40% respiratory illness patients testing positive for COVID have no travel/contact history: ICMR

First findings of India on SARI patients out, 1.8% confirm coronavirus infection

By DTE Staff
Published: Thursday 09 April 2020

Forty per cent of the total Severe Acute Respiratory Disease (SARI) patients who tested positive for novel coronavirus disease (COVID-19) in 20 states of India from February 15, did not have any international travel or contact history.

This is the conclusion reached in a paper released by Indian Council of Medical Research (ICMR) on April 9, 2020.

“Irrespective of the fact what term the ministry uses to define this — localised or large outbreaks —one thing this number clearly indicates is that infection is spreading in the community,” a senior scientist engaged with a Central government institute told Down To Earth (DTE) on the condition of anonymity.

“No travel or contact history is indicative of the spread gaining ground in the community,” she added.

Two per cent of all SARI patients had contact with a confirmed case, one per cent had an international travel history and in 57 per cent cases, the data on exposure could not be known, according to the findings.

ICMR expanded the ambit of testing and revised the guidelines on March 20 to include all SARI patients. Earlier, only those who had an international travel history or a contact history, were eligible for testing.

Thus, these are the first findings of SARI patients for COVID-19 positivity in India. Overall, 1.8 per cent of such patients were found to be positive for SARS-CoV-2. The positivity rate among these patients increased to 2.6 per cent by April 2, 2020, from 0 per cent before March 14, the paper said.

In fact, from February 8 to March 14, the positivity rate among these patients was zero, according to the paper. It increased to 1.9 per cent from March 15-21, 1.7 per cent from March 22-28 and 2.6 per cent from March 29 to April 2.

“This shows that the disease has just arrived in India. Therefore, you find the positivity rate among SARI patients going up gradually. It is a clear message that we now have to up the ante against the virus,” the scientist told DTE.

As the number of patients who were tested went up, the positivity rate too simultaneously registered an increase, this particular set of data suggests. So less the sampling, lesser the rate and vice versa.

To clarify, since the revision in guidelines to include SARI patients happened only on March 20, therefore the ones tested before them were actually tested retrospectively by stored samples.

All those SARI patients, who confirmed positive for COVID-19 without an international travel or contact history, are scattered among 36 districts of 15 states. While the paper recommends that COVID-19 containment activities have to be increased there, it does not specifically point out which these districts or states are.

“The ICMR has done good work by finally bringing out this data but for better statistical analysis, we need to know which are these districts,” the scientist said.

While the district-wise positivity rate is not shown, the state-wise rate is discussed. The highest per cent of SARI patients to be found positive was in Tripura, with 11 per cent. 

Tripura was followed by Delhi (5.1 per cent; 277 samples), Chandigarh (4.2 per cent, 24 samples), Telangana (4.2 per cent; 190 samples), Maharashtra (3.8 per cent; 553 samples) and West Bengal (3.5 per cent; 256 samples)

The head of epidemiology at Bangalore-based Indian Institute of Public Health echoed what the scientist had said.

“To me this data does not appear to be alarming but the clear takeaway is the surveillance among SARI patients has to be broadened much more. At present, as the paper lists in the limitations part, only government hospitals were chosen. This has to be expanded not just to other hospitals but non-hospitalised patients too,” he told DTE.

“Also, the sampling size should go up. This certainly does not mean indiscriminate testing as many say. Rather, it means that if you do not want to test every person having fever and displaying other COVID-19 symptoms, you at least have to check a representative sample of them. They can’t be kept out of the testing net anymore,” he added.

Another important bit of statistic is distribution of these cases among age and gender. The positivity rate among male and female SARI patients was 2.3 per cent and 0.8 per cent respectively.

As far as the age distribution is concerned, the highest rate (4.9 per cent) was found in people aged between 50-59 years, followed by 2.9 per cent in 40-45 year aged patients.

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