Getting over pandemic stage fright

06 May, 2020
10 Min Read

Tags:
COVID-19

Getting over pandemic stage fright

Dr. T. Jacob John is Retired Professor of Virology, Christian Medical College (CMC), Vellore. Dr. M.S. Seshadri is Retired Professor of Medicine, CMC, and now Medical Director, Thirumalai Mission Hospital, Ranipet, Tamil Nadu

Introduction

This year, on World Health Day, April 7, a patient asymptomatic for COVID-19 was admitted with chest pain in a hospital in Maharashtra. Diagnosed with coronary artery disease, he was treated surgically.

Five days later he developed COVID-19 pneumonia and eventually succumbed. Did he come infected or did he get infected in the hospital? Either way, evidence is clear for community transmission.

Is India in the 3^rd stage of COVID-19 transmission ? (Community transmission)

At the All India Institute of Medical Sciences, many doctors, nurses and other staff became infected with SARS-CoV-2 and had to be quarantined.
Recent reports indicate that one in 15 SARS- CoV-2 infected individuals in the national capital is a health-care worker.
A 62-year-old physician in Indore, Madhya Pradesh, to whom many slum-dwellers came for care, died of COVID-19, despite treatment. The Chief Medical Officer (CMO) told the media that his contact history was unknown.
On April 14, a popular 76-year-old “family doctor” died of COVID-19 in Kurnool, Andhra Pradesh. On March 25, he closed the hospital, complying with the lockdown. He died; his wife and children tested positive for the novel coronavirus. The doctor’s contact history could not be traced.

In all these situations, a correct understanding of the nature of the epidemic and acknowledging community transmission would have alerted the medical profession and avoided a loss of lives.

Epidemiologically important

What is community transmission?

One infected person in the community, unaware that he is infected, infects others in the community.

(If A was infected by a known contact B, in epidemiology we say B infected A. When contact is unknown we say ‘someone in the community’ infected A; hence the term “community transmission”. )

When did community transmission begin in India?

On March 18, Tamil Nadu reported the second infection in the State, an example of community transmission. A 20-year-old man travelled by train from Delhi and had no contact with any known infected person. In Chennai, he developed symptoms and tested positive on March 18. So community transmission had started in India by, or before, mid-March 2020.

Country of Origin

Every pandemic emerges from a country of origin — the 2009 H1N1 influenza pandemic originated in Mexico and COVID-19, in China. For every other country, the initial infection would be “imported” from another country.

What is Importation of infection ?

Stage 1

Importation means that the traveller got infected in a foreign country but developed symptoms and got diagnosed in the host country. If secondary transmission occurs from the imported infection, it is qualified as contact of imported case.

Stage 2

If the importation-contact further infects someone in the host country, such infection by in-country transmission is called “local”, “indigenous” or “autochthonous” infection.

It indicates the start of in-country epidemic, in other words, when the imported infection becomes indigenous.

Stage 3

As the epidemic advances, community transmission is natural and inevitable. If the intention is to intercept chains of transmission, then there should be acknowledgement of indigenous (community) transmission.

Necessary step

A country denies community transmission at its own peril.

Once community transmission of COVID-19 came to light on March 18, warning all medical professionals, coupled with strong recommendations for strict implementation of appropriate protective gear by all health professionals in all levels of health care, was the correct public health procedure.

Admitting community transmission does not lower the honour of mother India in the eyes of foreigners; on the contrary it boosts the sagging morale of health-care professionals, prevents avoidable loss of manpower in the face of the epidemic, and preserves the integrity of the entire health-care system.

Source: TH