Is India In Dreaded Stage 3 Of Community Transmission? A Doctor's Take

In addition to 111 ICMR-accredited laboratories, six private laboratories have now been permitted to undertake the real-time PCR-based Covid19 testing.

With some 400 positive cases within a population of 1.3 billion, the burning question in the minds of many is whether India is under-reporting. Until a couple of days ago, there were strict, conservative criteria for COVID 19 testing. Only people with travel history in the last 14 days with symptoms suggestive of coronavirus and those who have come in contact with confirmed cases were being tested. The Indian Council of Medical Research or ICMR has now extended the testing criteria. All hospitalized patients with severe acute respiratory illness without any travel and contact history, and asymptomatic direct and high-risk contacts of a confirmed case would be tested once between Day 5 and Day 14 of coming in his/her contact.

In addition to 111 ICMR-accredited laboratories, six private laboratories have now been permitted to undertake the real-time PCR-based Covid19 testing. Extending the testing criteria and screening a large number of "suspect cases" will give an idea regarding the extent of community transmission.

Community transmission happens when an individual tests positive for COVID 19 with no trace to the source of infection.

Firstly, accurate diagnosis will help in precisely identifying those who are sick so that appropriate care is provided to them. Those in the community who have tested positive with mild symptoms can be advised  to self-isolate which would go a long way in minimising the exponential spread of the virus.

Secondly, if an individual has tested positive, one can diligently trace the contacts and test them, and if they turn out positive, they can be isolated as well.

Thirdly, testing the "suspect cases" allows hospitals to be better prepared regarding the likelihood of how many cases they can expect.

And finally, testing enables us to evaluate the evolution of the disease and strengthen our efforts to control the virus.

Prevention of community transmission is the cornerstone in the fight against this virus. Currently, India has tested around 16,000 people. This is in striking contrast to a small country like South Korea (which has a population equivalent to Tamil Nadu) that tests 12,000 - 15,000 people every day. Countries such as South Korea, Singapore, Hong Kong, Taiwan, China have been able to "flatten the curve"(i.e. measures that keep the daily number of disease cases at a manageable level for medical providers) through innovative ways of diligently testing a large section of the community.

There is also an urgent need to buttress the fragile public health system in the country. Although the virus is asymptomatic and associated with mild infection in the vast majority, 5% of patients require ICU care. India does not have even one hospital bed per 1,000 people and has a dismally small number of some 70, 000 ICU beds that cater to 5 million patients who require ICU admissions every year. God forbid, should the community transmission transform the situation to a  full-blown epidemic, India would barely be in a position to deal with the catastrophic dimensions of an impending crisis.

The next few weeks will be crucial in determining whether India can contain the exponential transmission of the virus. We must do everything in our power to do the right things in record time.

(Dr P Raghu Ram is President, The Association of Surgeons of India, and is a Padma Shri awardee.)

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