COVID-19: Community transmission widespread in Chennai, say doctors

Chennai, a metropolis with a population of nearly a crore, is grappling with an exponential increase in the number of people testing positive for coronavirus with each passing day.

The Tamil Nadu government may be in outright denial, but experts say there is “widespread community transmission” in parts of Chennai as hundreds of people with “absolutely no travel or contact history” have contracted the virus.

The city is also flooded with complaints that even symptomatic family members of confirmed COVID-19 patients are being turned away from testing centers.

At least three people took to social media in the past two weeks to flag issues of symptomatic patients being turned away at testing centers and “rampant community transmission” in overcrowded areas in the city. They got tested only after their grievance caught the attention of the top brass of the government.

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Though the government maintains that its testing numbers are highest in the country, experts feel the number of tests conducted now – 3,500 to 4,500 a day in Chennai -- are “just not enough” to contain the virus in the city.

Testing combined with enforcing of rules need of the hour

Experts say the government should increase its testing numbers, which is currently 11,300 on an average for the entire state in a day, immediately to prevent further spread of the virus, while cautioning that testing and identifying confirmed patients alone are not enough. The government should focus on ensuring compliance of physical distancing, wearing of masks and other precautions followed universally, they told DH.

Despite repeated denials from the government, Dr Ram Gopalakrishnan, Senior Consultant, Infectious Diseases with Apollo Hospitals, Chennai, said there is widespread community transmission within the metropolis and that there is no second opinion on the issue.

“There is widespread community transmission within Chennai. We, in the medical profession, see patients who have absolutely no risk factors like contacts or travel but turn out to be positive. Within Chennai, there is no question that community transmission is happening. Outside Chennai, it is probably true that there is little or no community transmission,” Dr Gopalakrishnan told DH.

At last count on Thursday, the city had 12,762 Coronavirus patients, 106 deaths, the highest in the state, and 6,304 discharges. More than 8,000 cases were from six zones – four of which houses some of the heavily congested areas, a breeding ground for community transmission -- in the metropolis. Over 11,000 of these cases were reported this month alone with around 500 people testing positive every day for the past few weeks.

The city is also home to several clusters like the Koyambedu market that spread across Tamil Nadu and to a few neighbouring states as well. Sources said over a lakh people in Chennai have been tested so far, while the number of individuals tested across the state stands at 4,23,018.

‘It is a community spread, not clusters anymore’

Echoing Dr Gopalkrishnan on wide-spread community transmission, leading epidemiologist Dr Jayaprakash Muliyil went a step ahead to say that the government should not be embarrassed in admitting community transmission as it cannot be “classified as its failure.”

“At the moment, there is community transmission. It is no more local cluster or anything. That is obvious and I do not think that the government should feel embarrassed about it. It is fully expected as this is how an epidemic grows. And it cannot be considered as a failure on the part of the government because this is the nature of the disease,” Dr Muliyil, former principal of the Vellore Medical College, told DH.

However, Dr J Amalorpavanathan, former director of the Institute of Vascular Surgery at the prestigious Madras Medical College, said announcing community transmission will not serve any purpose as the treatment for those who teste positive is the same irrespective of the stage.

While advocating “aggressive testing” in containment zones to identify the source of the infection to contain it, Dr Amalorpavanathan told DH that people should follow the three cardinal principles of distancing, masking, and washing.

“What does one achieve by announcing community transmission? The treatment for confirmed patients in the same irrespective of the state. Categorizing will be useful for academic purposes. The focus should be on testing asymptomatic patients inside the containment zones to reduce the infection. We are clueless as to why it is not being done?” he asked.

Only increased testing can help identify more patients

Sumanth C Raman, a physician by profession and a political commentator who keeps track of COVID-19 developments in Tamil Nadu, feels the number of people being tested in Chennai currently is “very inadequate” and the government needs to test at least 15,000 people a day in the city.

“Since the prevalence of the infection is wide-spread in Chennai, the government should focus on aggressive testing to identify more patients and isolate them. 3,000 to 4,000 tests in Chennai per day is simply inadequate. 500 people testing positive out of these tests every day means one in seven people are testing positive and this is all the more a valid reason for ramping up the numbers,” he told DH.

He also sought to know what the point was in increasing the number of testing labs, while reducing the number of tests. While agreeing that testing is of prime importance, Dr Gopalakrishnan said the aggressive testing strategy alone will not work.

Testing every person and quarantining them and their contacts have “only limited benefit at this point” due to wide-spread community transmission and the focus now should be on strict implementation of measures like compulsory wearing of masks, maintaining physical distancing and avoid spitting on the road for the general population, he said.

‘Practicing universal aggressive precautions necessary’

“Test, test, and test is a reasonable strategy in the rest of Tamil Nadu which has low prevalence or medium prevalence. This virus spreads in asymptomatic fashion and we should move beyond testing and enforce certain rules. We need to practice universal aggressive precautions such as physical distancing and aggressively police certain measures like say to ensure that universal masking in public and avoidance of spitting,” he said.

Dr Gopalakrishnan also advocated the state to take “different approaches for different parts” of Tamil Nadu. “The government should change its approach towards Chennai by changing the focus on testing alone. While not losing focus on testing, it should lay emphasis on universal implementation of the preventive measures for all which is absolutely critical at this point,” he said.

Dr Muliyil said the fight against any epidemic – now COVID-19 – should be collective as people, government and private sector should join hands to respond to the situation. He added that the “final responsibility of their health” rests with the people and their families.

“You (government) should empower them to take care of themselves. Do not block the efforts of the families to take care of them. In our anxiety to fight COVID-19, we should not block their efforts and disempower the people,” he said.