Why community transmission no longer matters at this stage

    22-Jul-2020
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Amitabh Sinha
More than 1.1 million people have so far been infected with the novel coronavirus in India now. Covid-19 disease is present in every state and Union Territory, except Lakshadweep. Twenty-seven of these have seen more than 1,000 people getting infected till now. Even Andaman and Nicobar Islands, which is the lowest number of cases in the country, has more than 150.
The government, however, continues to insist that the disease has still not reached a stage where community transmission starts to happen. Several scientists and health experts told The Indian Express this was not true, that the government position was entirely “untenable”, that community transmission was no doubt taking place, but that it did not matter in any case.
But what is it, and why is it important?
Community transmission simply means that the epidemic has become so widespread in a community that it gets difficult, if not impossible, to determine who is passing on the infection to whom. The source and chain of infections can no longer be established. Determining the chain of infections is key to the containment strategy that is being followed. Contact tracing, identification, testing and isolation of suspect cases are all dependent on establishing this chain.
In the initial days, when the disease was being brought by travellers from abroad, every infected person was being checked for their travel history, or their contact with someone who had a travel history. And in those days, every new infection could indeed be linked with someone who was a primary or secondary contact of someone who had travelled abroad. At that time, the government’s repeated statements about the absence of community transmission was also seen as a move to reassure the public that only a small proportion of people, those who had come in contact with travellers abroad, could potentially be at risk, and thus there was no need for others to panic.
But when more than 1.1 million people have been infected, the insistence that there was no community transmission happening is something that, scientists said, was “laughable” and “not true”. As recently as last week, the Health Ministry said that a bulk of India’s cases, about 80%, were confined to just 49 districts out of a total of 733, and therefore any “talk of community transmission is not justified”.
So, is it happening?
Scientists and health experts this newspaper spoke to were in no doubt that community transmission was happening. “You talk to any epidemiologist of any repute, who is outside of the government, and he or she will tell you the same thing. It is a totally untenable claim. It was untenable even earlier, but now… I don’t even know what to say to this,” said Vineeta Bal, an immunologist and a visiting professor at the Indian Institute of Science Education and Research (IISER) in Pune.
One senior scientist, who is advising one of the state governments, said there was hard evidence and data to show that community transmission was a reality, and it was happening for a long time.
“Our team is looking at the raw data. And there is clear evidence. There are hundreds of cases in which the chain of transmission is totally absent. So, what I am saying is based on evidence that is there. In any case, to argue that with 11 lakh cases, there is still no community transmission happening, is totally indefensible,” the scientist said. He said he had signed a non-disclosure contract with the state government and therefore could not be quoted.
Shahid Jameel, a virologist and chief executive of Welcome Trust-DBT Alliance that funds health research in India, said the government stand lacked transparency.
“I think it is always better to be honest about such things, about matters related to science. Look, beyond a point, it is nobody’s fault that the cases have reached 10 lakh and still increasing. Frankly, I am not of the view that India is in a very bad situation, considering its size and population. But to say that there is no community transmission happening, with 10 lakh cases and more… how is that even possible? You remember the ICMR (Indian Council of Medical Research) had carried out a survey of people with serious respiratory diseases, and more than 40% of those surveyed did not know where they got the infection from. If that is not community transmission, what is? It is the government’s own data,” he said.
 Courtesy: Indian Express