Is India doing enough to check community spread?

New Delhi: There may be no known cases of community transmission of coronavirus disease (Covid-19) in India yet, but with several infected people turning up for

New Delhi: There may be no known cases of community transmission of coronavirus disease (Covid-19) in India yet, but with several infected people turning up for testing weeks after getting infected, experts believe it may be just a matter of time before people they interacted with test positive.

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Undetected community transmission is among the main reasons why the spread of the disease went out of hand in Italy, Spain and even in parts of the United States, stretching health care infrastructure and leading to the loss of lives. In India, where medical expertise and infrastructure in often in short supply or under stress, many fear that such an event could inflict greater damage.

So what is India doing to contain and control community transmission?

The country’s apex biomedical research body, the Indian Council of Medical Research (ICMR), will begin its second batch of random testing of samples of influenza-like illnesses (ILI) for Covid-19 on Sunday at 51 of its viral research labs, to see if there is any evidence of community transmission of the viral disease in India.

Since the day India reported its first case of the disease on January 30, which was the day the World Health Organization (WHO) announced the outbreak to be a “Public Health Emergency of International Concern”, India has reported a total of 84 cases and two deaths.

While the numbers are small, and India has taken measures to contain the spread of infection, the situation is not fully under control. “Since we are not into aggressive testing yet, lifting of random samples from its flu-like illness surveillance network is a good idea to check community transmission,” said a senior health expert, requesting anonymity.

ICMR’s network of viral research and diagnostic laboratories (VRDLs) across India are being utilised for the purpose. The first batch of testing was done with samples lifted between February 15 and 29 from 13 VRDLs, and tested for Covid-19 at its apex virology laboratory at National Institute of Virology in Pune. About 20 samples from each lab were randomly lifted of patients with febrile illnesses.

“So far none of the samples have returned positive, suggesting no community transmission of Covid-19. Our research labs are keeping an eye, since we can’t test everyone, we are lifting a select number of random samples that are doing surveillance work on influenza like illnesses,” said Dr Nivedita Gupta, a scientist at ICMR.

“All throughout the year, these labs get samples for flu like illnesses so we decided to lift samples from there. If we find anything suggesting community transmission for Covid-19 then our whole strategy will change towards disease management,” she added.

WHO recommends implementing a package of comprehensive measures to stop community transmission, many of which will need to be aggressively implemented in India in a short time. Apart from sensitising the public and ensuring adequate response on transport, finance and security, it calls for “enhancing hospital and community preparedness plans; and ensuring that space, staffing, and supplies are adequate for a surge in patient care needs”.

“A comprehensive package of measures is required for countries to prepare when there are no cases, sporadic cases, clusters of cases, community transmission, or countrywide transmission. The priorities and intensity of work for each technical area will depend on which scenario a country or a sub-national area currently faces,” WHO says.

Lav Aggarwal, joint secretary in the Union health ministry, said the most effective way to break disease transmission is by staying under home quarantine for 14 days for asymptomatic people.

“There is no community transmission in India but what we are seeing is local cluster transmission that doesn’t need everyone to be tested. The cases are mostly travel related and even where there has been local, human-to-human, transmission it has been due to coming in contact with an infected person who had a travel history,” Aggarwal said.

Experts say source of infection in all the positive cases in India can be traced so far.

“Community transmission is when you cannot detect the source of infection, meaning people with no known contact to an infected person or with travel history test positive. It is worrisome, but India has not yet reached that stage. If we are able to hold it from reaching that stage for even 30 days more then it should hold us in good stead,” says Dr Balram Bhargava, director general, ICMR.

But given that most countries reported a community transmission outbreak about three weeks after the first clutch of cases tested positive -- in India, the first signs of an uptick appeared in the first week of march -- the most vulnerable period may lie ahead.