Novel coronavirus, poor quarantine, and the risk of pandemic.

The novel coronavirus, after emerging in the City of Wuhan, China, has spread to several countries. The confirmed cases of more than 10,000 and fatalities of more than 200 during the first two weeks of outbreak has frightened and alerted the whole world [1]. At the time of writing (February 4th, 2020), cases in 27 countries have been confirmed and the toll is increasing at an alarming rate [2]. In general, control of the spread of infection uses strategies such as increasing awareness, protective clothing, treatment, and perhaps most importantly vaccination [3]. However, in the case of novel coronavirus (2019-nCoV), antiviral treatment and vaccination are not available [4]. Thus, to contain the further spread of infection, hospitalization, quarantine, and safety measures are key factors. Virus transmission appears to occur from infected individuals regardless of the appearance and severity of signs and symptoms. Thus, individuals travelling or recently travelled from China to other countries must be placed in quarantine [5]. Although the world is taking serious steps against the spread of 2019-nCoV, some individuals from developing nations either underestimate or are not fully aware of the risk of viral transmission to their community. These people are finding ways to move out from China without going through a proper quarantine procedure. Such practices have been recently observed among the overseas students in China. For instance, a number of Pakistani students flew from China and entered Pakistan via Dubai, Malaysia, or Bangkok. These students were not quarantined as Pakistan has not yet announced any quarantine procedures. In addition, some students have been flying repeatedly to several other countries after the lockdown in response to the outbreak of novel coronavirus. Quarantining people with suspected or confirmed infection helps to protect the public from diseases as practised against severe acute respiratory syndrome (SARS), which successfully ended the epidemic [6]. However, it is challenging for developing countries to allocate stations where people should be placed in quarantine.

In the current scenario of novel coronavirus outbreak, governments across the world are struggling to find ways to prevent the spread of coronavirus. Several countries including Singapore, Australia, UK, Japan, and USA are barring visitors from China, and their citizens in China are required to be quarantined for 14 days prior to entering their native countries. However, the situation is getting out of control and the risk of worldwide pandemic is increasing, as hundreds of people are entering other countries from China without being quarantined. It may increase the difficulties for the whole world rather than mitigating the spread of coronavirus. The governments of these countries (such as Pakistan, Bangladesh, India, Sri Lanka, Kazakhstan, Jordan, Nigeria, and Kenya) must take serious actions in order to educate the public on how best to protect themselves and ensure that everyone moved from China is placed in quarantine [[4], [5], [6]]. There is a real risk of the pandemic spreading out of control in underdeveloped countries as they do not have the facilities to combat the virus as China is doing currently.

Developing countries such as Pakistan, India, and Bangladesh already have higher mortality rates from common pneumonias, despite the availability of vaccination and treatment. These countries may also suffer from poverty, political instability, terrorism, other endemic or epidemic infectious diseases competing for limited public health resources, low levels of literacy, and a lack of diagnostic or research laboratories. In this scenario, how would these countries be able to fight against the 2019-nCoV? Already suspected or confirmed cases have been reported in some of these countries. Unlike China, these countries are unlikely to be able to implement or withstand lockdown for several weeks or months, for both financial and organizational reasons. Therefore, it would seem advisable for these countries to spend their resources and energy on the primary level of prevention; either they need to prevent entry of individuals from China or they need to provide some means of containing the risk that these individuals present, for example by isolation or monitoring. Without proper enforcement of such measures it is even possible that people in China will be motivated to travel to those countries that are not enforcing controls, further increasing the risk of spread of the virus. Some people are portraying the control measures by the Chinese government negatively through social media, which has the potential to discourage other countries from implementing effective control measures. We suggest that robust measures to limit the international movement of infectious individuals should be a current priority in our fight against 2019-nCoV.

Conflict of interest statement

None declared.

Funding sources

This study was funded by ‘Postdoctoral grant from The Second Affiliated Hospital of Zhengzhou University (for SK)’, and operating grant support from the (grants no: 81870942, 81471174 and 81520108011), (grant no: 2018YFC1312200), and Innovation Scientists and Technicians Troop Constructions Projects of Henan Province of China (for M.X.).