Has community transmission begin - Are hints being given?

Some patients suffering from severe acute respiratory illness (SARI) without any history of international travel or contact with anybody infected by the novel coronavirus (SARS-COV-2), have tested positive for the virus, the Union government said on March 28, 2020.

The comments by R Gangakhedkar, head of the Indian Council of Medical Research (ICMR)’s epidemiology division, at a press conference in New Delhi were the first officials indication that the novel coronavirus disease (COVID-19) may have infected patients outside the limited criteria of overseas travel history.

Gangakhedkar did not divulge any number of such patients who tested positive and said they were just “sporadic”. He downplayed that this could indicate community transmission of COVID-19.

Out of nearly 110-120 samples tested for SARI, as many as 10 per cent had been confirmed positive for COVID-19, sources from ICMR, said.

Phase-3, or community transmission, is a phase when the source of infection cannot not be known or traced either to international travel or contact history.

“Even if the number is small, this is an indicator that India is likely in stage 3,” T Sundararaman, former head of the Union Ministry of Health and Family Welfare’s National Health Systems Resource Centre, said.

It was wrong on the part of the government to deny such a ‘reality’ by taking refuge in the fact that such positive cases were less in number, he added.

“Absence of evidence is being used as evidence of absence. When one links it with our very less sampling, it is worrying,” he said.

“Despite being expanded on paper, the testing criteria remains limited in practice. It is difficult for an acute respiratory illness patient to be tested for COVID-19 in reality, despite guidelines saying so. I think it is no longer a matter of discussion in which stage we are but rather channelise all our resources in preparing hospitals for phase-3,” he said.

Emergency preparations afoot

Meanwhile, officials across states seem to scrambling in order to prepare the health infrastructure for phase-3.

A WhatsApp message late on the night of March 27 to a senior official of Chhattisgarh jolted him out of his slumber.

“Book all private hospitals, clear all roads from remote areas to district hospitals, count and clean all ICU instruments and please put all available ventilators at your direct control,” the message read.

The official is among those managing the state's response to the pandemic. Within five minutes of him receiving the message, he got a call from a senior official in neighbouring Odisha. “How many ventilators are there in Raipur? And how many affected people?”

In the next 20 minutes, senior officials directly in charge of the fight against COVID-19 in nine states including Kerala, Odisha and Madhya Pradesh and Uttar Pradesh carried out an extensive assessment of the situation.

“Unofficially, Delhi (shorthand for the Indian Council of Medical Research that comes under the Union government) has confirmed community transmission occurring at a speed and reach higher and wider than expected,” an official from UP, said.

The influx of thousands of migrants to and from these above states since March 26 has added to the panic.

By the evening of March 28, official spokespersons of Odisha and Chhattisgarh hinted that a community transmission was imminent.

Activities at village level in states like Odisha and UP point to enhanced alertness. Odisha has granted panchayats Rs 5 lakh for isolation and critical medical expenditure. There is more focus on mapping out infrastructure.

While all these are standard practices of preparedness, the message originating from Delhi and being officially communicated with urgency to district collectors has added to the fear that government assessment of the situation is different than what it is projecting.

“We all know Stage 3 is a reality. With or without declaration, we have to prepare. But the official internal communications of the last 24 hours are pointing to certainty about it,” a senior official dealing with the Chhattisgarh chief minister's team on COVID-19, said.

Delhi’s Chief Minister Arvind Kejriwal had also posted a tweet to this effect: “I have received the report from the panel of doctors headed by Dr Sareen recommending measures to prepare for a potential stage-3 outbreak of COVID-19 in Delhi,” Kejriwal said

The state government was ramping up capacity for an eventuality of 1,000 daily positive cases for testing, treatment and isolation, he had added.

So far, India has had quite a few instances of people testing positive for COVID-19 without any prior international or contact history. A 20-year-old male from Tamil Nadu was tested psotitive for SARS-CoV-2 on March 18.

The state’s health minister C Vijaya Bhaskar described his case as a domestic case. The patient had a travel history of Delhi. “We have not been able to find any other contact or international travel history,” Sampath Palani from the state’s health department said on March 28.

Madhya Pradesh’s Indore, Chattisgarh’s Raipur and Odisha’s Raipur too have witnessed such cases. more  

View all 8 comments Below 8 comments
Well said and sensible suggestions more  
As commented by T Sundararaman, former head of Ministry of health and family welfare it is fact that India has reached stage III and any such doubt or hesitation to admit this will cause more damage for the country than good.
Now entiore country must prepare for the best. There is no alternative. As health care personal we are at high risk though as yet PPM are inadequate for health care worker to face this disase burden that is giong to surprise every one nation wide sooner than later. more  
Yesterday was screw up day. With nijamuddin news. Hieghest deth. Hieghest cases in a day.. worst yet to come due to this more  
This is not time to hide facts and figures by any one taking care of this pandemic all , Govt official , public and planners and our Netas should be in same page as far as battle against corona is concerned. more  
What they did in South Korea with the patient data, to contain the disease, could inform a science fiction movie. Beginning in February, the government posted the precise movements (without names) of everyone who tested positive — everything from the seat numbers they occupied in movie theaters to the restaurants where they stopped for lunch.

The government obtained the information from cellphone records, credit card receipts and other private data it is authorized to collect in a health emergency.

Hong Kong has tracked some high-risk people under quarantine with wristbands.

Of course, we are 130 crores. This figure itself is mind-boggling.

Is such a move possible in India? If Aadhar is linked to PAN, people are on streets to protest. The SC intervenes to decide the validity of such a move.

1500 people gathered for a prayer. 10 lac labourers tried to return to their village. We do not know who is infected and who is not.

What transparency and facts & figures are we talking of?

It is a sincere request from a citizen of India that we should not indulge into such matters on such a platform. The Government is doing its job and let it continue to do so. We can always discuss the actions taken at some later date. It could de-moralise people who have already made their efforts.

Let us believe in the Government. The Media is already giving out its coverage. Let us not get involved to the best of our ability. more  
In my view, transparency is required in such matters to prevent speculation and rumours. It is learnt that South Korea contained this pandemic with limited lockdown and transparency. more  
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