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Admission At Last

A different strategy needed to combat community transmission

After living in a denial mode for several weeks, the state government finally admitted Goa was witnessing community transmission. The director of All India Institute of Medical Sciences (AIIMS) Dr Randeep Guleria had described the outbreak in many parts of the country as “local community transmission”. His argument was fallacious: he said the nation could not be said to be witnessing a “community transmission” as the virus had not spread throughout the country! But at the same time, he said, it had become improbable in hotspots to trace the source of infection, so it had ceased to remain a “local transmission” either. Hence he had coined a hybrid term, “local community transmission” as it was local but sources could not be tracked! When Mangor Hill happened, it fitted the AIIMS director’s hybrid term, “local community transmission”. But the state government continued to insist it was “local transmission” with no elements of “community transmission”. That sounded phony even at that time, and much more fallacious as the virus spread.

The situation now is indeed of greater concern. The number of COVID-19 positive cases crossed one thousand mark on Friday. The state has recorded three deaths linked to the coronavirus so far. Despite the state recording dozens of coronavirus positive cases on a daily basis for over a month with the source in many cases remaining undetected, the state leadership stuck to its point that community transmission had not happened in Goa yet. Chief Minister Pramod Sawant should have explained what changed on Friday with regard to the spread of the virus that made his government accept that the state was witnessing a community transmission. That would have made the scene clearer in the minds of Goans who depend entirely on the state government to lead and guide them out of the frightening times of the pandemic. Was the government waiting for coronavirus cases to cross the one thousand mark to admit the prevalence of community transmission? Or was it waiting for directions from the ICMR to declare that Goa was in the community transmission stage? The Director General of Indian Council of Medical Research (ICMR) Dr Balram Bhargava had insisted earlier this month that India was definitely in community transmission as one percent of people in rural areas and slightly higher in urban areas were COVID-19 positive.

The official declaration on community transmission could be made only with the approval of ICMR, and it can be assumed that approval has been received by the state authorities in this regard. It is evident that preventive measures taken by the central and the state government have failed to contain the spread of virus. While initially most cases of infections could be traced, the number of cases where the source of infection could not be traced started multiplying across the country including Goa over the last several weeks. A good number of the carriers of COVID-19 were asymptomatic, which helped them hide their medical condition leading to virus being passed on to unsuspecting people. Could the big increase in the number of coronavirus positive cases in recent weeks in the country and the state be attributed to the failure of authorities to accept the prevalence of community transmission?

Goa has come a long way unfortunately from being free from coronavirus initially for a few weeks to being one with just seven cases, which were imported with all afflicted persons recovering from the disease. Now that the government has accepted that community transmission was prevalent in the state–which according to the experts is not an ideal situation from an infection control perspective–it has to change its strategy of dealing with the spread. Rather than imposing general lockdown, the state has to resort to micro containment policy. Asymptomatic patients should be put under strict home quarantine and not admitted to care centres. This will help save the beds for those with moderate and severe signs of the disease. It is an accepted norm to stop efforts to identify and trace individual cases and instead divert resources to monitor the spread and characteristics of the virus and prevent further spread of the virus. It remains to be seen whether the state government would adopt these measures to contain the spread of the virus.

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