As it braces for the next stage of COVID-19 epidemic, when community transmission of the disease could derail even the best laid-out plans and overwhelm an already strained health system, Kerala is banking on the strength of inputs from the scientific community to guide the State through what could be a prolonged engagement with the pathogen.
The Rajiv Gandhi Centre for Biotechnology (RGCB) is conducting epidemiological investigations into the ongoing epidemic of COVID-19 which could help the State improve its strategies in surveillance and containment.
On Wednesday, the Indian Council of Medical Research approved the RGCB as one of the official testing sites for COVID-19. Sample testing will commence as soon as test kits are received. With four PCR platforms, the RGCB can handle nearly 500 samples daily.
“The focus should not just be on diagnosing and counting cases. Unless we look more closely at the acute pneumonia cases being reported in hospital ICUs, we could be missing the silent transmission of COVID-19 in the community. The RGCB had already initiated the screening of all acute cases of pneumonia being reported in private hospitals. The State has now requested us that we include cases from the government hospitals and medical college hospitals too in our surveillance study,” RGCB Director M. Radhakrishna Pillai told The Hindu .
All hospital-based cases of acute pneumonia with bilateral lung infiltration should be screened to determine whether it was bacterial or viral pneumonia and the causative agent should be identified.
If at all a case of viral pneumonia due to SARS CoV-2 is detected, (which is not officially accounted for), it could be the first indication of COVID-19 silently transmitting in the community.
What is proposed is the identification of sentinel sites, at least 10 hospitals in each district, from where respiratory samples (from pneumonia cases) would be collected and diagnosed using RT-PCR assay. Detecting community transmission early can help the State intensify surveillance and containment efforts.
“We also propose to do the whole genome sequencing of the virus and strain identification studies. Another major study we are initiating immediately is sero surveillance studies amongst health-care personnel working in hospitals to detect SARS-CoV 2 viral antibodies (IgG or Immunoglobulin G) in their blood samples. This is another indication of community spread because front-line health-care workers would be the first persons in the community at risk of contracting infection from a potential COVID-19 case,” Dr. Pillai said.
COVID-19 mostly presents as a mild infection, and it is very difficult to clinically distinguish it from common cold or even H1N1, from which healthy young individuals recover normally. IgG studies amongst health-care personnel would thus indicate the asymptomatic transmission of COVID-19.
The RGCB also plans to conduct epidemiological studies by studying the blood samples of COVID-19 patients who have since recovered from the disease.
“The magnitude and impact of COVID-19 is huge and the virus is going to be with us for a long time. The sooner we invest in real science, the better grip we will have over the epidemic,” he said.