COVID-19: Community Transmission Starts In India: ICMR

A new study from the Indian Council of Medical Research (ICMR) suggests that community transmission of COVID-19 has begun in several parts of India. The study found that out of 5,911 people across the country suffering from severe acute respiratory infections (SARI) since February, 104 were positive for COVID-19. Forty of these cases had neither a history of international travel, nor any contact with others who had COVID-19. In another 59 cases, public-health officials don’t yet know how the patients contracted the viral illness. Together, these data suggest that COVID-19 has spread beyond travelers and their close contacts in parts of India, making contact-tracing infeasible here. 

The study, published in the Indian Journal of Medical Research, is the first time that ICMR has released comprehensive data on its testing among SARI patients, which began on February 15. Testing for COVID-19 in people who have no travel history is a valuable tool for nations to gauge the extent of community transmission. And the data, which comes from 41 laboratories across the country, shows a steady rise in COVID-19 positive cases in the last few weeks. While there were 0 positive cases in the week starting February 15, this percentage rose to 1.9% two weeks later. Then, between March 29 and April 2, 2.6% of all tested SARI patients turned out to be positive for the SARS-COV-2 virus.

The jump in the week ended April 2 may have to do with the fact that India began testing all SARI patients on March 20, instead of just a small random sample of cases coming to each of the sentinel labs.

Despite this rising trend of COVID-19 positivity, ICMR has been denying community transmission for a while. “Tests on SARI patients show no community transmission,” the agency told NDTV two weeks ago.  However, it is critical to note that as of today, the World Health Organisation (WHO) hasn’t classified any country, including the badly-hit Italy, as undergoing community transmission. This may be because the WHO defines community transmission as a situation in which a large number of cases have no travel history. But the WHO doesn’t explain what “large” means. So, ICMR may continue to insist that India is seeing only local transmission, depending on whether it considers 40 to be a large enough number or not.

The new study also highlighted how widespread COVID-19 cases are in India today. About a third of all positive SARI patients were from 36 districts of 15 states. Some of the worst affected districts included eight in Maharashtra, six in West Bengal and five each in Tamil Nadu and Delhi. In 15 states, more than 1% of SARI patients were COVID-19 positive. The authors recommend that these districts be prioritized for COVID-19 containment activities.

Nearly 84% of SARI patients with COVID-19 in the study were men. Meanwhile, 82% of the patients (from all genders) were older than 40 years.

The study also suggests that older people are more likely to contract COVID-19, a phenomenon seen in other parts of the world too. While 25% of the SARI patients were aged between 20 and 29 years, just nine of them had COVID-19. In contrast, among those aged 50-69 years (constituting 23% of the total patients), 57 tested positive.

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