Community transmission explained: Is India in stage 3 of Covid-19?

NEW DELHI: The Karnataka government on Tuesday told a Central team that there was no community transmission of Covid-19 in the state and that the pandemic has not yet reached the third stage.
This came after Karnataka minister JC Madhuswamy said that coronavirus is spreading at the community level in the state, which once again started the debate in the country over the spread of Covid-19 pandemic.
On July 5, India surpassed Russia as the third worst-hit country by Covid-19 after its case tally crossed 6.9 lakh on Sunday, according to statistics aggregator Worldometer, with several states recording their highest single-day spike.
However, the government has, so far, maintained that India is not in the community transmission stage of Covid-19 spread, even as cases and deaths continue to mount in the country.
What is community transmission?
Community transmission is the third of the four stages of a pandemic, according to the World Health Organization (WHO).
Community transmission is a stage when you are not able to track down the source of infection of a positive case despite thorough contact tracing. Then it is presumed that the virus is in general being transmitted in the community.
For example, if a person has contracted the virus and the authorities are not able to trace the contact or the source of the infection and this happens with several positive case, then it can be inferred that the virus is in the community transmission stage.
The WHO has described community transmission as “evidenced by the inability to relate confirmed cases through chains of transmission for a large number of cases, or by increasing positive tests through sentinel samples (routine systematic testing of respiratory samples from established laboratories)."
The community transmission can also be localised.
Stages of the virus
The coronavirus pandmeic has four stages as declared by the WHO:
* Stage 1: In the first stage, the virus doesn't spread locally and the postive cases usually have a travel history to a country affected by the infection.
* Stage 2: When a person, who has travelled from an affected country, transmits the virus to the people he/she came in contact with. During this stage, it is easy to do contact tracing and find the source of the positive case. The transmission is usually local.
* Stage 3: This stage is called community transmission where you are not able to find the source of the virus. The positive cases generally do not have a travel history in this stage.
* Stage 4: In this last stage of the Covid-19, there is a widespread outbreak of the virus as the cases begin to multiply rapidly. The disease becomes endemic in this stage. Controlling the infection becomes very difficult. China has been in stage 4 of the Covid-19 where the infection spread in clusters.
Is India in the stage 3?
In India even as there are now more than 7 lakh confirmed cases, the ICMR continues to hold that there is no community spread. But this position is being increasingly questioned by some state governments and doctors.
In Delhi, health minister Satyendar Jain has said that the source of infection is not known in as many as 50% of the cases. That would seem a textbook case of community transmission.
On June 11, the government asserted that India was definitely not in the community transmission stage of COVID-19 spread, trying to refute the statement by some experts and doctors.
Indian Council of Medical Research (ICMR) Director-General Balram Bhargava said, "There is a heightened debate around this term community transmission. Having said that I think even WHO has not given a definition for it. And as we have so shown that India is such a large country and the prevalence is so low."
"The prevalence has been found to be less than 1 per cent in small districts. In urban and containment areas it may be slightly higher. But, India is definitely not in community transmission. I would like to emphasise it," he added.
Experts differ with ICMR
Amid the massive spurt in coronavirus cases in India, experts have come down hard on the ICMR for its sero-survey findings to assert that there was no community transmission of Covid-19, saying it was not reflective of the current situation and the government was showing "obstinacy" in accepting the truth.
Emphasising that community transmission was on in many parts of the country, the experts asked the government to admit it so that people don't get complacent.
The assertion came from the experts from the field of virology, public health and medicine after ICMR's statement saying India was not in the community transmission stage.
AIIMS former director Dr M C Mishra said there is no doubt that there has been community transmission in several parts of the country.
Dr Ravi Shekhar Jha, head of the department, Pulmonology, Fortis Escorts Faridabad, said he strongly feels that community transmission has occurred. "The government has stopped contact tracing. Earlier the government was doing rigorous contact tracing, but in the last 7-10 days no government, in Delhi or anywhere, is doing it. They know community transmission is happening, but are not accepting it," Jha said.
Dr Vikas Bajpai, assistant professor, Centre for Social Medicine and Community health at the Jawaharlal Nehru University, said if the government has decided that "obstinacy and blindness to truth" is going to be a matter of policy for it in fighting against this Covid-19 pandemic then it is pointless to try and make them see reason.
Jharkhand man without travel history tests Covid positive
A man from Domchanch became Koderma’s first person without any travel history to be diagnosed with Covid-19 on June 30, sparking fears of community transmission of the virus in the district.
The 45-year-old does not even any identified contact with a positive case, civil surgeon Dr Parvati Nag said, adding that the case is a concern for the district administration.
Without commenting on whether it is a case of community transmission, Koderma DC Ramesh Gholap said the patient has been admitted to a Covid-19 hospital. “The district administration and the health department are trying to find his source of infection. A detailed investigation is underway and more than 25 of his primary contacts have been identified and put under institutional quarantine at Domchanch. The area where he lives has been sealed and sanitized.”
India's fatality rate per million population lowest in world
India's total number of coronavirus cases and fatalities per million population is one of the lowest in the world, the Union health ministry said on Tuesday even as the country's infection tally went past the 7 lakh-mark and the death toll rose to 20,160.
Referring to the ‘WHO Situation Report-168' dated July 6, the ministry said India's Covid-19 cases per million population is 505.37 as against the global average of 1,453.25.
Chile has witnessed 15,459.8 Covid-19 cases per million population, while Peru has 9,070.8 cases per million people.
The US, Brazil, Spain, Russia, the UK, Italy and Mexico have 8,560.5, 7,419.1, 5,358.7, 4,713.5, 4,204.4, 3,996.1 and 1,955.8 cases per million, respectively, according to the WHO report.
During the last 24 hours, a total of 15,515 Covid-19 patients have been cured, taking the cumulative figure of recovered cases among Covid-19 patients in the country to 4,39,947 as on Tuesday.
Enhanced focus on “Test, Trace, Treat” augmented with various measures has facilitated widespread Covid-19 testing by states and Union territories.
(With agency inputs)