A medic wearing a face mask screens devotees at the main entrance of the Golden Temple.(Sameer Sehgal/Hindustan Times)
A medic wearing a face mask screens devotees at the main entrance of the Golden Temple.(Sameer Sehgal/Hindustan Times)

Community transmission of coronavirus may have already started: Experts

Community transmission occurs when a person with no travel history to a Covid-19-affected country or known contact with a confirmed case tests positive for the disease.
Hindustan Times, New Delhi | By Sanchita Sharma, New Delhi:
UPDATED ON MAR 19, 2020 09:02 AM IST

Has community transmission of coronavirus (Covid-19) outbreak begun in India? It may well have, but we wouldn’t know because we are not testing enough people, say experts.

“Community transmission began in India two to three weeks ago, around the same time as other countries. India is not an exception to the way the virus behaves. We just haven’t tested a representative sample that the country’s population of 1.34 billion demands,” said Ramanan Laxminayanan, director and senior fellow at Center for Disease Dynamics, Economics & Policy.

Community transmission occurs when a person with no travel history to a Covid-19-affected country or known contact with a confirmed case tests positive for the disease. It indicates undiagnosed and often asymptomatic people are unknowingly causing infection, which makes it difficult to break the chain of transmission.

India must re-evaluate its strategy and test more people, according to the World Health Organization (WHO), as the country has reported 151 confirmed Covid-19 cases and three deaths to date.

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“The situation is evolving rapidly. We need to scale up emergency response mechanisms to engage with people; find, isolate, test more cases and trace every contact; ready our hospitals and protect and train health workers,” said Dr Poonam Khetrapal Singh, regional director, WHO South-east Asia Region.

To detect an invisible epidemic, the Indian Council of Medical Research (ICMR), which is entrusted with the responsibility of preventing new cases, is randomly testing around 2,000 samples of patients, who are suffering from severe acute respiratory infections (SARI), including severe pneumonia. But 2,000 is too small a sample, say experts.

“Unless you test, you won’t know. Enough testing is not happening. In the initial phase of the epidemic, there are very few cases. But once it begins, its spreads like wildfire. So testing more people holds the key. Take the example of Italy and South Korea, it is very clear that the east Asian nation tested and did better. Enough surveillance is not happening, we should test all cases of SARI in all our hospitals, especially cases of patients on ventilator support,” said a senior public health expert, who didn’t wish to be named.

 

Since December, when it was first identified, the Sars-CoV-2 virus that causes the disease has infected around 205,000 people, and killed at least 8,200 people. Italy has confirmed over 31,000 cases and more than 2,500 deaths since January 30, when the first case was reported in the European nation. Though South Korea reported its first deaths on January 20, mass testing helped it keep the count of infections down 8,300 with 81 deaths.

ICMR maintained that there is no community spread in India yet.

Testing patients admitted in intensive care units may be a risky proposition amid reports of suspected cases evading quarantine and isolation. What’s more people having mild disease and asymptomatic people unknowingly spreading infection in the community, say experts.

“If 80% people have mild disease, testing only 5% patients does not work because the rest will be moving around infecting more people, as it happened in China, Italy and the US,” said the senior public health expert.

“All SARI cases must be tested, both in the public and private sector. We need the private sector on board to step up testing and treatment to encourage people to come forward — especially the middle class, which doesn’t prefer government hospitals — to get diagnosed. Making Covid-19 notifiable will ensure there is no under-reporting,” he added.

Random testing of the free-living population is what is needed. “We need to test people in hospital OPDs [Out Patient Departments] and ask people with mild symptoms to stay quarantined at home and treat the sick in isolation to save the patient, stop infection and get a handle on the invisible epidemic. If testing is not stepped up immediately, it will be too late,” warned Ramanan.

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