Health

COVID-19: Nearly 30,000 cases in India but no community transmission, says WHO

Classification based solely on country's ‘self-reporting’, says UN health body. Several with fewer cases have declared community spread

 
By Banjot Kaur
Last Updated: Tuesday 28 April 2020
Homeless people take refuge at Yamuna sports complex during the nationwide lockdown, in New Delhi. Photo: Vikas Choudhary
Homeless people take refuge at Yamuna sports complex during the nationwide lockdown, in New Delhi. Photo: Vikas Choudhary Homeless people take refuge at Yamuna sports complex during the nationwide lockdown, in New Delhi. Photo: Vikas Choudhary

The novel coronavirus disease (COVID-19) may have the whole world in its grip, but India has placed itself in an interesting position — at nearly 30,000 cases, it still classifies itself among countries with ’clusters of cases’. Most others with such case count, or even less, have admitted that ‘community transmission’ is a reality.

Experts have taken it sceptically.

A situation report by the World Health Organization (WHO) on April 27, 2020 stated that despite recording 27,892 cases positive for the novel coronavirus SARS-CoV-2, the stage of transmission in India was restricted to ‘cluster of cases’. This classification of transmission, the United Nations body said, was based solely on the country’s ‘self-reporting’.

According to the situation report, several countries that reported fewer cases declared community transmission. These include eight countries in the region of the Americas, six in Africa, one in southeast Asia and 14 in Europe. A few of these countries reported less than 10,000 cases; some recorded even less than 1,000. 

According to the latest update of the Union ministry of Health and Family Welfare (MoHFW), the number of COVID-19 cases in India was 29,435, as of April 28, 2020. 

There are some countries (Spain, Portugal, etc) that have stated their status as ‘pending’. China, from where the pandemic originated, also classifies itself among those with clusters.   

“Classifications are reviewed on a weekly basis and may be upgraded or downgraded as new information becomes available,” the WHO said.

The WHO defines ‘cluster of cases’ as ‘countries / territories / areas experiencing COVID-19 cases, clustered in time, geographic location and/or by common exposures.’

DTE sent a query to the WHO communications team seeking clarification on this. The story would be updated once a response is received. 

Meanwhile, senior scientists believe community transmission began in India long ago, but the government does not want to declare that it has.

“It is strange. What explains the rise in the number of cases if they are not coming from within the community?” said a senior scientist with an institute under the Union science and technology ministry.

COVID-19 cases rose by daily average of 1,000-1,500 in the last one week.

“It seems officials want to project that the outbreak is controlled and don’t want to declare it. It has been more than a month of the lockdown now. The incubation period of the virus is 14 days. If they claim they have identified everybody’s transmission chain, then no new cases should have come up after 14 days of the lockdown,” she added.

T Sundararaman, former head of the  MoHFW’s National Health Systems Resource Centre, said: “Undoubtedly, community transmission started in India long ago. The government may reject it, but it is high time it ramps up testing to know the true extent of the problem.”

Madhukar Pai, Canada Research Chair in Epidemiology and Global Health, expressed similar concerns.

“India has more than 29,000 confirmed cases of COVID-19, but the actual numbers have to be higher because we are not testing enough. South Africa, for example, is testing five times more than India. The confirmed cases there are about one-fourth than India’s,” Pai said. 

He added that it was important to make testing easier in public and private sectors. “Testing should be free. Testing will help focus only on those who are positive to the virus; others would eventually be able to get back to work.”

The government take 

Of all severe acute respiratory illness patients who were tested positive for SARS-CoV-2, as many as 40 per cent did not have any travel or contact history, according to an Indian Institute of Medical Research study published in March. Yet, no conclusions regarding possible community transmission were made by the health ministry. 

It was not the first time though that apprehensions regarding this classification of transmission have been raised. 

Several state government officials have pointed at community transmission. West Bengal Chief Minister Mamata Banerjee claimed that “things were at a very bad stage”, warning of an impending community transmission. A state government official earlier told DTE that community transmission had begun in the state.

Mumbai’s civic body Brihanmumbai Municipal Corporation, too, has has denied community transmission. However, in several clusters, index cases could not be identified for confirmed COVID-19 patients.

Punjab CM quoted a study of Post Graduate Institute of Medical Education and Research (PGIMER-Chandigarh) on April 10 stating there were indications of community transmission.

Later, however, the institute denied any such study.

 

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