On June 7, AG Ahangar, director of the Sher-i-Kashmir Institute of Medical Sciences in Srinagar, said the Kashmir Valley was “facing community spread of Covid-19”. The Sher-i-Kashmir is the region’s pre-eminent medical facility and has been desginated a Covid-19 hospital. “This is a reality and we must accept it and learn to live with it,” Ahangar told IANS.

Ahangar’s assessment comes at a time when Jammu and Kashmir has registered a sharp rise in cases. As of June 10, Jammu and Kashmir had 4,507 cases. In the government bulletin, 1,605 cases are listed as “travellers” while 2,902 are marked as “others”. A staggering 2,061 cases have been reported in June alone. The Union Territory also had 51 Covid-19 related deaths till June 10. The Kashmir Valley accounted for 3,522 cases and 46 deaths.

Cases have surged across states in June. But both Central and state governments across the country have been reluctant to concede to community transmission, although the Delhi health minister suggested on June 10 that it had reached that stage. The Jammu and Kashmir government has not offered any explanation for the sudden rise in cases either.

According to the World Health Organization, “Community transmission is evidenced by the inability to relate confirmed cases through chains of transmission for a large number of cases, or by increasing positive tests through sentinel samples (routine systematic testing of respiratory samples from established laboratories).”

Eight of 10 districts in the Valley are still red zones, areas with a high caseload. But does the spread of the infection in Jammu and Kashmir fit the pattern of community transmission, as some doctors claim? Medical opinion is divided even among doctors working with the health department.

‘Community transmission, no doubt’

A physician with the Jammu and Kashmir health department, who did not want to be identified, agreed with Ahangar’s assessment. The surge in cases, he said, suggested that the coronavirus had reached the community transmission stage in the Valley.

“Generally, there are two ways to get Covid-19,” explained the physician. “One is that you have been living in an area where there was Covid-19 positivity. For example, if somebody came from international travel or somebody came from another state where there was a possibility that he or she had contracted a Covid-19 infection and brought it here. Second, from a person who’s in contact with a Covid-19 positive patient. Generally, a healthcare worker or maybe a relative.”

If the source of infection could not be traced to either of these causes, he continued, it suggested community spread. “When you don’t know how and where a person got infected, it’s called community transmission,” he said. “The way the number of positive cases has been increasing, it’s certainly in the community. There’s no doubt about that.”

Kashmiris who were stranded in Goa have their temperatures taken on their return to Srinagar. Credit: Tauseef Mustafa

Tracking the source

Top government officials did not respond to calls or questions put to them by Scroll.in. But health officials at the district level said they had managed to trace the source of most infections, suggesting there was no community spread.

In South Kashmir’s Anantnag district, health department officials claimed that they had traced the source of infection in positive case. The district has 202 active cases. “As soon as we get a case, a team led by doctors, including paramedics and Asha workers, are sent to the area to start contact tracing and ascertain the source of infection,” said a senior official from the district’s health department.

Officials in South Kashmir’s Kulgam district said they had been able to trace the source of infection in “more than 90% cases”. “There are cases where we have been unable to trace the source of infection,” said Kulgam health official. “We are working on them and we hope that we’ll be able to do that soon.”

The situation, he said, “is under control. We can’t say that there’s community transmission at this stage.”

A rush of passengers

According to a professor of medicine at Srinagar’s Shri Maharaja Hari Singh Hospital, the surge in cases in June is tied to the rush of people entering the Valley after months of being stranded outside because of the nationwide lockdown to contain the coronavirus.The physician from the health department also acknowledged the role played by the easing of travel restrictions, warning that, like in other parts of the country, the Valley’s healthcare system would be overwhelmed. “It’s really unfortunate that the government, for whatever reason, eased restrictions on movement at this stage,” he said. “They imposed strict restrictions when there were very few cases. Now, the danger is that there will be greater inter-mixing of people.”

As of June 8, Jammu and Kashmir had ensured the return of 115,508 residents by road and special trains. All incoming passengers are tested for Covid-19. Based on the results, the district authorities, in consultation with the health department, recommend home or institutional quarantine. Passengers flying in are also tested.

A municipal worker sprays disinfectant at GB Pant Children Hospital in Srinagar. Credit: Tauseef Mustafa/AFP

A statement released by Jammu and Kashmir government on June 8 said “21,4595 travellers and persons in contact with suspected cases have been enlisted for surveillance which included 42,381 persons in home quarantine including facilities operated by government, 51 in Hospital Quarantine, 2,916 in hospital isolation and 55,577 under home surveillance.”

According to the professor, the rise in the number of cases also stems from increased testing capacity. “J&K is the only Union Territory which is carrying out 10,000 tests in a single day,” he said. “We have a population of 1.25 crore and we are doing so many tests. In comparison, Uttar Pradesh, which is India’s most populous state, is carrying out only 2,000 tests in a day. If we are getting 300-400 cases every day out of these samples, it means that the situation is still under control.”

If there were thousands of cases every day, he continued, the Valley could be held to have entered the community transmission phase. “At that time, all of our hospitals will be overrun and the healthcare system will be unable to cope with it,” he added.

‘A silver lining’

Both doctors predicted a grim scenario for the Valley in weeks to come. But the physician said there was a “silver lining” – “fortunately, 90% of the cases are asymptomatic or with mild symptoms. We don’t get a lot of sick patients.”

This trend has now prompted doctors to call for a change in strategy. “Our hospitals are full because we are hospitalising patients wrongly,” said the professor at Shri Maharaja Hari Singh Hospital. “Asymptomatic patients or patients with mild symptoms should be put under home or administrative quarantine. Hospitals should be kept open and available for serious Covid-19 patients. There needs to be a change in the strategy now.”

This reporting was supported by a grant from the Thakur Family Foundation. Thakur Family Foundation has not exercised any editorial control over the contents of this article.