How 'eye-opening' 2009 swine flu pandemic helped India devise COVID-19 strategy

Speaking at a news conference, the Indian Council of Medical Research (ICMR) credited the 2009 swine flu outbreak as an event that helped shape India's COVID-19 testing strategy. "A decade ago, when India witnessed one of the worst flu pandemics (swine flu in 2009), the public health system was paralysed due to severe dearth of infrastructure for molecular diagnosis of viral infections. Public health professionals helplessly watched the pandemic quickly escalating to all parts of the country," the ICMR said.

Though the country was equipped to carry out serology-based ELISA or rapid blood tests, the virus was challenging and could not be detected in the blood. Molecular virological test was the only option for detection of H1N1 and it was available only in two institutions—National Institute of Virology (NIV), Pune, and National Centre for Disease Control (NCDC), Delhi, according to the ICMR.

"The event was an eye-opener for the public health system of the country wherein glaring gaps in testing capacity were brought out," the health research body said, adding that this, in turn, paved the way for strengthening molecular diagnostic facilities for viruses in India through the Virus Research and Diagnostic Laboratory (VRDL) Network.

"Contrary to 2009, in January 2020, when the threat of COVID19 epidemic knocked at our doors, the government could immediately scale up its preparedness by standardising diagnostic assays at ICMR-NIV, Pune, and immediately commissioning diagnostic facility in 13 VRDLs based on their location in cities with international airports," the ICMR said.

The ICMR said that COVID-19 being an imported infection, the labs were mapped based on their presence in cities where flights from China and other countries with reported coronavirus infections would land. With the country lacking adequate testing facilities in every district, it adopted an "intelligent testing strategy" to trace and track the virus and anticipate areas where testing would be required and all possible institutions both in the public or private like laboratories, universities and private medical colleges were identified.

AIIMS-like institutions were roped in, to handhold these institutions especially private medical colleges and private labs while lab technicians were trained to handle the sample and carry out tests with accuracy. Supply of testing kits was ensured and Indian companies were helped to develop and scale up indigenous production of testing kits while ensuring they adhered to the quality and standards.

This led to developing COVID-19 molecular diagnostic capacity in 'difficult to reach' areas like Arunachal Pradesh, Nagaland, Sikkim, Ladakh, Goa, Andaman and Nicobar Islands among other, it said; from 13 laboratories in the first week of February and 123 laboratories on March 24, India now has 610 COVID-19 testing labs.

Most states have been working with the National Tuberculosis Elimination Program (NTEP) to deploy TrueNAT machines for COVID-19 testing. Through this machine, testing is done in such areas/ districts where modern virological laboratory in private or public doesn't exist, the ICMR said. "Due to this, the testing infrastructure is not overwhelmed in any state to date. No state has a significant backlog of samples to be tested. More labs are being set up and additional machines are deployed in states like Uttar Pradesh, Bihar, West Bengal as well as in the rest of the country to meet the possible higher requirement," it said.

What does the health ministry have to say on COVD-19 situation in India now?

Even as the death toll rose to 4,167 and the number of coronavirus cases climbed to 1,45,380 in the country, the COVID-19 fatality rate in India is 2.87 per cent, the lowest among countries badly hit by the pandemic, the Centre claimed. 

Joint Secretary in the Union Health Ministry Lav Agarwal said from 3.38 per cent in April, the fatality rate in the country has come down to 2.87 per cent as against 6.4 per cent globally, and attributed the timely lockdown, early detection and management of coronavirus infection cases as the main reasons for the low death toll. The country has been registering 6,500 new cases daily for five days in a row and is among the 10 top nations worst hit by the pandemic.

"For India, the fatality rate is as low as 2.87 per cent, one of the lowest among countries which have reported high number of COVID-19 cases," Agarwal said.

Referring to the WHO situation report 126 dated May 25, Agarwal said that France has a fatality rate of 19.9 per cent, followed by Belgium at 16.3, Italy at 14.3, UK at 14.2, Spain 12.2, Sweden 11.9, Canada 7.6, Brazil 6.3, the US at 6.0, China 5.5 and Germany at 4.6 per cent. Further, India has 0.3 deaths per lakh population as against the 4.5 deaths globally,which is among the lowest in the world, he said.

-Inputs from PTI