After being in denial, India takes a decisive step to confirm community spread

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After displaying extreme reluctance to admit community transmission despite having over 67,000 cases and the nature of the virus spread, India has finally decided to confirm community spread by testing 30,000 people in 75 hotspot districts.

As early as March 28, the Health Ministry acknowledged that there was “limited community transmission” of novel coronavirus (SARS-CoV-2) in India. On April 9, researchers from the Indian Council of Medical Research and Health Ministry, some of whom are also members of the national task force for COVID-19, in a paper published in a scientific journal, provided evidence suggesting the prevalence of community transmission in 36 districts spread across 15 States.

The sentinel surveillance for community transmission undertaken by the task force among patients hospitalised for severe acute respiratory infections (SARI) found 40 of the 102 who tested positive for the virus had no travel history or contact with a known positive case, while data on exposure was not available for another 59 SARI patients.

Yet, ICMR has consistently maintained that the virus has not spread to the community. On May 5, even when the total number of cases reported across the country was close to 47,000, the Health Minister said that the virus spread in India had not gone to stage three.

While there has been no hesitation whatsoever in declaring local transmission caused by people who have a travel history, the government has been extremely hesitant to admit community transmission. The reluctance is particularly surprising given that the total number of cases reported so far has already crossed 67,000, and the nature of the virus spread is through droplet transmission and contact with contaminated surfaces.

In contrast, on February 26, when the total number of cases was just 60, the U.S. confirmed community spread when the first case with no travel history or contact with a known positive case was detected in California.

One reason why India refused to confirm community spread early on could be the compulsion to expand testing even when India did not have the capacity to test huge numbers each day. But there is no reason now to continue being in denial, as that erodes the trust the people repose in the government.

Against this background, the latest decision to initiate a study in 75 hotspot districts to confirm community spread and ascertain the proportion of community already exposed to the virus is encouraging. The study had apparently got delayed by about a month due to the non-availability of reliable rapid antibody tests.

Due to the unreliability of rapid antibody test, the government will instead use the ELISA test to check for coronavirus infection. Since ELISA test detects antibodies to the virus, the survey will be able to pick people who were previously infected, including those who were asymptomatic for the entire duration of the infection. Since it takes one-three weeks for the antibodies to develop, the ELISA test will miss people who have been recently infected.

The survey, scheduled to begin by the third week of May, will randomly test about 30,000 people in the general population and will be undertaken in collaboration with the respective State governments.

Meanwhile, all States should continue with strict containment and mitigation measures acting on the assumption that the virus has spread in the community.

Published in The Hindu on May 11, 2020

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