Introduction:
In December 2019, health authorities from Wuhan, Hubei province in
China, local hospital were monitoring and reported group of pneumonia
cases (Chinazzi et al., 2020; Haider et al., 2020). The specific
pathogen triggering this viral pneumonia, on 7thJanuary 2020, was identified by Chinese Center for Disease Control and
Prevention, and was named 2019-nCov, the new coronavirus, by the World
Health Organization (Chen et al., 2020). Further investigations traced
the origin of 2019-nCoV to a local Huanan seafood market. Since then
2019-nCoV was exported to many cities across the globe (Wu, Leung, &
Leung, 2020) and ~12.6 million people have been infected
due to 2019-nCoV resulting in more than 68000 deaths across the globe as
on 7th April 2020, marking this as one of the biggest
pandemics in this century. Since the detection of the first case in
December 2019 in China, the 2019-nCoV has already reached in more than
200 countries/territories, with ~62% of infected cases
are being in USA (26.3%), Spain (10.4%), Italy (10.2%), Germany
(7.9%), and France (7.1%). There is no doubt that 2019-nCoV outbreak
is posing the serous risk for human well-being and the world economy
(Boldog et al., 2020; Hui et al., 2020).
India, the second most populous country in the world with total
population of ~1.35 billion inhabitants, registered its
first case on 30th of January 2020, as a 20-year-old
female medical student, along with two other students, travelled from
Wuhan to the south-western state, Kerala. Since then India has
registered ~657 cases till 25th March,
out of which ~62% were reported to be the imported
cases traveling from various other affected countries. Eventually,
India then suspended all international flights to curb the domestic
spread due to 2019-nCoV on 25th March 2020. Right from the early days of the pandemic, body temperature screening to
verify if the traveler has a fever, as an indication for the infection,
as a major test was introduced at all international airports in India.
However, it has been noticed that asymptomatic contact transmission of
2019-nCoV and passengers successfully passing the symptom-based
screening have been tested positive for 2019-nCoV (Bwire & Paulo,
2020). If such passengers passing thermal screening test are later
tested positive for 2019-nCoV, challenges this approach as body
temperature screening could miss the passenger incubating the disease or
concealing the fever by other means during the travel (Bwire & Paulo,
2020). Further to this India has also introduced an additional step of
marking the passenger arriving from most affected countries and
compelling self-isolation or home quarantine for the 14 days upon
arriving in India.
The timing of 2019-nCoV outbreak and aftermath encompassing the lunar
new year celebrations in China coincided with very large amount of human
movement between China and rest of the world imposing major threat for
rapid spread of infection (Haider et al., 2020). Owing to such risk it
was important that countries take timely decisions to suspend the
flights from affected areas, mainly from Chinese cities in this case.
Amid the 2019-nCoV outbreak, WHO has observed that many countries are
violating the International Health Regulations (IHR) defying the travel
restriction against China during 2019-nCoV outbreak (Habibi et al.,
2020). Further, many researchers in this direction have already made the
assessments of risk of 2019-nCoV spread from China to the rest of the
world including the effect of travel restriction on spread of 2019-nCoV
(Anzai et al., 2020; Backer, Klinkenberg, & Wallinga, 2020; Boldog et
al., 2020; Chinazzi et al., 2020; Gilbert et al., 2020; Nishiura et al.,
2020; Pullano et al., 2020). Thus, while the outbound risk from China to
many other countries/territories have been investigated in detail, the
inbound risk of 2019-nCoV infection particularly to hugely populated
India, however, is not investigated. Here, in a maiden attempt we
estimate the risk of importation of 2019-nCoV due to international
arrivals in India by screening available data from 19 international
airports across the globe and developing the index for risk assessment.