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Spectre of community spread looms over Kerala

Even as the government states categorically that community transmission is yet to happen in the State, the time may have indeed come for every doctor in both COVID and non-COVID hospitals to treat every patient as a potential source of COVID-19.

The death of a 77-year-old priest here on Tuesday of COVID-19, who might very well have contracted the infection in either the Government Medical College Hospital (MCH) here or the Peroorkada District Hospital where he was treated, has also raised the spectre of hospitals becoming epicentres of the disease.

An expert committee last week had suggested that the government revisit its COVID 19 containment strategy, fully assuming that community transmission is already happening. Now, the onus is on the Health Department to alert medical professionals and hospital staff to strictly follow all infection control protocols as they can hardly distinguish a potential COVID patient from any other.

‘Drill in the message’

Public health experts point out that when all lockdown norms are eased, people could be lulled into a false sense of security.

The public should be taken into confidence so that campaigns like ‘Break the Chain’ and universal wearing of masks would result in better compliance .

The government has ruled out the possibilities of community spread even though as Chief Minister Pinarayi Vijayan himself said there were at least 30 cases in which a clear epidemiological link could not be established. As an epidemic advances, community transmission appears inevitable.

“Once the contacts of imported infections get infected, local transmission is likely to begin. Contacts of infected contacts means indigenous transmission. From then on, indigenous and community transmissions are one and the same from the disease epidemiology point of view. Any other definition like “infection from known source versus unknown source” is more politics than science,” T. Jacob John, former Professor of Virology, Christian Medical College (CMC), Vellore, told The Hindu in an email.

Community transmission is not a dirty word. Kerala tried to prevent community transmission from happening but no epidemiologist will perceive its occurrence as a failure, he added.

‘Inevitable result’

“Community transmission has already begun in kerala. The only debatable point is the extent to which it has happened. However, it was inevitable and the sooner we understand it and act, the better. Asymptomatic transmission being our main threat, the most important step would be to advise health-care workers to manage all patients like potential COVID patients, maintain social distancing and to tighten all infection control measures,” said Anoopkumar, Chief of Critical Care Medicine, BMH Hospital.

Special care is needed to ensure that hospitals do not become an amplifying source of cross infections. Fever patients should not be allowed to mix with general patients, he added.

Once community transmission becomes rampant, the number of serious cases requiring ICU care as well as COVID-related mortality will increase significantly.

The focus should be on increasing ICU care facilities and in setting up critical care teams in all secondary and tertiary public sector COVID hospitals. “The strategy should be mainly mortality prevention while epidemic curve is flattened. Flattened curve does not mean zero infection. Infection will slip through and spread slowly at first and more rapidly later. The epidemic will continue to grow until July-August and then begin to come down in frequency. I expect very low numbers in November-December 2020,” Dr. Jacob John said.

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