Traveler as a risk factor for migration of COVID-19 in India

To the Editor,

Today, one of the most dangerous health issues is the wide outbreak of COVID-19 infection. An outbreak of coronavirus disease 2019 (COVID-19) caused by the 2019 novel coronavirus (SARS-CoV-2) began in the city of Wuhan in China and has widely spread worldwide (Wang et al., 2020; Huang et al., 2020). More than 200 countries and territories all around the world have confirmed imported cases of SARS-CoV-2 infection (https://www.who.int/, 2020), and the disease (COVID-19) has been declared as a Public Health Emergency of International Concern (PHEIC). Major initial symptoms of COVID-19 include fever, cough, muscle & joint ache, soreness of throat, and dyspnea (Tan et al., 2020; Zhu et al., 2020). Some patients showed typical symptoms, such as diarrhea and vomiting, while some remained asymptomatic. Considering the massiveness of transmissibility of the disease the World Health Organization has declared it a pandemic, and till date, 10.04.2020, it has affected around 1439,516 people in more than 200 countries and territories resulting over 85,711 deaths (MoHFW, 2020; Worldometer, 2020; https://www.mygov.in/covid, 2020). The WHO has declared the coronavirus pandemic as a global health emergency.

International and national flight ticket sales have increased significantly over the past decade. COVID-19 remains one of the most important health problems encountered by travelers to developing countries, the risk being widespread throughout the world. India is the neighboring country of China. In many Indian students are going to different Universities in China for studies. All these students are returned home in air travel due to outbreak of COVID-19 in China. A total of 650 people were brought back from Wuhan in China on 1st& 2^nd February 2020 by two 747 Boeing Air India aircrafts after the massive outbreak of the novel Coronavirus in China. More than 500 people from COVID-19 stricken Italy were also airlifted.

The population of India is 138.2 crores and it is the second most populated country in the World (after China) with a population density of nearly 464 per square kilometer (Worldometer). The first case in India confirmed in Kerala's Thrissur district when a student had returned home from Wuhan University in China. According to the up to date report of the Ministry of Health, Govt. of India, there are a total of 5709 confirmed COVID-19 affected cases in India which includes 47 foreign nationals. 504 of them have been discharged, while 199 have deceased (MoHFW, 2020; Worldometer, 2020; https://www.mygov.in/covid, 2020). COVID-19 was spread rapidly human-to-human transmission either via respiratory droplets or via contact. India is therefore at high risk ofCOVID-19transmission, and in order to prevent spreading of the disease the Govt. of India has taken some preventive actions (https://boi.gov.in/content), such as:

• •All the 34 international airports in India have been equipped with thermal scanners and it was decided that all the flights coming from China or other Countries would be scanned and suspicious passengers would be quarantined compulsorily for a minimum period of 14 days.
• •A maximum travel time of 20 hours would be permissible for such commercial passenger aircraft to land in India.
• •Govt. of India has strongly advised its citizens to avoid all non-essential travelling to China, Italy, Iran, Republic of Korea, Japan, France, Spain and Germany.
• •The Govt. has suspended all regular visas/e-visas granted on or before March 3 to nationals of China, Italy, Iran, South Korea and Japan who have not yet entered India.
• •Even regular visas issued to foreign nationals who have travelled to coronavirus affected countries have been suspended until April 15, 2020.
• •India has also restricted export of about 26 active pharmaceutical ingredients and formulations including antibiotics, vitamins and hormones like Paracetamol, Tinidazole, Metronidazole, Vitamins B1, B6, B12, hormone progesterone, with immediate effect.

Control and prevention of the disease is very difficult in India due to its large population. Moreover, since during the first two weeks of March 2020 it was observed that almost all the confirm COVID-19 cases in India either had a history of travel to COVID-19 affected countries or had direct connections to the persons coming from these countries, it therefore became important to control the outbreak of coronavirus, by imposing restriction on travel from other countries. Our doctors, nurses and other healthcare providers have been putting their paramount efforts in the unexpected war against an invisible lethal enemy. While a lot is still unknown about the virus that causes COVID-19, we do know that it is transmitted through direct contact with respiratory droplets of an infected person. People can also be infected by touching surfaces contaminated with the virus and touching their face thereafter (e.g., eyes, nose, mouth). Since there is no vaccine discovered against this disease so far, the most effective way to control this viral outbreak in India is to avoid close contact at the individual level and social gathering. It is therefore very important for communities to take specific action for restricting further transmission, reducing the impact of the outbreak and supporting regulatory measures.

Funding

None.

Ethical approval

Not required.

Author contributions

All authors contributed to conceptualization, data collection, writing, reviewing and editing.

Declaration of competing interest

The authors declare no Conflict of Interest.