Coronavirus | India resists ‘community transmission’ tag despite soaring cases

WHO classification has implications for pandemic control measures

May 13, 2021 06:58 pm | Updated November 18, 2021 04:00 pm IST - NEW DELHI

Logo of the World Health Organization at the WHO headquarters in Geneva. File

Logo of the World Health Organization at the WHO headquarters in Geneva. File

Inspite of adding the highest number of cases in the world every day, India continues to label itself as a country with no community transmission (CT), opting instead for the lower, less serious classification called ‘cluster of cases’, according to the latest weekly report by the World Health Organisation (WHO) on May 11.

 

Countries such as the United States, Brazil, United Kingdom, France — and a perusal of the list of over 190 countries suggest the majority — have all labelled themselves as being in ‘community transmission’. Among the 10 countries with the most number of confirmed cases, only Italy and Russia do not label themselves as being in ‘community transmission’. Both countries have been on a declining trajectory for at least a month and together contribute less than 20,000 cases a day — about 5% of India’s daily numbers.

India, since the beginning of the pandemic has never marked itself as being in community transition.

Risk for more people

Broadly, CT is when new cases in the last 14 days can’t be traced to those who have an international travel history, when cases can’t be linked to specific cluster. The WHO guidelines further suggest four subcategories within the broader definition of CT. CT-1 implying “Low incidence of locally acquired, widely dispersed cases...and low risk of infection for the general population” with the highest, a CT-4 suggesting “Very high incidence of locally acquired, widely dispersed cases in the past 14 days. Very high risk of infection for the general population.”

States and countries are expected to classify themselves appropriately and point to the kind of public health measures in place.

Instead, the classification, ‘cluster of cases’, that India chooses to describe itself in says “...Cases detected in the past 14 days are predominantly limited to well-defined clusters that are not directly linked to imported cases... It is assumed that there are a number of unidentified cases in the area. This implies a low risk of infection to others in the wider community if exposure to these clusters is avoided”.

India’s national positivity rate, or the proportion of tested cases returning positive, is around 21% and around 533 of the 734 districts had reported positivity greater than 10%. There are 24 States with more than 15% positivity and 10 with over 25%, according to figures from the Health Ministry on Thursday. With lockdowns or some form of major restrictions on public movement in at least 18 States, it underlines that no area in the country is safe from the coronavirus.

Health Ministry officials have even advised wearing masks at home, acknowledging the scientific consensus that the virus spread through aerosols than from contact with large droplets from surfaces.

The closest Indian government came to acknowledging CT was when Union Health Minister Harsh Vardhan, in October said at public, web-meeting, in the context of West Bengal that “...In different pockets across various States, including West Bengal, community transmission is expected to occur, especially in dense areas. However, this is not happening across the country. It is limited to certain districts occurring in limited States.”

In denial

An expert told The Hindu that India’s refusal to describe itself as being in community transmission was an “ostrich in the sand” approach since being in CT — far from being stigmatic or an indicator of failure — had a bearing on how authorities addressed a pandemic.

If cases were still a cluster, it would mean that the government ought to be prioritising testing, contact tracing and isolating to prevent further infection spread. CT, on the other hand meant prioritising treatment and observing advisories to stay protected.

“We may have been in community transmission since last April. Testing continues to be useful for forecasting the future course of the pandemic (through random tests) and preparing for it,” said Dr Jacob John, epidemiologist and Professor, Christian Medical College, Vellore. “Or it is useful if there is a specific course of treatment, or medicine, that can be prescribed once someone tests positive. However, that’s not really why the government seems to want to avoid the term. It just makes us look stupid.”

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