By Abantika Ghosh and Karishma Mehrotra
India reported its third novel coronavirus (Covid-19) death on Tuesday - a 64-year-old man in Mumbai with travel history to Dubai. While the total number of cases has touched 137, 14 people have recovered so far. The Union health ministry has now recommended use of Lopinavir/Ritonavir combination, usually a second-line HIV medication, on a case-to-case basis, for high-risk patients aged above 60 with underlying conditions.
The antiviral drugs were first administered to two Covid-positive Italian tourists - a 69-year-old man and his 70-year-old wife - in Jaipur, who have now tested negative. Tightening the lockdown further, India has banned entry of passengers from Afghanistan, Philippines, Malaysia till March 31. On Monday, passengers from "the European Union, the European Free Trade Association, Turkey and United Kingdom" were barred. "Travel of passengers from Afghanistan, Philippines, Malaysia to India is prohibited with immediate effect. No flight shall take off from these countries to India after 1500 hours Indian Standard Time (IST). The airline shall enforce this at the port of initial departure," said the new travel advisory.
Meanwhile, the Indian Council of Medical Research (ICMR) is in talks with 51 NABL accredited laboratories in the country for opening up coronavirus testing to the private sector, with the condition that test results will have to be conveyed real time to the local officials of the Integrated Disease Surveillance Programme. "We are in talks with them… they may need 7-10 days for procurement of reagents. Many of them had offered help in the national interest. We appeal to them to make the test available free of cost," said Dr Balram Bhargava,ICMR DG and secretary, department of health research. The testing criteria has now been expanded to include health workers caring for Covid-19 patients who show symptoms.
Earlier, it was limited to symptomatic people with travel or contact history. Defending India's testing criteria, Dr Bhargava said India has conveyed to the WHO country office that the "test test test" prescription of WHO DG Dr Tedros Adhanom Ghebreyesus was premature for India, as it is still in the local transmission phase. "By the end of this week, there will be 72 functional ICMR labs for Covid-19 testing and 49 others in the government system - these are DBT, DRDO, CSIR and government medical colleges… We are also in talks with 51 NABL-accredited private laboratories to start testing," he said.
In addition, he said, two laboratories with the capacity to process 1,400 samples each per day were being readied. Senior scientist Dr Nivedita Gupta said equipment for the confirmatory test has been distributed to 51 ICMR laboratories across the country. She said the first batch of 500 samples of people without travel or contact history, to check for community transmission, had all tested negative. According to the revised clinical management guidelines for Covid-19 patients, "There is no current evidence from RCTs to recommend any specific treatment for suspected or confirmed patients with Covid-19. No specific anti-virals are recommended for treatment of Covid-19 due to lack of adequate evidence from literature. The use of Lopinavir/ Ritonavir in PEP regimens for HIV (4 weeks) is also associated with significant adverse events which many a times leads to discontinuation of therapy. In light of the above, Lopinavir/Ritonavir should only be used with proper informed expressed consent on a case to case basis for severe cases, within the under-mentioned framework along with supportive treatment as per need."
The drug is to be used in patients who have hypoxia, hypotension, new onset organ dysfunction (one or more) and those in "high risk groups", including people with "diabetes mellitus, renal failure, chronic lung disease, immuno-compromised persons or those aged above 60 years". The guidelines for last rites in case of Covid-19 deaths have also been laid down to prevent spread of infection.
Taking precautionary measures, the Department of Personnel and Training (DoPT) on Tuesday ordered the installation of thermal scanners and hand sanitisers at the entry points of government buildings, advised against official travel, and meetings through video conferencing wherever possible. The government has also increased the number of lines on the Covid-19 helpline to 100. While a 76-year-old man from Kalaburagi in Karnataka, who had returned from Saudi Arabia, died last Tuesday, a 68-year-old woman died in Delhi on Friday.