Health Ministry says no evidence of COVID-19 community transmission yet

Published : March 27, 2020 11:29 IST

A media briefing by Health Ministry Joint Secretary Lav Agarwal (centre), DG, ICMR, Balram Bhargava (left) and Principal Director General, PIB, K.S. Dhatwalia. Photo: PTI

The focus of the Health Ministry and the Union government has been on promoting physical distancing and national lockdown to break the chain of COVID-19 transmission, thereby sidestepping important questions on community transmission, testing, tracing and the shortfalls in the provisioning of personal protective equipment (PPE) for medical and paramedical staff.

Briefing the media on March 26, Lav Agarwal, Joint Secretary in the Health Ministry, played down the prevalence of any community transmission, stating that there was no evidence of it. He said that the country was in the stage of “local transmission” only and that if community transmissions was taking place, there would have to be much more involvement at the ground level. The question today he said was not how much time it would take for local transmissions to get converted into community transmission. He was emphatic that if “social distancing and treatment” were followed, community transmission would not happen.

Dr Raman R. Gangakhedkar, head of the Epidemiology and Communicable Diseases Division in the Indian Council of Medical Research, who was also present, said that they had “nothing to hide” as there was no evidence of “community transmission”.

Lav Agarwal said that while the overall number of cases had gone up, the rate of increase of positive cases had “stabilised”. However, he cautioned that the figures did not “establish a clear trend” and the way in which the situation was “evolving”, it was not possible to relax. He said physical distancing and the lockdown ought to be “an individual and collective responsibility” and added that hundred per cent lockdown should be implemented properly.

The government has all along maintained that community transmission was not a challenge as yet for India contrary to what most public health experts and the World Health Organisation have said, which is that the lockdown has to be complemented with testing, treating and contact tracing. Lav Agarwal deflected questions on community transmissions, insisting that the issue now was less about community transmission and more about preparedness to take on the collective responsibility of fighting the spread of the virus.

As of March 26, there were 649 cases in all and 16 deaths. There were COVID-dedicated hospitals in 17 States. A nodal centre for ensuring uniformity in treatment protocols has been set up at the All India Institute of Medical Sciences in Delhi. The National Institute of Mental Health and Neurosciences has been given responsibilities for module-level training, though the mental health challenges faced by both the infected persons and the health workers were not spelled out in the briefing.

The media was informed that the Accredited Social Health Activists and Auxiliary Nurse Midwives would receive “online” orientation programmes in order to reach services to everyone, but little was stated about PPE kits for health workers, paramedical staff and doctors. Reports of shortages of PPEs have been reported the world over, including in the United Kingdom where doctors threatened to quit the National Health Services owing to lack of PPEs. The Rs.1.7 lakh crore package of the Pradhan Mantri Garib Kalyan Yojana announced by the Finance Minister includes an insurance scheme for health professionals in government hospitals and health care centres. Under it, any health worker who meets with an accident (the nature of the accident not specified) while treating a COVID-19 patient would be compensated with Rs.50 lakh. Some 22 lakh health workers are supposed to be covered under the scheme. This figure includes all health personnel—doctors, specialists, technicians, safai karamcharis, paramedics, nurses, ward boys and so on—and is a gross underestimation of the total number of people involved in COVID-19 management.

Dr Raman Gangakhedkar made it clear that testing was limited only to symptomatic cases, including that of health workers. “We cannot say that testing is happening on a large scale,” he said. Twenty-five laboratories had been given approval for testing and they had their collection centres for samples. Regarding the special needs of the elderly, he admitted that the elderly were more vulnerable but added that their well-being was not the responsibility of the government alone. There was a constant emphasis on collective responsibility, which seemed to imply that the onus of containing the spread of COVID was more on the people than on the government. The officials advised the media not to report on “sporadic cases” and label them as evidence of community transmission without proof.

Community transmission concerns have arisen as there have been cases with no evidence of travel histories. Interestingly, the officials also expressed difficulties in getting the travel histories of all infected persons and stated that until that was not ascertained, it was difficult to conclude that there was community transmission. “If we are not able to trace the contacts of a person who has travelled abroad, it does not mean that community transmission is happening,” said the Joint Secretary.

Notwithstanding the position taken by the Health Ministry, the Ministry of Science and Technology (Department of Biotechnology) issued an office memorandum on March 20 setting up a Rapid Response Regulatory Framework for COVID-19. In view of the “rapid spread in various countries and the need for immediate research and product development”, this will help deal with applications, and help fast-track the regulatory approval process, for development of vaccines, diagnostics, prophylactics and therapeutics.