As Maharashtra denies community transmission, sporadic cases spike

Also, among these cases is that of a 40-year-old woman from Kandivali in Mumbai, the wife of an autorickshaw driver, who died on Saturday in KEM hospital from COVID-19. Brihanmumbai Municipal Corporation (BMC) officials are yet to trace how she contracted the virus. She had not left her house for several days, they have found.

There are others whose contact tracing has not yet yielded a source for their infection.

* A 65-year-old woman living in a chawl, who sells vada pav in Prabhadevi in Mumbai, died in Kasturba Hospital on March 26, three days after testing positive. Civic officials are still trying to locate the transmission source.

* A 64-year-old man from south Mumbai died in HN Reliance hospital on March 21, 13 days after developing initial symptoms. He had travelled to Surat and returned by train, but his family has reported no travel abroad or contact with an infected person.

* A 53-year-old general physician in Mumbai tested positive on March 27 but has no foreign travel history. The BMC is trying to trace patients he had treated in the last fortnight.

* On March 29, a 66-year-old woman admitted in a private hospital, a 57-year-old woman admitted in Jogeshwari Trauma hospital, a 23-year-old man admitted in Rajawadi hospital, and a 63-year-old man admitted in Mumbai Port Trust hospital in Mumbai had tested positive. They have not travelled abroad or come in contact with infected patients.

Dr Pravin Amin, a Mumbai-based intensive care expert, said: “In a pandemic, such cases will raise alarm bells.” He added that although India is not seeing an exponential rise in pneumonia cases, a close watch on asymptomatic patients is necessary.

Dr Tanu Singhal, infectious disease expert in Kokilaben Dhirubhai Ambani hospital, said, “Sporadic cases mean there is community transmission, but it has not yet escalated to a worrisome level since the percentage of swabs coming positive is not high.”

Even as stray instances of COVID-19 are surfacing, state epidemiologist Dr Pradeep Awate said there are no signs yet of community transmission in the state. “If there is community transmission, there will be an exponential rise in cases from a local area. That has not happened,” he added.

Health Minister Rajesh Tope agreed. “Each infected person must have come in proximity with another infected person. We are not able to find that link, that is the only problem.”

Data from Maharashtra shows that of the 3,572 high-risk people examined, 5 per cent have tested positive. While the World Health Organisation is asking all countries to aggressively test more, the state government is testing only 300 to 400 samples daily.

Experts said more testing is the real test of community transmission. The current guidelines do not support the testing of a person with no foreign travel history unless he has acute respiratory illness, which means the person enters an advanced stage of disease by the time he is diagnosed. A sporadic case is usually detected late and reduces the chances of survival, said public health officials, pointing to the case of the Prabhadevi vada pav seller and the 64-year-old south Mumbai resident, both of whom died.

“We are testing people with foreign travel history or people who have been in contact with infected persons, so this does not reflect what is happening in the community, but actually reflects the level of infection in the places people have come from,” said Professor Gagandeep Kang from the Wellcome Trust Research Laboratory.

The case burden is also shifting from those with a travel history to those who have come in close contact with the infected. On March 26, a state government report had shown that 29 per cent of the total number cases were people who had come in close contact COVID-19 patients returning from abroad. By March 29, their share grew to 35 per cent.

In contrast, the percentage of those with travel history testing positive dropped from 54 to 44 between March 26 to March 29.

Dr Shahid Barmare, general physician, said the delay in testing is infecting those who had come in close contact with COVID-19 patients. “The government needs to change its testing criteria. A US-returned patient visited Kasturba Hospital for a test. He had no symptoms and was refused a test. Four days later, he developed symptoms and tested positive. He must have come in contact with 14 to 20 people. The four-day delay could have spread the infection,” he added.

At least 137 of 195 patients in Maharashtra are asymptomatic. They were administered the test because they were either contacts of symptomatic and infected patients or asymptomatic senior citizens with international travel history. An analysis of 159 cases also shows that those in the 31-40 age group form the bulk (24 per cent) of the total COVID-19 burden. Maximum patients in this age group have travelled abroad. Those above 60 comprise 13 per cent of the total cases, but report maximum fatality. Thirty-three per cent of infected senior citizens have died so far in Maharashtra.

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