Coronavirus: Has community transmission already begun?

Coronavirus: Has community transmission already begun in India?

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The gains of the two-months long lockdown period notwithstanding, the COVID-19 virus now sweeps through the community silently infecting others, even as the government keeps mum, say doctors and public health specialists tracking the pandemic.

On the eve of the Lockdown 5.0 that would focus on 13 cities accounting for 70 percent of the cases, DH spoke to a cross-section of medical specialists who are unanimous in claiming that the virus is out in the open.

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"At the moment, there is community transmission. It is not the case of a local cluster anymore. It is fully expected as this is how an epidemic grows," said Jayaprakash Muliyil, former principal, Christian Medical College, Vellore and one of the country's leading epidemiologists.

Gujarat health officials too admit on condition of anonymity that in cities like Ahmedabad, Surat and Vadodara the infection tracking efforts have been abandoned as the virus is being found in people who neither had a travel history nor were in contact with those who had such history. 

Earlier this month, in Ahmedabad alone, the health officials detected over 700 COVID-19 cases in milkmen, grocers and vegetable vendors, signalling a spread in infection as a result of community transmission.

On the other side of the country, officials in Kolkata also noted that the infection is being spread to people with no travel history and no link to people with travel history.

"Community transmission is going on in most of the affected places. Our major challenge is the return of the migrant workers. Just wait for two weeks. It will become clear how the influx of migrant workers aggravate the situation in the eastern state," he said.

In fact, some of the actions taken by the Indian Council of Medical Research are, in a sense, a tacit admission of the reality. 

For instance, the council had advised all healthcare workers (doctors, nurses and paramedics) as well as police and other front line workers to take hydroxychloroquine as a preventive medicine. 

 

The decision raises eyebrows with the experts questioning the need for such wide scale use of the controversial medicine, if there is no community transmission.

But on the record, neither ICMR scientists nor  health officials at the central and state governments admit that the outbreak has moved from stage 2 to stage 3 in India whereas experts outside the government have a different opinion altogether.

"The community transmission is indeed happening in India since mid-March. It has caused many infections and deaths that could have been potentially prevented if the public and healthcare personnel were warned in mid-March onwards of increasing spread among people so that they could take personal precautions," said T Jacob John, one of India's foremost virologists and a retired professor of CMC Vellore.

Citing a number of cases of doctors falling prey to the virus, John said all those lives would have been saved if the government was forthcoming with the alert.

"In Mumbai alone there are several cases of doctors who got the infection after opening their clinics. How did this happen? This is purely community transmission," said a senior doctor,  associated with the Indian Medical Association's Maharashtra unit. 

While ICMR has undertaken a large scale sentinel survey to check if the virus is spreading in the community, a brief research paper published by its scientists last month lets the cat out of the bag.

Carrying out an early surveillance exercise on 5,911 patients from 51 districts with SARI (severe acute respiratory illness) and ILI (influenza like illness) between February 15 and April 2, the researchers found 104 COVID-19 positive cases.

Out of those 104 cases, there were 40 positive individuals from 36 districts with no travel and contact history - a sure shot signature of community transmission.

(With inputs from ETB Sivapriyan, Satish Jha, Mrityunjay Bose and Soumya Das)

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