COVID19 and Community Transmission

COVID19, a disease confined to the visitors of a market in Wuhan, which later engulfed the whole of China, is now seen extending its claws to the entire humanity. Today it is there just a breath away, waiting for a careless gesture of ours to attack and conquer mankind.

? How does COVID19 spread in the community?

There are 3 phases for the transmission of COVID19 in the community.

1️⃣First phase
Disease only in persons who travelled to areas with local transmission of the disease.

2️⃣Second phase
Disease in a primary contact, which means transmission from a confirmed case of COVID.

3️⃣Third phase
Disease in a secondary contact which means that the person acquired the infection by contact with a primary contact of a confirmed case.

Till the second phase, it can be called a LOCAL TRANSMISSION of the disease. After this phase, it is called the COMMUNITY TRANSMISSION which means that the disease has percolated into the community through multiple contacts. Cases will be reported from different parts of the community and it is practically impossible to trace back to the index or source patient. The number of cases may exponentially increase and the death toll may rise.

? What is the status of India right now?

At present, we have reported cases in persons who travelled to areas with local transmission of the disease and in their primary contacts. Hence, India is in the second phase, but we are probably at the doorstep of the third phase which indicates community transmission.

? So, are we in a safe zone? Is it sufficient that the patients and their contacts are quarantined?

Unfortunately, we are not…
In India, laboratory testing is being done only for persons who have travelled to the listed areas/countries or those with symptoms of severe disease. Hence, there is a chance that mild symptoms may not be tested and maybe missed. So it is unwise to think that the number of confirmed cases represent all the cases in the community. There can be more cases that are not identified as they are not tested.

? Are there reasons to think that community transmission has started in India?

If we look at the pattern of COVID confirmed cases or deaths in the world, we can see that there are multiple cases around the index patient who were not identified by the health system earlier. Hence, there is indeed a gap between the number of laboratory confirmed cases and the number of real-life patients in society. This hypothesis is supported by the pattern of the spread of COVID in countries like China and Italy. The ability of a patient to transmit the disease to others even when he is asymptomatic adds to the worry.
To confirm community transmission in India, we will have to wait for 1-2 weeks more. But, its suicidal to wait till confirmation to intervene as we have a good number of countries as examples before us who had to pay the price for their watchful non-intervention.

? What can we do to prevent community transmission?

? Individuals

?Gather adequate knowledge about COVID from reliable sources

?Maintain adequate personal hygiene including hand hygiene, hygiene during coughing /sneezing

?Physical distancing (at least one metre )

?Make sure what to do and what not do in case you develop symptoms

?Persons with mild symptoms like fever, cough should stay at home

?Avoid unnecessary travel and gatherings

?Avoid visitors

?Keep records of essential medicines, ambulance, their availability and emergency contact numbers.

?In case you are infected, identify the high-risk persons in your family and take adequate precautions to avoid transmission of infection to them.

? Schools, colleges, exams

?Declaring holidays for schools, colleges.

?Postponement /cancellation of exams.

?Reinforce the personal hygiene in preventing COVID spread to the students.

?Identify children who had contact with patients and quarantine them.

?Avoid sending children with any symptoms to school.

? Religious, political and other organizations

?Avoid gatherings.

?Discourage group prayers and rituals.

?Make arrangements for isolation facilities in case of increasing demand.

? Workplace

?Encourage working at home

?Make facilities for personal hygiene measures like hand washing at the workplace.

?Disinfect door handles, tables, handrails frequently.

?Avoid going out to work if you have symptoms

?Ensure leave with pay for people who are in isolation

? Health department

?Frequent updating of the list of suspects and contacts

?Strict isolation of the confirmed patients

?Strict quarantine of the contacts

?Keeping constant contact with the people in quarantine.

?Make sure that the patients and the public adhere to the instructions given.

?Improve the facilities of hospitals especially isolation and intensive care facilities, personal protection equipment for the health workers taking into consideration the probable increase in patients.

?Ambulance service and adequate precautions to handle dead bodies are to be kept ready.

Our aim is not to eradicate the disease, but to decelerate and contain the spread. It is just like the controlled release of water from a dam depending on the rise in water levels rather than a dam failure which will cause catastrophic damage to life and property downstream.

Remember, a stitch in time saves nine…