Delhi has reported more than 32,000 cases of Covid-19 as of June 10 and over the past few days, the Delhi government has hinted that the “community transmission” stage of the epidemic has begun in the city.

Community transmission is said to be occurring when the source of infection for a person with the coronavirus cannot be traced to contact with a confirmed Covid-19 case or has travelled from an area in which the disease is present.

On June 9, Delhi’s Health Minister Satyendar Jain said that the source of infection in the city could not be detected in almost 50% of the cases recorded. Despite this, on the same day, Deputy Chief Minister Manish Sisodia said that according to the Centre’s officials, there was no community spread in Delhi.

On June 10, Jain made another statement about on the subject. “There is transmission in the community, but if it is community transmission or not that can be declared by the Centre only, it is a technical term,” he said.

Why does the Delhi government have to wait for the Centre to make a declaration about whether this stage has been reached?

Officials in the Delhi government’s health department said that the Centre was in charge of announcing the level of transmissions in the country. “The definition [of community transmission] has to come from the Centre,” said an official who did not wish to be identified.

If the Centre declares community transmission, then the strategy of dealing with the virus would change, the official said. “The entire strategy changes...from containment it goes to mitigation...that’s a call the Centre takes for the whole country,” they said.

People want for Covid-19 tests at Delhi's Ram Manohar Lohia hospital. Credit: PTI

‘Pretend everyone is infected’

Alarm bells about the possibility of community transmission were sounded when one in every four migrant workers who returned to Bihar from Delhi tested positive for the virus, according to data released by the Bihar government, reported on May 19. The state had tested 835 people who returned from Delhi, of whom 218 or 26% tested positive for the infection.

But Delhi’s health officials had denied the possibility of community transmission at the time, citing the results of random tests on low-risk groups that had been conducted in the city in May. Not a single positive case was recorded from these tests to indicate community transmission, the officials said.

At present though, the Delhi government has discontinued conducting random tests, said the official from the health department who did not want to be identified.

For epidemiologists, however, Jain’s statement on June 9 about the rate of cases with an unknown source of infection clearly indicated that the National Capital has entered the stage of community transmission.

Dr Jayaprakash Muliyil, an epidemiologist and former principal of the Christian Medical College in Vellore, called entering this stage a “warning”. “It is a warning to people that they need to watch out for themselves,” said Muliyil.

For some experts, the indicators of community transmission came early on.

Dr T Jacob John, one of India’s leading virologists, said that the “engine of the epidemic is community transmission.” “India has been in community transmission [stage] since mid-March,” John said. “It is widespread.”

What kind of changes would the government have to make on declaration of this stage?

Muliyil said that it would depend on the case load . “The whole concept of contact tracing, isolation, quarantine [it] loses its meaning because your emphasis now depends on the case load,” he said.

He said that the committee heading the state government’s efforts should shift its focus to three things. “Individuals need to take the responsibility of protecting themselves,” he said. “Families need to take the responsibility of taking care of the elderly.”

Thirdly, hospitals had to become more patient-friendly, he said. “In other words, people should not be scared,” he said. “You understand that very notion that a healthy person has to be quarantined somewhere prevents somebody else from being taken to the hospital.”

“That is why we have to make sure only sick people need hospitalisation in these areas,” he said. “But there are some parts in India that are struggling to control the disease and eliminate the virus...that is fair enough. In such cases we should continue testing and looking at the contacts.”

Muliyil added that not everyone could be quarantined in official facilities as public hospitals were overburdened. “When there are a huge number of people infected and we cannot say who gave it to who…you can’t test everyone and put them in quarantine and isolation,” he said.

“Hence, the hypothesis is that you identify people and quarantine them or isolate them that will protect others.

Finally, the objective was to minimise mortality. “You just pretend that everyone is infected,” he said.