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New Delhi: A new study by the Indian Council for Medical Research (ICMR) suggests that community transmission of COVID-19 has started in various parts of India. the study found that of 5,911 people nationwide suffering from severe acute respiratory infections (SARI) since February, 104 were positive for COVID-19. Forty of these cases had no history of international travel, nor any contact with others who had COVID-19. In 59 other cases, public health officials still don’t know how 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 not feasible here.
The study, published in the Indian Journal of Medical ResearchIt is the first time that ICMR has published comprehensive data on its tests among SARI patients, which started on February 15. Testing for COVID-19 in people with no travel history is a valuable tool for nations to measure the extent of community transmission. And the data, which comes from 41 laboratories across the country, shows a steady increase in COVID-19 positive cases in recent weeks. While there were 0 positive cases in the week beginning February 15, this percentage increased to 1.9% two weeks later. Then, between March 29 and April 2, 2.6% of all SARI patients tested positive for the SARS-COV-2 virus.
The jump in the week ending April 2 may have to do with the fact that India began evaluating all SARI patients on March 20, rather than just a small random sample of cases reaching each one. from sentinel labs.
Despite this growing trend of COVID-19 positivity, ICMR has been denying community transmission for a while. “Tests on SARI patients do not show community transmission,” the agency told NDTV two weeks ago. However, it is essential to note that, as at present, the World Health Organization (WHO) has not classified any country, including the severely affected Italy, as having undergone community transmission. This may be because WHO defines community transmission as a situation in which a large number of cases have no travel history. But the WHO does not explain what “big” means. Therefore, ICMR may continue to insist that India only watches local broadcast, depending on whether it considers 40 to be a large enough number or not.
The new study He also highlighted how widespread COVID-19 cases are in India today. About a third of all SARI-positive patients came from 36 districts in 15 states. Some of the worst affected districts were eight in Maharashtra, six in West Bengal and five 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.
Almost 84% of the SARI patients with COVID-19 in the study were men. Meanwhile, 82% of patients (of all genders) were older than 40 years.
The study also suggests that older people are more likely to get COVID-19, a phenomenon that is also seen in other parts of the world. While 25% of SARI patients were between 20 and 29 years old, only nine of them had COVID-19. In contrast, among people aged 50 to 69 years (who make up 23% of all patients), 57 tested positive.
Study limitations
However, the study has several limitations. For example, it is not known what proportion of all hospitalized SARI patients were analyzed by each of the 41 sentinel laboratories.
“This ratio is expected to be lower during the first weeks of surveillance. However, with the expansion of testing criteria to include all SARI patients, it is assumed that the majority of ARI patients hospitalized in these facilities would have been screened for COVID-19, ”the authors say.
In addition, most of the sentinel hospitals that tested COVID-1 are state-run and located in urban areas. This means that the study could not detect community transmission in rural areas, if it is happening. Also, the fact that private laboratories and hospitals do not send their SARI samples to government test sites is a blind spot.
Finally, the authors say that the study might have missed some COVID-19 positive SARI patients, because the test used, called real-time reverse transcriptase polymerase chain reaction (RT-PCR), which looks for viral nucleic acids in patient samples, can return false negatives. Tests to detect antibodies to SARS-COV-2, in addition to nucleic acids, could have yielded more positive cases, the authors said.
India’s COVID-19 test strategy
On Thursday, the ICMR revised its testing strategy, incorporating the recommendations made by the study. Until now, testing has targeted symptomatic individuals who have a history of international travel, laboratory-confirmed symptomatic contacts of COVID-19 patients, symptomatic healthcare workers, and all SARI cases. Now, India will include people suffering from flu-like illnesses at all the critical points identified in the country. Under the new strategy, all direct, high-risk asymptomatic contacts from a confirmed COVID-19 patient will also be evaluated once, between day 5 and day 14 of contact.
