A question that most Indians fear the answer for but yet want to know about it. It is well known that COVID-19 cases in India are increasing on a day-to-day basis. As of 21st May 2020, the total number of positive cases and deaths in India are 1,12,359 and 3,435 respectively [1]. According to the World Health Organization (WHO), the stage of transmission in the nation is classified as a “cluster of cases” [1]. What does this mean? Well, here is what you need to know to understand it and know where we stand in our fight against COVID-19.
Is India In The Stage 3 Of COVID-19?
To understand this, you need to know about the different stages of viral transmission. In general, there are four stages of transmission of a virus which includes:
Stage I: Imported cases only (from affected countries)
Stage II: Local transmission (close contact of an infected person, like family and friends)
Stage III: Community spread (some of the infected people in an area might not know how or where they got infected)
Stage IV: Spread through several communities (epidemic), with no clear endpoint
According to the Union Health Ministry, India is between stage 2 (local transmission) and stage 3 (community spread). While most of India is currently at stage 2 of the COVID-19 pandemic, localised community transmission is seen in some hotspot areas of the country (this is known as “cluster of cases”). It is defined as countries/territories/areas experiencing cases, clustered in time, geographic location and/or by common exposure [2].
On 5th May 2020, Dr. Harsh Vardhan, Union Minister of Health and Welfare, tweeted [3] that “During an interview with @CNNnews18 I assured that no #communitytransmission has taken place in India so far and we have managed to prevent this stage by doing massive contact tracing and surveillance.”
As testing each and every individual is not feasible given that Indian has a population of more than 1.3 billion people, the WHO recommends sentinel surveillance. This can not only help to know the extent of viral transmission in a community but also help to test small clusters for COVID-19 testing.
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What is Sentinel Surveillance?
Sentinel surveillance is carried out to check the prevalence of a disease in a community or a subset of population. According to the WHO, it is conducted when high-quality data is needed about a particular disease but cannot be obtained through routine methods [4].
How it helps: It helps to identify and understand the spread and extent of transmission of coronavirus disease 2019 (COVID-19) in a particular community.
When was it done: Since February 15, ICMR has initiated sentinel surveillance to detect community transmission of COVID19. The surveillance sites have been scaled up from 16 sites on Feb 29, 2020 to 51 sites by March 15, 2020 [5].
How is it done: For this, a cross-section of population across districts is selected. This is picked up randomly in the areas with known and increased COVID-19 positive cases. The samples of the people suffering from severe acute respiratory infection (SARI)/influenza like illnesses are tested from the sites. Sentinel surveillance among severe acute respiratory illness (SARI) patients can help identify the spread and extent of transmission of coronavirus disease 2019 (COVID-19). The samples were reported from 52 districts in 20 States/Union Territories [6].
What did the results say: According to a research study [6] published in the Indian Journal of Medical Research (dated 9th Apr 2020), a total of 5,911 people with severe acute respiratory illness (SARI) were tested by the Indian Council of Medical Research (ICMR). Of these, 104 (1.8%) tested positive for COVID-19 and among them around 40 (39.2%) did not have any travel history or contact with a coronavirus-positive case.
What does this indicate: Intensifying the sentinel surveillance in districts reported COVID-19 cases can help to contain the pandemic.
What is the Government Doing?
As the number of COVID-19 cases in India is rising exponentially, here are a few measures taken by the Indian Government to contain the spread of the coronavirus transmission.
– Increase capacity of the laboratories to screen increased numbers of samples using molecular testing for COVID-19 for the purpose of surveillance.
– In areas with low prevalence of COVID-19 (positive cases of less than 2%), sample pooling and testing are done using real-time RT-PCR to screen for coronavirus. A pooled testing means samples from multiple individuals are taken and run together. If the test comes positive, then individual testing is done [7].
– Populations in hotspot areas are tested using rapid antibody tests. If the test comes positive, then a confirmatory test using the RT-PCR (Reverse transcription polymerase chain reaction) test after taking oral and nasal swabs is recommended.
– With a view to managing COVID-19, every district of the country has been divided into 3 zones: Hotspot districts, Non-Hotspot districts with reported cases, and Green zone districts. Hotspot districts are those from which more cases are being currently reported or where the rate of growth of cases is more [8].
– Containment plan for large outbreaks has also been set in place. According to this strategy, except for essential services, the rest of the movement and activities will be restricted in these containment zones. Cases will be actively monitored and surveyed by special teams in the containment zone. Special teams are set up to trace all contacts as well as conduct house to house surveys [9].
– Districts were also told to classify hospitals as: COVID Care Centres for mild cases or very mild cases, COVID Health Centres for clinical moderate cases requiring oxygen support and COVID Dedicated Hospitals for severe & critical cases with ventilator support.
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Should I Need To Worry?
It goes without saying that the current situation is very critical for the entire nation. As the cases are evolving rapidly, the transition of COVID-19 to stage 3 will largely depend on how we perform as a community to slow down the spread of coronavirus. It is advised that community awareness on COVID is the key to prevent the spread of this disease [10]. So the best way is to
– Focus on personal hygiene, hand hygiene, and respiratory etiquettes
– Practise social distancing and avoid large gatherings
– Self-quarantine for people in high risk groups (those above 65 years of age, comorbid conditions, children below 5 years and pregnant women)
– Wear face covers and masks when in public (banks/groceries)
– Consult doctor in case of feeling sick or experience any symptoms of COVID-19 (fever/cough/breathlessness)
– Do not panic but stay informed
Here is a simple and quick guide to stay aware of the latest happenings and authentic information on COVID-19.
(The article is reviewed by Dr. Ashish Ranjan, MD Pharmacology and Dr. Swati Mishra, Medical Editor)
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References:
1. Situation Report 122. Coronavirus disease (COVID-19). The World Health Organization (WHO). https://www.who.int/docs/default-source/coronaviruse/situation-reports/20200521-covid-19-sitrep-122.pdf?sfvrsn=24f20e05_2
2. WHO. Global surveillance for COVID-19 caused by human infection with COVID-19 virus. https://www.who.int/docs/default-source/coronaviruse/global-surveillance-for-covid-v-19-final200321-rev.pdf
3. Dr Harsha Vardhan. Status. Twitter. https://twitter.com/drharshvardhan/status/1257405921728139264
4. WHO. Sentinel Surveillance. https://www.who.int/immunization/monitoring_surveillance/burden/vpd/surveillance_type/sentinel/en/
5. Press Release. ICMR. https://www.icmr.nic.in/sites/default/files/press_release_files/PressRelease_ICMR_19March2020.pdf
6. IJMR. Severe acute respiratory illness surveillance for coronavirus disease 2019, India, 2020. http://www.ijmr.org.in/preprintarticle.asp?id=282179
7. Advisory on feasibility of sample pooling. https://icmr.nic.in/sites/default/files/upload_documents/Advisory_on_feasibility_of_sample_pooling.pdf
8. Ministry of Health and Family Welfare. Updates on COVID-19. https://pib.gov.in/PressReleseDetail.aspx?PRID=1614770
9. Containment Plan for Large outbreaks of COVID-19. MoHFW. https://www.mohfw.gov.in/pdf/3ContainmentPlanforLargeOutbreaksofCOVID19Final.pdf
10. Ministry of Health and Family Welfare. Updates on COVID-19. https://pib.gov.in/PressReleseDetailm.aspx?PRID=1625744