China records ‘sudden’ spike in new cases, new diagnostic methods fuel concerns

As big questions lurk over the future course of the of the new Coronavirus outbreak or COVID-19, the “sudden” spike in number of new patients in mainland China have fuelled concerns over the actual situation in the country at the forefront of the new disease.

Within a span of 24 hours, the Hubei province of China, the epicentre of the outbreak recorded as many as 14,840 new cases, against the average of 2,500-3,000 new cases recorded daily till date. The number of deaths, too, rose by 242, witnessing the largest single-day spike so far.

The mysterious virus is indeed spreading ‘very fast’, but the sudden jump in cases has appalled many. “China seems to be over-cautious now. But, it is better to over-report cases, than under-report them. India so far has recorded only three positive cases, the rest are only suspected. We are not planning any such changes,” said Union Minister of Health, Dr Harsh Vardhan on Thursday.

According to Chinese Health authorities, the sudden spike is due to inclusion of ‘clinically diagnosed cases’ from Hubei in the total infected cases, which means people who show clinical symptoms of the new disease, but are yet to be tested ‘positive’ in the lab results have also been included.

With this, China has expanded its case definition, from what was stated by World Health Organization (WHO)- according to which, a confirmed case of Covid-19 is the one which has been tested positive in nucleic acid test conducted in laboratories, essentially involving assays based on real-time PCR (Polymerase Chain Reaction).

“RT-PCR is a laboratory intensive exercise and not every laboratory is equipped to perform. It seems, Chinese authorities were lab testing only the hospitalized cases initially, but with the current scale of epidemic, it is just not feasible to test every suspected case in real time,” said noted virologist, Dr G ArunKumar, who heads the Manipal Institute of Virology.

According to scientists, it is a common strategy, adopted by countries during an epidemic. “With over 60,000 infected cases, which country can afford to do laboratory testing on such large-scale? It’s humanly not possible. China has been facing lot of criticism lately for under-reporting cases, but we must understand, that the country is really fighting hard to contain the epidemic. They may have probably reached their limits,” said Dr Shobha Broor, a New-Delhi based virologist.

As on Thursday, 60,349 infected cases have been reported across the world, including 527 from over 24 other countries. The death toll has surpassed that of SARS and reached 1,370, mostly in mainland China.

“We have already reached a point, where the numbers have become irrelevant. The virus has really taken a toll on China. We still do not know the rate of community infections. It is time that we just focus on strict containment and preventive strategies of each country. We all should be prepared,” added Dr ArunKumar.

The move could prove helpful in stepping up early action in local hospitals, but it is also certain that the new methodology leaves room for doubt, as lung-imaging or symptom-based diagnosis cannot be taken as accurate way for confirming positive patients.

“It is not really significant to count infected cases, after a certain time during an epidemic, especially when there is no “immediate treatment”. It makes sense, to test only those require hospitalization and not just every suspected patient,” said Dr Abdul Gaffur, infectious diseases expert, Apollo Hospital, Chennai.

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