The Union Health Ministry on Friday denied evidence of community transmission (CT) of COVID-19 while reporting at least 700 new cases since Thursday evening. The nationwide death toll from the epidemic touched 206, and the Ministry confirmed 6,761 positive cases.
The Ministry’s response follows an Indian Council of Medical Research (ICMR) report on Thursday of nearly month long surveillance of 5,911 randomly chosen samples of patients who exhibited Severe Acute Respiratory Illness (SARI), whom 104 tested positive for COVID-19. All but two were tested between March 21-April 2 and 40 had no history of international travel or contact with someone with travel history but had picked up the infection, indicating community transmission , the ICMR said.
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The World Health Organisation describes such transmission as when there are large clusters of outbreaks when it is no longer possible to trace the original source of an infection.
Over the last few weeks, there have been reports from several States of people testing positive but who were unable to explain the possible source of the infection. However, the Health Ministry has consistently maintained that this was not evidence for CT.
Health Ministry spokesperson Lav Agrawal said all of the cases of SARI were from districts where there were confirmed cases of the disease and that travel histories of those SARI patients were being investigated. “We’ll be the first ones to tell if you if such transmission has begun,” he said.
The Health Ministry response comes even as States have announced an extension of the lockdown beyond April 14 citing CT; Chief Minister Amarinder Singh declared on Friday that CT had been observed in Punjab.
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Reports from State Health Departments put the death toll at 252 with 6618 active cases. Maharashtra reported 197 fresh cases even as the death toll in the State climbed to 110
The ICMR had randomly tested samples from laboratories in 52 districts in 20 states. As of now, nearly 280 districts have reported confirmed cases.
While the ICMR has restricted testing to those who showed symptoms and had international travel history or contact with someone who'd tested positive, health workers taking care of those who had confirmed positive and those hospitalised with SARI, it has now expanded the testing to those who manifest 'influenza like illnesses' in hotspots. Also, beginning April, everyone who manifests SARI like conditions are advised to test.
Independent epidemiologists said the ICMR still had too few surveillance sites to detect CT evidence and ought to be expanding it manifold.
“Sentinel site surveillance of all SARI (or at-least all X-ray positive pneumonia) is essential for getting an idea about the spread of COVID-19. All cases reporting to these sites have to be tested. At least 10-20 sites in every district have to be selected and sample collection facilities have to be arranged there. Sites will have to be increased in a locality if community transmission occurs,” Dr. Iype Joseph, an epidemiologist at the Rajiv Gandhi Centre for Biotechnology in Thiruvananthapuram, told The Hindu in an email.
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In the daily media briefing, Mr. Agrawal said India needed about 1 crore hydroxychloroquine tablets and had stocks nearly three times that.
“Arrangements for additional two-three crore tablets have been made and through private sector two crore tablets had been sent to the field,” he added.
Hydroxycholoroquine is prescribed for health workers who are in extensive contact with patients and asymptomatic household contacts of laboratory cases. It is to be made available only under prescription. However evidence for its efficacy as a prophylactic is thin and interest in it surged after U.S. President Donald Trump endorsed it. India initially imposed a ban on the drug's exports but then lifted after international pressure, which raised more questions on whether India had enough stocks for itself. While a low-value anti-malarial drug it is also prescribed for rheumatoid arthritis and other auto-immune disorders.
