of the world compared with China. WHO has shipped nearly 1.5 million coronavirus tests to 120 countries.

In view of this, ICMR has also increased random testing for COVID-19 cases as the number of cases is on the rise. The testing was initiated from 15^th March, and each of the 51 Indian Councils of Medical Research laboratories has been assigned to test 10 samples every week. With the rising demand for testing, Centre has also agreed to allow accredited priate labs to test for COVID-19.

With the objective of early detection of virus transmission, SARI or all viral pneumonia should be made notifiable. A rising trend of SARI/Pneumonia cases may indicative of possible COVID-19 infection.

The criteria for reporting the cases are: 1) age above 15 years 2) fever 3) any respiratory symptoms -- severe cough or shortness of breath 4) hospitalisation. If a patient meets any four criteria points, the case should be immediately reported.

Prevention of airborne transmission for healthcare professionals

WHO is considering airborne precautions for medical staff after a new study showed that the coronavirus can survive in the air in certain situations. In presence of factors such as heat and humidity, the coronavirus can remain suspended in the air as per the new study.

The virus is transmitted through droplets, mostly through sneezing or coughing. When an  aerosol-generating procedure is done in a medical care facility, there are chances of aerosolizing these particles, which means they can stay in the air a little bit longer. It’s very important that health-care workers take additional precautions when they’re working on patients and while performing those procedures. Health officials recommend medical staff wear so-called N95 masks because they filter out about 95% of all liquid or airborne particles.

Cancellation of mass events

In a press release CDC has also recommended the cancellation of all in-person events that may consist of 50 or more people throughout the United States for the next 8 weeks.  CDC recommends that, ‘events of any size should only be continued if they can be carried out with adherence to guidelines for protecting vulnerable populations, hand hygiene, and social distancing. When feasible, organizers could modify events to be virtual.’

Clinical trial starts for vaccine against COVID-19

An investigational vaccine called mRNA 1273 designed to protect against COVID-19 hasentered the Phase I of clinical trial at Kaiser Permanente Washington Health Research Institute (KPWHRI) in Seattle. This is an open-label trial which will enroll 45 healthy adult volunteers ages 18 to 55 years over approximately 6 weeks. The first participant received the investigational vaccine on Monday, 16^th March, 2020. The investigational vaccine directs the body’s cells to express a virus protein that may elicit a robust immune response. The m-RNA-1273 vaccine has shown promising results in animal studies and I snow being tested for the first time in human subjects.

Scientists at NIAID’s Vaccine Research Center (VRC) and Moderna were able to quickly develop mRNA-1273 because of prior studies of related coronaviruses that cause SARS and MERS. Research was already ongoing on an investigational MERS vaccine targeting the spike, which gave a head start for developing a vaccine candidate to protect against COVID-19. Once the genetic information of SARS-CoV-2 was available, the scientists selected a sequence to express the stabilized spike protein of the virus in the existing mRNA platform.

Study participants will receive two doses of the vaccine via intramuscular injection in the upper arm approximately 28 days apart. Each participant will be assigned to receive a 25 microgram (mcg), 100 mcg or 250 mcg dose at both vaccinations, with 15 people in each dose cohort. The first four participants will receive one injection with the low dose, and the next four participants will receive the 100 mcg dose. Investigators will review safety data before vaccinating the remaining participants in the 25 and 100 mcg dose groups and before participants receive their second vaccinations. Another safety review will be planned before participants are enrolled in the 250 mcg cohort.

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Dr KK Aggarwal

President CMAAO, HCFI and Past National President IMA