India reported the first confirmed case of the coronavirus infection on 30 January 2020 in the state of Kerala. The affected had a travel history from Wuhan, China.

Since the Wuhan coronavirus outbreak in China, the highest number of suspected cases in India, the second most populated country in the world,  has been reported in the state of Kerala. Suspected coronavirus cases have also been reported in multiple cities such as New Delhi, Mumbai, Bengaluru, Hyderabad, and Patna.

Religious tourism and weddings: potential coronavirus clusters in India

Places of religious gathering such as temples, mosques and churches can be clusters for coronavirus transmission in India, where religious tourism is high and community gatherings for celebrating festivals are huge.

ISKCON, one of the popular Hindu religious organisations running temples that attract foreign devotees, is reported to have advised foreigners from the coronavirus-affected countries not to visit for two months, as a precautionary measure.

Agra, another popular hotspot for tourists including foreigners, is a potential cluster.

One more potential coronavirus cluster in India is weddings where the average guest counts run from few hundreds to more than a thousand.

Coronavirus cases in India: Confirmed, suspected and recovered

Thousands of suspected cases have been tested resulting in 83 confirmed coronavirus cases in India. Coronavirus quarantine measures have been announced in Maharashtra, including in Mumbai, Navi Mumbai, Thane, Nagpur, and Pimpri-Chinchawad up to 30 March. The measures include closure of malls, gyms, movie theatres and swimming pools.

Two cases were reported in Nagpur, Maharashtra, on 13 March. An employee of Google in Bangalore tested positive on 13 March, while a COVID-19 positive case was confirmed in Noida on the same day.

First death due to coronavirus in India was reported in Karnataka on 12 March.

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Coronavirus: Kerala situation update

The regions in Kerala where cases have been reported include Kottayam, Pathanamthitta and Ernakulam.

The first three Indians tested positive for coronavirus are from Kerala and have been discharged, but home-quarantined. Kerala reported five more coronavirus cases on 08 March and continues to report fresh cases .

Coronavirus: Punjab situation update

Two out of three Italians who arrived in Hoshiarpur in Punjab tested positive in a preliminary test conducted at All India Institute Of Medical Sciences (AIIMS) in New Delhi, according to the Hindustan Times. Samples were sent to Pune for confirmation and one of them tested positive for the virus.

Coronavirus: Pune situation update

Eight COVID-19 cases have been reported in Pune, Maharashtra. The first infected were a couple who returned from Dubai. They were admitted to the Naidu Infectious Disease Hospital for treatment.

Coronavirus: Hyderabad (Telangana) and Andhra situation update

One coronavirus-infected was identified in Hyderabad on 02 March. The infected person returned from Dubai to Hyderabad after completing a business trip. One person in Nellore, Andhra Pradesh, tested positive for coronavirus on 12 March, after returning from a trip to Italy.

On 04 March, an employee working at a company based in Raheja Mindspace, in Cyberabad, an IT cluster in Hyderabad, was found to be coronavirus-infected in initial tests. The samples were sent to the nodal lab testing for coronavirus in Pune, for second round of testing, which showed a negative result. Raheja announced that Building No. 20 at Mindspace, Madhapur, was sanitised and disinfected.

Other companies located in the same building, such as Cognizant Technology Solutions (CTS) too asked employees to work from home temporarily. IT companies including TCS, HCL, Wipro, Mahindra and initiated precautionary measures and limiting offshore travel of employees where possible.

Hyderabad Metro trains are also being disinfected as a precautionary measure. Similar measures followed suit in other metros such as Delhi Metro and Jaipur Metro.

Health officials identified a total of 88 people including family members who came in contact with the confirmed case in Hyderabad and taken their samples for testing. Among the 88 people, 45 were admitted to the state-run Gandhi Hospital.

Coronavirus: Jaipur, Rajasthan, situation update

Coronavirus was confirmed on 03 March in a 69-year-old male Italian who arrived in Rajasthan. The first test on the Italian tourist yielded a negative result but a second test turned out to be positive. His wife was also diagnosed to be positive later, on the same day.

A total of 16 Italian tourists and one Indian driver were found to have contracted coronavirus.

Coronavirus: Delhi and Gurugram COVID-19 situation

A Delhite with travel history to Thailand and Malaysia was tested COVID-19 positive on 06 March.

An employee of payments company Paytm in Gurugram tested positive for coronavirus after returning from Italy, announced Paytm on 04 March.

On 02 March, two confirmed cases were reported including one in New Delhi. The COVID-19 infected in New Delhi was a person who returned from Italy.

The crew of the Air India flight that carried the infected in New Delhi has been asked to self-isolate at their homes for 14 days.

The Indian Ministry of Health announced on 03 March that samples taken from six people who came in contact with the confirmed case in New Delhi showed high viral loads. The samples have tested positive at the National Institute of Virology in Pune.

The government has set up a task force to monitor and control the Delhi coronavirus situation.

Coronavirus: Bangalore, Karnataka COVID-19 cases and update

The south Indian city of Bengaluru, the capital of Karnataka state, witnessed a techie working in Intel having been suspected to be exposed to coronavirus. The suspected person has been quarantined.

One new case of coronavirus has been confirmed in Bangalore (officially Bengaluru), which is popularly called the Silicon Valley of India for being a major IT services exporter.

Three new cases of coronavirus infection were reported in Karnataka on 10 March.

Educational institutions such as IIIT started asking students to stay at home and take digital classes.

Indians on quarantined cruise ship Diamond Princess

The latest coronavirus cases in India are reported from the Diamond Princess cruise ship quarantined off the coast of Yokohama in Japan. A total of 16 people from India have tested positive for the virus on the ship as of 26 February. The infected persons are reported to be a stable condition. A total of 132 passengers and six crew members from India are reportedly on board the ship.

A total of 124 Indian nationals including five foreign nationals who have tested negative for the virus were evacuated in a special flight on 27 February.

Coronavirus disease in India: Approved treatments

The Drug Controller General of India has granted approval to the Indian Council of Medical Research to use a combination of lopinavir and ritonavir in the event of the coronavirus disease in India turns into a public health emergency, reported the Economic Times.

Lopinavir and ritonavir have already been approved for the treatment of HIV.

COVID-19: Measures India has taken to control the Wuhan coronavirus spread

The Indian government has announced a number of preventive measures to minimise the entry and spread of coronavirus, as detailed below. India’s prime minister Narendra Modi is reviewing the country’s preparedness in combating COVID-19 coronavirus in India, if it spreads further in India, and has appealed to Indians to avoid mass gatherings.

A control room operational 24×7 to address queries has been launched.

Evacuation measures

The Indian government arranged for the evacuation of 324 Indian citizens from Wuhan in a special Air India flight on 31 January 2020. The passengers were placed under quarantine for a period of 14 days.

The second batch of 330 passengers, including seven Maldivan citizens evacuated by the government, arrived from Wuhan on 01 February 2020. The repatriated passengers are currently being monitored. India evacuated 654 people including 647 Indians citizens by 11 February.

The health condition of all of them was monitored on a daily basis. They were tested twice for COVID-19 infection and found to be negative. All the evacuvees were discharged on 18 February.

A total of 76 Indian nationals and 36 foreign nationals were evacuated in a special flight from Wuhan on 26 February. They are placed under quarantine in Manesar and have tested negative in the first test.

India has commenced evacuation of hundreds of Indians stranded in Iran. The first flight carrying 58 Indian nationals landed in Ghaziabad on 10 March.

Coronavirus: Visas cancelled for foreign nationals travelling from affected countries

India announced the cancellation of existing e-visas issued to all foreign nationals of China, on 05 February and advised Indians to avoid travelling to China.

Further, India announced that people travelling to China will be quarantined upon return. India temporarily suspended visa on arrival for Japanese and South Korean nationals on 27 February.

On 03 March, India announced the suspension of all visas issued to nationals of Italy, Iran, South Korea and Japan who have not yet entered the country. Visas issued to foreign nationals who travelled to China, Iran, Italy, South Korea and Japan who have not yet entered the country have also been cancelled.

The cancellation is not applicable to diplomats, officials of the international bodies, OCI cardholders and aircrew although medical screening is mandatory for all. Medical screening and submission of self-declaration form including travel history for all passengers arriving from the restricted countries are also mandatory.

Ensuring availability of coronavirus drugs in India

The Department of Pharmaceuticals is assessing the availability of drugs in the country due to the increase in cases of coronavirus infection. A report submitted by a committee formed by the department revealed that the existing stock of APIs will be sufficient to manufacture drugs for two to three months.

Various government organisations including the National Pharmaceutical Pricing Authority and Drugs Controller General of India have been instructed to ensure an adequate supply of APIs and check black-marketing or illegal hoarding. The organisations have also been asked to monitor the availability of APIs and drugs.

The Directorate General of Foreign Trade (DFGT) has been instructed to restrict the export of 13 APIs and formulations, the majority of which are made in Hubei, China. According to the latest reports, many Chinese pharmaceutical companies have partially resumed production and expected to resume full production by the end of March. Logistics, however, have not resumed fully, which may delay the availability of APIs.

Coronavirus screening, testing and quarantining at Indian airports

Starting from 04 March, India mandated universal screening at all airports in the country given the rise in coronavirus imports.

Thermal screening has been installed at 21 airports including those in Delhi, Mumbai, Kolkata, Chennai, Bengaluru, Hyderabad, and Cochin to check for coronavirus in India. Universal screening has been mandated for flights from China, Hong Kong, Singapore and Thailand at the aero-bridges ear-marked for the purpose.

Screening measures have also been implemented at 12 major seaports and 65 minor seaports and land borders.

The Ministry of Health announced on 06 February that all 645 evacuees from Wuhan tested negative.

Two quarantine centres have been set-up to isolate any passengers showing symptoms of the infection. One centre is located at Manesar, Haryana, and is managed by Armed Forces Medical Services, while the second is located at Chawla Camp in New Delhi and is managed by Indo-Tibetan Border Police (ITBP).

A total of 406 evacuees who were quarantined at the ITBP facility were discharged and allowed to return home on 19 February.

By 14 March, India screened approximately 1.2 million visitors.

Labs testing for coronavirus in India

The NIV and 52 other laboratories under the Indian Council of Medical Research’s (ICMR) Viral Research and Diagnostics Laboratories network are equipped to test samples.

The National Institute of Virology lab in Pune is serving as the nodal lab for coronavirus testing in India. The Pune lab has facilities for COVID-19 molecular diagnosis and next-generation sequencing.

The labs are equipped with reagents to test up to 25,000 samples. The Indian government is in the process of adding more coronavirus testing laboratories in the country.

India COVID-19: Visa cancellations and travel restrictions

The Indian government has mandated that non-resident Indians (NRIs) arriving to the country should carry a coronavirus-negative certificate from designated hospitals in the countries they are travelling from.

The Indian government has advised all Indians to avoid non-essential travel abroad. Self-quarantine is mandated to passengers arriving in India from China, Hong Kong, Republic of Korea, Japan, Italy, Thailand, Singapore, Iran, Malaysia, France, Spain and Germany.

Visas have been suspended to French, German and Spanish nationals as well as foreigners with a travel history to these countries. Visas of foreigners already in India, however, remain valid.

The Indian government had earlier issued a travel advisory on 17 January 2020 to the general public to refrain from travelling to China and avoid contact with anyone with travel history to China since 15 January 2020.

The government had also temporarily suspended e-Visa facility for Chinese passport holders and noted that already issued e-Visas are temporarily invalid. Online application for a physical visa from China was also disabled.

The Indian government is expected to extend visa cancellations to more countries with the fresh cases reported in Maharashtra, Delhi and Bangalore.

Coronavirus impact on India

Coronavirus is expected to present both opportunities and challenges to Indian pharmaceutical manufacturers, while trade with China is expected to be hit.

Initial estimates of the COVID-19 impact on India’s trade were $348m, but likely to increase given the global spread.

Impact on India’s trade with China

With China under lockdown, India is expected to witness a major impact on imports and exports in various industries including pharmaceuticals, electronics, mobiles, and auto parts.

China is the biggest exporter to India, followed by the US and UAE. In 2018, China exported goods worth $90.4bn to India and accounted for 14.63% of the exports.

In 2017, telecom instruments, electronics components, computer hardware and peripherals, industrial machinery for dairy, and organic chemicals were the top five items imported by India accounting for 46% of the imports from China.

How the COVID-19 outbreak impacts the Indian pharmaceutical industry

Bulk drugs and drug intermediates accounted for $1.5bn or 3% of India’s imports from China.

According to the Trade Promotion Council of India, approximately 85% of active pharmaceutical ingredients (APIs) imported by Indian companies are from China.

India’s overdependence on China for APIs exposes it to raw material supply disruption and price volatility. Another major hindrance to the Indian pharmaceutical industry is its low capacity utilisation, according to a report from the Ministry of Commerce and Industry (MCI). India has a capacity utilisation between 30% and 40% as against 75% of China.

Mankind Pharma and Granules India are airlifting APIs and other input materials for their manufacturing due to limited land movements and shipping delays from China as inventories are drying up, reported Economic Times.

Opportunities for Indian pharmaceutical manufacturers

Although the Wuhan coronavirus outbreak could have a significant impact on the Indian pharmaceutical industry unless it is brought under control over the next few months, it also provides an opportunity to India’s pharmaceutical manufacturers to grab share from their Chinese competitors.

Indian pharmaceutical companies currently have two months’ stock of APIs and intermediates, quoted the Economic Times. In the absence of a major disruption due to the outbreak, the existing stocks may address the issue of shortage, it added.

The report from MCI, however, noted that improving the overall capacity utilisation of existing manufacturing plants in India as a short-term solution to such supply disruptions. The report noted the need for assured purchase agreements from the government for the existing manufacturing plants.

It also noted that the government should absorb the price differential to improve capacity utilisation.

Export ban on protection equipment

The DGFT issued a ban on the export of personal protection equipment such as respiratory masks and protective overalls, on 31 January. The exact reason for the ban has not been notified, though.

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