On Monday and Tuesday, India reported three more coronavirus disease (COVID-19) cases — one each from Delhi, Hyderabad and Jaipur (an Italian tourist) — bringing the total number to six. While the first three cases, reported from Kerala, were in young adults who had arrived directly from China, the two new cases were Indians who had arrived from Italy and Dubai. Italy and the UAE have reported local transmission of the novel coronavirus (SARS-CoV-2), thus marking all the five as imported cases. Detection of the three cases is no surprise considering that hundreds of passengers have arrived in India from China and other countries where local transmission of the virus has been going on for the last couple of weeks. On Tuesday, the Health Ministry said that six people in Agra who had come in contact with the COVID-19 index case in Delhi have been “detected with high viral load” and kept in isolation. Their samples have been sent to the Pune-based National Institute of Virology for confirmation. If even one of the six is confirmed to be positive, it would indicate local transmission of SARS-CoV-2 and will automatically change the status of virus spread in the country. The silver lining is that it highlights the ability of the system to trace and test people who have come in contact with the index case. Community transmission should not come as a surprise in light of the fact that the six confirmed cases had come in contact with many people before their infection status was confirmed.
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The Health Ministry’s Integrated Disease Surveillance Programme (IDSP) network is in hot pursuit to trace people who have come in contact with the six people whose samples have been sent for confirmation. Already, about 26,000 arriving passengers have been put under community surveillance of the IDSP network. Care should be taken to ensure that people under community surveillance do not flee, as was the case in Kerala when two adults under observation for coronavirus left the country unnoticed. While thermal screening at airports and seaports does help in detecting people with a fever so that further screening and testing can be performed to ascertain the infection status, it is essential that people who have arrived in the country seek immediate medical care and testing when symptoms show up days after landing. The median incubation period after infection is three days; the incubation period can also last more than three weeks as per one study. Infected people do not show symptoms during the incubation period and hence thermal screening at airports and seaports will be unable to detect such cases. It is therefore heartening that universal screening of passengers arriving from 12 countries is being undertaken. It is also important that people and health-care providers are made aware that molecular testing does not have very high sensitivity and hence may turn up false negatives. It is hence essential that at least two negative tests are obtained before a person is certified as being uninfected.
