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ICMR plays down signs of community transmission
On Tuesday, a day when the number of cases in India rose by 146 (and number of deaths by 3), Dr Raman R Gangakhedkar, head, division of epidemiology and communicable diseases, ICMR, defended the organisation’s stand on both.
The Indian Council of Medical Research (ICMR) has come under scrutiny over the past few days for its continued insistence that there is no community transmission of Covid-19 in India, and delays in approving testing kits, parameters for which have been set at absurdly high levels, according to many experts.
The National Institute of Virology (NIV) was also taking far too long to evaluate the kits — delaying the entire testing process, which was only last week opened to private laboratories. ICMR eventually opened up six more testing sites to start clearing the backlog.
On Tuesday, a day when the number of cases in India rose by 146 (and number of deaths by 3), Dr Raman R Gangakhedkar, head, division of epidemiology and communicable diseases, ICMR, defended the organisation’s stand on both. He maintained that there is no community transmission and that at the stage of the disease India is, it cannot afford to compromise on the parameters of the testing kits.
Gangakhedkar explained that a recent Union health ministry document on transporting of positive patients mentioning “limited community transmission” was actually referring to localised transmissions that have erupted in certain pockets of the country that are still manageable.
“We are nowhere close to being in community transmission. If there was community transmission then I wouldn’t be recommending healthy people to not wear a mask. There is an increase in number but it is not an alarming increase. Look at other countries that are reporting cases in thousands, that’s what community transmission is,” he said.
ICMR has already expedited the process of evaluating test kits, Gangakhedkar said in an interview. Explaining the very exacting 100/100 (sensitivity/specificity) parameter for validating all new testing kits, he said: “This is because we don’t want to compromise on quality. At the initial stage of transmission, only foolproof testing is needed so as to pick up maximum true positive cases. We need highly sensitive and specific results; we don’t need any false negatives or false positives at this stage in the outbreak.”
Sensitivity or true positive rate is a measure of the proportion of infected people correctly identified. Specificity or true negative rate is a measure of the proportion of uninfected people identified as uninfected. ICMR has said that only kits with 100% in both will be approved.
“Even false positives and false negatives samples are used to check the kit’s ability whether it is able to pick up the results accurately or not,” said Gangakhedkar.
However, ICMR has also said kits approved by the US FDA and European CE will be allowed — some of which do not follow the 100/100 parameter ICMR has set for new kits.
“Even in these, we have recommended the best available ones to open up more options in case we need to scale up,” Gangakhedkar explained.
It usually takes a couple of days for serological test (blood test) kits to be evaluated and kits based on polymerase chain reaction test evaluation may take four to five days, he said, adding that “since National Institute of Virology was overburdened there was some lag period in evaluating the kits, which is why we opened up other six sites to validate kits testing that has helped speed up the process.”
Gangakhedkar said it was difficult to put a number to the infections at which it could be said that India was in the community transmission stage. “Before community transmission, there has to be focal transmission. Even with focal transmission, that we are seeing in India at the moment, if you are able to get to the source of transmission, and manage the cases.... There is no particular number or percentage as such after which you can say community transmission has occurred.”
India’s approach of not testing more widely has come in for criticism, but even those countries that test widely started doing so only after there was community transmission, Gangakhedkar added. At that stage, he said, the strategy would be “aggressive containment measures, ... mapping of clusters, door-to-door surveys, and aggressive testing.”
“Right now, we are testing about 4,000 to 5,000 people a day across the country. This is a very small number. My feeling is that Delhi alone should test about 3,000 people a day — this would include the contacts of those positive but also all the health care workers, ambulance drivers, anyone who comes in contact every few days. Now that we have the kits, we should be more liberal with testing. I think, by nature’s design, community transmission must have started – I would be very surprised if it hasn’t – the number of cases are likely to surge by next week,” said Dr SK Sarin, director, Institute of Liver and Biliary Sciences, who heads the Delhi expert committee on Covid-19 management.
