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Wednesday, August 12, 2020

Explained: Here’s why community transmission no longer matters at this stage

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.

Written by Amitabh Sinha | Pune | Updated: July 22, 2020 11:09:06 am
A Family wears mask to prevent from Covid19 infection in New Delhi (Express Photo/Praveen Khanna)

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.

A police officer helps a man adjust his mask in Mumbai (Express photo/Nirmal Harindran)

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”.

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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.

delhi coronavirus cases, delhi covid cases, coronavirus cases delhi, delhi news, city news, indian express A health worker collects a sample of a man for COVID-19 test at a centre, in New Delhi. (Express Photo By Amit Mehra)

“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 Wellcome 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.

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So why the insistence?

Scientists said they could only speculate since they just did not understand this reluctance to admit community transmission.

“I don’t know, but does the government believe it would be taken as some sort of failure on its part to effectively identify and isolate all the primary and secondary contacts? May be that could be the motivation behind denying it, I am not sure. I can’t think of any other reason,” said Jayprakash Muliyil, former principal of CMC Vellore and one of India’s best-known epidemiologists.

“Once you accept that there is community transmission, then none of these containment zones, red zones or green zones make any sense. People might ask why should we follow all these. So, may be government wants to avoid that kind of situation. But frankly, I don’t know,” he said.

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The scientist who did not wish to be named because of his non-disclosure agreement said it could be possible that the government was going by the geographical concentration of cases. “It is a fact that the lockdown, movement restrictions, and the adoption of masks and other precautions, has kept the rural areas largely protected from the disease. But it is a very lame defence,” he said.

Does it matter now?

Muliyil and other scientists also argued that it was immaterial whether the government admitted to community transmission.

“There is no definition of community transmission in epidemiology textbooks. In very simple terms, it just means, whether the disease gained a foothold in my country, or my community. Everything else is humbug,” Muliyil said.

Jameel said he could not think of anything that the government would be forced to change if it accepts that community transmission was happening. “Nothing changes. The same processes will have to be carried out. Test, isolate, treat. For general public also, there is nothing that will change. Follow the same safety procedures, take the same precautions,” he said.

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