Coronavirus: Community transmission of Covid-19 certainly on, say experts

NEW DELHI: The government insists that there is no community spread of Covid-19 in India, but associations of epidemiologists, public health practitioners and experts in preventive and social medicine have issued a joint statement that “community transmission is already well-established across large sections or sub-populations in the country”.
The statement added that the “draconian lockdown” was “presumably in response to a modeling exercise from an influential institution which presented a worst case simulation”, which was shown to be way off the mark by subsequent events.“Had the Government of India consulted epidemiologists who had better grasp of disease transmission dynamics compared to modelers, it would have perhaps been better served. From the limited information available in the public domain, it seems that the government was primarily advised by clinicians and academic epidemiologists with limited field training and skills,” said the statement.
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It added that India was paying a heavy price both in terms of a humanitarian crisis and disease spread because of policy makers “having relied overwhelmingly on general administrative bureaucrats”, instead of engaging with expert technocrats in the areas of epidemiology, public health, preventive medicine and social science.
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In a hard-hitting statement, the three associations — the Indian Public Health Association (IPHA), Indian Association of Preventive and Social Medicine (IAPSM) and Indian Association of Epidemiologists — pointed out that open and transparent data sharing with scientists, public health professionals and the public, was “conspicuous by its absence till date”, and that this ought to be ensured at the earliest.
Noting that most Covid-19 cases were either asymptomatic or mildly symptomatic, the associations recommended treatment of most cases at home instead of hospitalisation. They also stated that if migrants had been allowed to go home at the beginning of the epidemic when the spread was low, the current situation of returning migrants taking the infection to each and every corner of the country could have been avoided. The associations noted with concern that the migrants were mostly returning to rural and peri-urban areas, in districts with relatively weak public health systems and lacking in facilities for clinical care.
The associations also said that the lockdown could not be enforced indefinitely as the deaths attributable to the lockdown, primarily because of the shutting down of routine health services and disruption of the livelihood of the entire bottom half of the population, may overtake lives saved due to slowing of Covid-19 progression. They recommended control of the pandemic at the state and district level using evidence-based interventions while simultaneously “ensuring optimal provisions for the livelihood of the poor and marginalised”.
The associations made 11 recommendations including replacing lockdown with cluster restrictions, scaling up diagnostic facilities to test, trace, track and isolate, sentinel and active surveillance to identify hot spots or clustering, avoiding social stigma, and protective gear for health workers.