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Community transmission: Can India control COVID-19?

The Centre continues to cling to claims that community transmission of COVID-19 is not occurring in India. However, according to a report drafted by epidemiologists, public health practitioners and experts in preventive and social medicine, “community transmission is already well-established across large sections or sub-populations in the country.”

Coronavirus in world. Novel coronavirus 2019-nCoV. Concept of coronavirus with flag of India. Illustration of COVID-19 case count. Coronavirus pandemic in India. Active COVID-19 cases.As previously noted by Health Issues India, “community transmission refers to an individual testing positive for COVID-19 without having had contact with a confirmed patient or a travel history to a country affected on a large scale by the pandemic.” There was earlier ostensible confirmation of “limited community transmission” of COVID-19 in India by the Union Government. However, the issue has been the subject of controversy given the impression by some that authorities are attempting to downplay the issue. 

The presence of community transmission would explain the current case count — now surging across the nation and nearing 200,000 cases. It would also fit in with the course of events that saw untold thousands of migrant workers and day labourers flee urban centres in droves to return — often by foot and in significant crowds — to their home villages.

The mass exodus of workers at the beginning of the lockdown presented ample opportunity for COVID-19 to spread. These infected individuals may then have passed the disease to fellow migrant workers among the crowd and, in turn, taken the disease back to their home towns and villages.

The report, compiled by experts from the Indian Public Health Association (IPHA), Indian Association of Preventive and Social Medicine (IAPSM) and Indian Association of Epidemiologists (IAE), has been submitted to Prime Minister Narendra Modi. The report offers a bleak view of the situation. 

“It is unrealistic to expect that COVID-19 pandemic can be eliminated at this stage given that community transmission is already well-established across large sections or sub-populations in the country,” the report said. “The expected benefit of this stringent nationwide lockdown was to spread out the disease over an extended period of time to flatten the curve and effectively plan and manage so that the healthcare delivery system is not overwhelmed. 

“This seems to have been achieved albeit after [the fourth] lockdown with extraordinary inconvenience and disruption of the economy and life of the general public.”

In addition to criticisms of the lockdown, a major concern was that influential epidemiologists and academics focused on disease transmission were not consulted. “Had the Government of India consulted epidemiologists who had better grasp of disease transmission dynamics compared to modellers, it would have perhaps been better served,” the report asserted.

The lockdown has achieved the globally cited aim of “flattening the curve” and relieving pressure on health institutions by slowing the rate of infection — and thereby patients needing the facilities of India’s already overstretched intensive care units (ICUs). However, it has not stopped the disease from spreading.

The rate of onset of COVID-19 has been staggering. Much like many European nations and the United States, the encroachment of the disease began slowly. Indeed there were only 606 cases on March 25 when lockdown measures were imposed. In the subsequent two months, cases have risen to 199,785.

Despite the surge in cases and potential for community transmission, the country is now seeking to open up the lockdown measures. With the exception of containment zones, the Union Ministry of Home Affairs (MHA) has announced a phased relaxation of quarantine measures in what is being termed “Unlock 1.0.”

As Health Issues India recently reported, the loosening of quarantine measures in non-containment zones will occur in three phases. The first phase, effective from June 8th, will permit the reopening of places of worship, hospitality businesses such as hotels and restaurants, and shopping malls. The second phase will see the reopening of educational institutions. 

The third phase will see the country return to a state far more akin to pre-lockdown India, permitting international air travel; metro rail; entertainment facilities such as cinemas, theatres, entertainment parks and auditoriums; exercise facilities such as gyms and swimming baths; and similar facilities. It will also see a decision made concerning the resumption of “social/ political/ sports/ entertainment/ academic/ cultural/ religious functions and other large congregations.”

While the lockdown has had its criticisms — such as the countless people left in situations without work or homes and in danger of starvation — a disordered removal could see cases surge. 

Likewise the lockdown cannot remain in place forever. A total economic stall could leave India in a position where infrastructure, healthcare and otherwise, is left to decay. Millions could be left in poverty, leaving them vulnerable to other health concerns as a result. 

India must proceed with caution. Community transmission combined with a poorly defined and enforced removal of lockdown measures at a time when disease numbers are rising in the country at an unprecedented rate could result in a situation where all control is lost. It is a very real possibility that the disease at this stage may simply become endemic. If cases rise further COVID-19 could become a permanent fixture of India’s disease landscape, joining the ranks of malaria and tuberculosis as a consistent and major public health issue.


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