Limited community transmission of the Covid-19 disease has begun in India, a Union health ministry document has said, in the first indication that the country is entering that phase of the outbreak when the source of a patient’s infection cannot be traced and isolated.
India has reported 1,190 cases and 29 deaths due to the Sars-Cov-2 virus, which causes the deadly infection, till Monday morning.
A document detailing the standard operating procedure (SOP) for transporting a suspected/confirmed patient, issued by the ministry of health and family welfare late on Sunday night, said: “This SOP is applicable to current phase of Covid-19 pandemic in India (local transmission and limited community transmission), wherein as per plan of action, all suspect cases are admitted to isolation facilities.”
There are four main stages of disease outbreak. Stage I is usually when cases are imported and are not of local origin. Stage II is when there is local transmission, which means a section of people testing positive have come in contact with a positive patient having a travel history. Stage III is community transmission. Stage IV is an epidemic, when there several clusters of the infection.
The Indian Council of Medical Research (ICMR), tasked with containing the epidemic, has publicly maintained that India is still in Stage II, despite the number of cases of people with no known contact to an infected person or travel history rising over the past week.
Community transmission happens when the source of infection is untraced and the patient has no travel history or known contact with a confirmed Covid-19 case. It indicates that undiagnosed cases are infecting others, which is when infection clusters spiral out of control and turn into epidemics.
At a press conference later on Monday afternoon, the health ministry, however, reiterated that Covid-19 in India technically is still in local transmission stage and that there has been no community transmission so far.
A senior public health expert, who spoke on the condition of anonymity, said: “We’ve had pockets of community transmission in several locations in half a dozen states, but now the number of people with untraceable infection is increasing, which is a sign that community transmission has begun. It is irreversible now.”
Raman Gangakhedkar, head of epidemiology and communicable diseases, ICMR, said: “I cannot comment on this right now, this issue will be addressed in the ministry briefing.”
According to T Jacob John, head of the department of clinical virology and microbiology at Christian Medical College Vellore, community transmission in India began mid-February.
“Instead of splitting hair, the focus should be on preparing to be three steps ahead of the virus. It’s not a cops and robbers game, we should not be fooled into reacting to the virus but should be fooling the virus by anticipating the curve and proactively deciding what we need to do stop the spread,” said John, Emeritus Medical Scientist, ICMR.
The US Centers for Disease Control (USCDC) declared its first case of a person in California with no relevant travel history or exposure to another known patient as “possible instance of community spread of Covid-19 in the United States” on February 26.
“At this time, the patient’s exposure is unknown. It’s possible this could be an instance of community spread of COVID-19, which would be the first time this has happened in the United States. Community spread means spread of an illness for which the source of infection is unknown, ” said the USCDC in a statement.