Experts have long argued that this is already happening; need to keep up contact-tracing and increase testing
The Indian Medical Association (IMA) has now distanced itself from a claim of community transmission of Covid-19 by Dr VK Monga, chairman of its Hospital Board of India, that had been reported by the media a couple of days ago. The governments of Kerala and Assam have also said that there is community transmission in certain areas in their respective states—when the chain of transmission can’t be determined for a case—though the Centre is steadfast that this isn’t the case. Indeed, health minister Harsh Vardhan recently told CNN-News18 that there is no community transmission anywhere in the country. Even the Indian Council of Medical Research (ICMR), which is spearheading India’s Covid-19 response, last month rejected claims of community infection, even though more than 40% of the Covid 19 cases in its study on the inclusion of Severe Acute Respiratory Illness in the testing strategy for Covid-19 couldn’t be attributed to a source. The unofficial stance, as reported by some media outlets, is that such patients are assumed to have forgotten to report a suspect/confirmed case they came in contact with. But, scientists and experts outside the government agree that, as reported by Indian Express, with cases in the country at over 11 lakh, the ‘no community infection’ stand is simply not tenable.
The reasons behind the Centre’s stance are not clear. An admission of community infection could be read as the government’s contact tracing, testing and isolation efforts, even perhaps the lockdown measure, having failed. It could also spur people to defy containment zone/other (such as those prescribed for a red zone) restrictions; the government would, without doubt, wish to avoid such a scenario. And, if the government were to declare community transmission, it would also not perhaps be saddled with the burden of contact-tracing, which becomes difficult with a large infected population; each new case could simply be treated as community-acquired. While the Delhi government had last month talked about limiting contact-tracing efforts, even the feeble contact-tracing that has happened so far is too vital to lose, some public health experts argue. Were community infection to be declared, some others argue, chances are people would be more careful about activities that risk exposure and also voluntarily adhere to the restrictions otherwise given effect by lockdowns.
Against such a backdrop, the important question to ask is: What purpose will declaring community transmission solve? It is amply clear from the infection numbers today that India missed the bus on declaring community transmission and attempting to stem the Covid-19 tide long back. Indeed, Dr Gagandeep Kang, who headed the now-disbanded panel on research on pharmacological interventions against Covid-19 that had been set up by ICMR, had said in late-March that India needed to step up community testing; wider community testing would have helped report instances of unaccounted transmission (as defined by the testing strategy of the time). Given these could have been in much smaller numbers then, an attempt could have been made to check spread. Now, the authorities and the public must proceed with the assumption that community transmission is happening, even as contact-tracing is kept up wherever possible to check spread. While the ICMR has ramped up testing, India is still not testing enough—it has conducted 10.2 tests per million compared with the US’s 146, Russia’s 173 and Brazil’s 23 (as per the latest data available for that country). And, much of the increased testing, as has become evident from the case of Delhi, is on the back of rapid antigen tests (RAT), which miss a large number of infected cases. The solution perhaps is to increase testing through all means—RAT, RT-PCR (including confirmatory testing for RAT negatives), and even serology—apart from allowing voluntary testing and having frequent sero surveys to correctly assess spread.