Even after the Health Ministry on March 28 acknowledged on its website that there was “limited community transmission”, India’s national taskforce for COVID-19continues to deny it . Now, a paper in the Indian Journal of Medical Research , by ICMR and Health Ministry researchers , provides evidence of community transmission in 36 districts in 15 States. The study is based on sentinel surveillance undertaken by the task force among severe acute respiratory infections (SARI) patients who have been hospitalised in public sector institutions to identify the spread and the extent of transmission of COVID-19 disease in the community. If there were 1.9% (two of 106) SARI cases positive for the SARS-CoV-2 virus by the end of March third week, the number increased to 104 by April 2. Of the 102 coronavirus positive SARI cases tested between March 22 and April 2, 40 (39%) had no travel history or contact with a positive case; data on exposure were not available for 59 (58%) cases. If more than 1% of SARI patients tested positive for the virus in 15 States, at 21 (3.8%), Maharashtra had the most number of coronavirus positive SARI cases in eight districts followed by Delhi (14 cases; 5.1%), Gujarat (13 cases; 1.6%), and West Bengal (9 cases; 3.5%). Kerala had just one SARI patient testing positive. The authors point out that antibody-based testing carried out in those testing negative for molecular test could have helped identify more positive cases.
With community transmission, or the third stage, now being confirmed in 36 districts, an expansion and change in testing strategy has become imperative in the high focus areas for the lockdown to be more meaningful. Though the taskforce has not openly declared community transmission, it is reassuring to note that the ICMR has already initiated changes in the testing strategy in response to the change in the pattern of community spread. On April 9, the ICMR revised the testing strategy for hotspots/clusters and large migration gatherings/evacuees centres. While the criteria for testing across India remain the same, the testing norms for the high focus areas will now include people with influenza-like illness (ILI) with certain symptoms. Antibody testing should be carried out whenever molecular tests on these patients turn out negative. It is important to include antibody testing along with molecular testing when necessary in the high focus areas. Together with containment measures, this approach will help in snapping the transmission chain. Syndromic surveillance of all SARI and ILI patients along with quick and effective tracing, quarantining and testing of their contacts should be the way forward now. How well India responds now will determine whether the spread is contained quickly or leads to more cases and deaths.
