Ever since COVID-19 was declared a pandemic,‘community transmission’ has become a dreaded term. While some people have been eager to prove its presence, an equally vocal section is keen to counter them.
However, community spread may be inevitable when the number of COVID-19 cases rises significantly in a society. So the concern should be the rate of community transmission and not its presence itself.
In all countries except China, the first patients were people who arrived from abroad. These patients passed on the disease to their primary contacts who, in turn, transmitted the virus to the secondary contacts. A chain was thus formed among the population. In most cases, the patient would be part of such a chain, making them patients of traceable origin. However, in some rare cases, it would not be possible to form a chain connecting the patient. Such a person could be termed as a patient of untraceable origin and this situation points to shortcomings in contact tracing.
As patients of untraceable origin are often identified when people having symptoms of the disease are tested for COVID-19, more such affected persons could be traced if random tests are done among high-risk groups.
But such a situation may spread panic in society and so we need to set benchmarks for community transmission. However, we have to first decide whether the label of community spread is necessary at all. The term becomes relevant if a policy change or new containment method has to be implemented.
The benchmark of community transmission can be decided as follows: If the number of cases of untraceable origin is very small, no change in policy or containment measures is necessary. But if this figure is at least one-third of the total number of COVID-19 cases, we have reasons to worry. And when the number of cases of untraceable origin crosses 50 per cent of the total figure, it could be assumed that community transmission has occurred.
When this stage is reached, keeping every contact of a COVID-19 patient in quarantine would have no benefit. The main effort then should be to test all persons showing symptoms of the disease and isolate those who test positive. Alongside, social distancing has to be practised without fail.
We also have to take things calmly. If community transmission occurs, it will not be the end of the world. However, we should not deny its presence or start a blame game. In fact, it would be a surprise if community spread does not take place when a large number of people arrive in the state from areas where the disease is raging.
Steps Kerala can resort to include anticipating when community transmission can occur and launching effective containment measures. The most useful means of combating the pandemic would be carrying out widespread tests and identifying maximum number of positive cases. Every patient having symptoms like flu or fever seeking treatment all health institutions starting from the primary health centres should be subjected to random testing for COVID-19.
Present indications show that community transmission has not started in Kerala yet. But we have to start early to tackle the threat.
Having set an example for other states in containing COVID-19 during the first phase of the pandemic, Kerala can certainly continue the good work and create new models.
(The opinions expressed by the author are personal)