As early as March 28, the Health Ministry acknowledged that there was “limited community transmission” of the novel coronavirus in India. On April 9, the ICMR and Health Ministry researchers — some of them are national task force members for COVID-19 — in a journal paper, provided evidence suggesting the prevalence of community transmission in 36 districts across 15 States. The sentinel surveillance for community transmission undertaken by the task force among patients hospitalised for severe acute respiratory infection (SARI) found 40 of the 102 who tested positive for the virus had no travel history or contact with a known positive case, while data on exposure was not available for another 59 SARI patients. Yet, the ICMR consistently maintained that the virus had not spread to the community. On May 5, even when the total number of nation-wide cases was close to 47,000, the Health Minister said that India’s virus spread had not gone to stage three. While there has been no hesitation in declaring local transmission caused by people who have a travel history, the government has been extremely hesitant to admit community transmission. The reluctance is surprising given that the total cases reported so far has already crossed 63,500, and the nature of spread is through droplet transmission and contact with contaminated surfaces. In contrast, is the U.S. On February 26, when the total number of cases was just 60, it confirmed community spread following the detection in California of the first case with no travel history or contact with a known positive case. One reason why India refused to confirm community spread early on could be the compulsion to expand testing when the country did not have the capacity to test huge numbers each day. But there is no reason now to continue being in denial, as that erodes public trust in the government.
Against this background, the latest decision to initiate a study in 75 hotspot districts to confirm community spread and ascertain the proportion of community already exposed to the virus is encouraging. The study had apparently got delayed by about a month due to the non-availability of reliable rapid antibody tests. Due to the unreliability of rapid antibody test, the government will instead use the ELISA test to check for infection. Since the ELISA test detects antibodies to the virus, the survey will be able to pick previously infected people including those who were asymptomatic for the entire duration of the infection. Since it takes one to three weeks for the antibodies to develop, the ELISA test will miss people who have been recently infected. The survey, scheduled to begin later this month in collaboration with the States concerned, will randomly test about 30,000 people in the general population. Meanwhile, all States should continue with strict containment and mitigation measures, acting on the assumption that the virus has indeed spread in the community.