India continues to deny community transmission of coronavirus. Who is it fooling?

By refusing to acknowledge the reality, the government is covering up its failure with self-deception.

WrittenBy:Jammi N Rao
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On July 21, India recorded 37,148 new coronavirus infections, taking the total to over 1.15 million, with 28,084 deaths. Still, officially, India’s “transmission status”, as reported in the World Health Organisation’s daily situation report remains “clusters of cases”.

The stage of transmission is determined not by WHO, but by each member country. In India, the official line from the health ministry is that “there is no community transmission”. This is an astounding line to take, a reluctance to admit the obvious.

In early April, when India had reported under 6,000 infections and 540 deaths, it might have been reasonable to say what we were experiencing was, in fact, clusters of cases. Now, with 200 times as many cases, denying community transmission is no longer tenable. It’s really a refusal to acknowledge the gravity of the situation.

Among the 16 countries with the most infections, only Russia, Saudi Arabia, Spain and Italy, apart from India, have chosen to report “clusters of cases”. Russia reported 5,842 new cases on July 21, Saudi Arabia 2,429, Italy 190. Spain had recorded no new cases on July 20 but saw a surge of 4,581 infections the following day.

India is the only country apart from Brazil and the US to report over 1,00,000 new cases over the last seven days, yet it stands out in resolutely denying community transmission.

Source: WHO Situation Report, 182

So, what is a country’s transmission status and why does it matter?

According to the WHO, there are four stages of transmission:

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One could argue this classification is simply an academic exercise. The pandemic in India is at the stage it is at and merely changing the declared transmission status changes nothing on the ground. This is not a sound argument.

Firstly, the idea behind classifying the progress of the epidemic into various stages was to signal the need for control measures specific to each. A lockdown was the early response to contain the epidemic at the stage where local outbreaks were growing and likely establishing a pattern of community transmission. But a lockdown was never a strategy in itself. At best, it was meant to buy time to prepare for the inevitable by building up emergency healthcare facilities, stocking up on PPE, oxygen and ventilators, and, most importantly, developing the infrastructure for testing, tracing and isolating cases. A lockdown came with a heavy economic price tag.

India didn’t use its early lockdowns wisely. Instead of building up capacity and trust, we created division and distrust. Instead of training the healthcare workforce to test, track and trace – as Kerala did – we relied on the unproven technology of Aarogya Setu app.

Now, by denying community transmission, we are covering up failure with self-deception.

Secondly, other countries use the transmission status as one of the factors in drafting travel advisories for their own citizens as well as foreigners. For example, Britain recently revised its global travel travel advisory against “all but essential travel”, exempting 77 countries that “no longer pose an unacceptable risk”. Of course, the advisory also affects people from these countries travelling to Britain: they no longer need to be quarantined after arriving

Clearly, WHO’s system of self-certification on transmission status is viewed by many countries with suspicion. India’s insistence that there’s no community transmission fools no one but the country’s government and its supporters.

Thirdly, and this may be the most damaging effect of India’s continued self-deception, there is the question of trust and candour. In a democracy, citizens expect the government to level with them. It defies logic that small clusters of local outbreaks would propel India, in a span of just three months, from a few thousand cases to the third most infected country. Almost every expert you speak to knows that there’s widespread community transmission. Yet, professional bodies have been shying away from public statements asserting the obvious.

Two days ago, a senior doctor at a Delhi hospital went on record to back an alleged statement from the Indian Medical Association that India had moved into the community transmission phase. VK Monga, chairman of the IMA’s Hospital Board, told NDTV that he was surprised by the government’s denial of the obvious. Yet, a day later, the IMA seemed to row back on its statement, saying Monga was “expressing a personal opinion” and it was for the designated authorities to determine the stage of transmission.

Test, track and trace isn’t an easy strategy to implement. Its success depends not merely on the availability of resources, but also on people trusting the system to do what’s right. People asked to isolate themselves need confidence that the health officials will support them through a difficult time. That trust is lost when the highest levels of the government continue to deceive themselves in a futile attempt to deny facts on the ground. And professional bodies such as the IMA do their own reputations no favour, nor do they serve the people, when they shy away from speaking truth to power.


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