Kerala is apparently in a happy place wherein the disease transmission has remained low and the number of new COVID-19 cases being detected post lockdown has been steadily declining.
However, a month or more into the COVID-19 epidemic, even as the Health officials swear that there has been no evidence of community transmission anywhere in the State, the fact remains that Kerala is yet to put in place a mechanism for the systematic surveillance and testing of Severe Acute Respiratory Illness (SARI) cases in hospitals, which alone can give early warning signals about possible silent disease transmission in the community.
Community transmission should be suspected if and when a case outside the quarantined pool of people turns up, who has no travel history or no known contact with any potential source of infection.
“The State is being lulled into complacency or a false sense of security that with new COVID-19 cases on a downward swing and the apparently low rate of disease transmission, everything is back to near-normal. The reduction in new cases was predictable because testing is being done on a finite population which is already quarantined. Soon, the number of tests being done will go down because the indicated population is dwindling. So where does surveillance go from here? If we do not think ahead and a mechanism for systematic surveillance in the community is not put in place at least now, the State would not be able to manage any unexpected events as the COVID-19 situation evolves,” a public health expert pointed out.
ICMR directive
In fact, the testing of persons hospitalised with SARI for COVID-19 was one of the prime additions in the ICMR’s revised testing strategy for COVID-19, issued on March 21. The ICMR communication to States says that all persons with SARI (defined as fever and cough and/or shortness of breath with hospitalisation) are to be tested for COVID-19.
Apart from incorporating this point into the State’s guidelines for testing and quarantining on April 1, the Health Department is yet to do any COVID-19 testing amongst hospitalised patients with SARI. Health officials said that while it had been conveyed to district hospitals and downward about the need to be alert about SARI clustering or influenza-like illness in the community, there were many logistic issues involved in sample collection for COVID-19 testing from smaller hospitals.
They also point out that hospitals are often flooded with patients having fever and cough/breathlessness and that it would be difficult to test all of them.
Public health scientists point out that random testing is totally different from testing for surveillance, and that the latter is done with an intent for long-time monitoring and requires an organised system to be put in place so that samples from seriously sick patients with SARI from sentinel sites are regularly collected and tested for COVID-19.
“It is true that SARI, as defined by ICMR, would mean an unwieldy number of patients. But at least the samples of patients with pneumonia — especially those without a travel history — should be systematically collected and sent for COVID-19 testing. This kind of monitoring alone can alert the State about a possible silent transmission because we are currently not testing anyone unless he has a travel history or he has been in touch with someone with a travel history. The “safe” feeling that is being projected widely, solely on the basis of dwindling case numbers, is very misleading,” epidemiologists said.
