New Delhi: At least 25 per cent of Delhi’s Covid-19 cases have been reported from outside containment zones, with the number extending up to 80 per cent for individual districts, ThePrint has learnt. And Delhi government officials say they don’t know the source of infection in most of these cases.
Interviews with district and health officials in Delhi seem to back expert estimates that the capital may well be experiencing community transmission, the third stage of a pandemic where the source of infection can no longer be determined.
Delhi Director General Health Services (DGHS) Nutan Mundeja said around 25 per cent of the total cases are “isolated”, which means they have been reported from outside containment areas, while district officials claimed the number may extend up to 80 per cent in different pockets of the capital.
They all admitted that tracing contacts for isolated cases is complicated, many a time because patients are unable to offer an accurate list of people they have been in contact with.
Their statements follow remarks from the Delhi health minister last month that suggest the source of infection is unknown in nearly 50 per cent of fresh Covid-19 cases, raising fresh questions about the exact situation of coronavirus in the capital.
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The spectre of community transmission
Community transmission means practically everyone is at risk of infection — whether or not they have travelled to a Covid-19 cluster or come in contact with an infected person.
WHO guidelines suggest that community transmission means “intensive efforts to identify and trace individual cases” — which guides current surveillance efforts in India — “are no longer the main priority”.
“Resources should instead be focused on monitoring the spread and characteristics of the virus, identifying and managing severe cases, preventing onward transmission of the virus, alleviating strains on health-care services, informing the public, and reducing overall social and economic impact,” they add.
On 10 June, Delhi Health Minister Satyendar Jain appeared to suggest there is community transmission in Delhi, a day after he said the source of infection was not known in nearly half of the fresh cases reported. However, he said community transmission, per se, was a technical term and only the central government could declare if Delhi had indeed reached that stage.
The Government of India, meanwhile, continues to deny the country has reached the community transmission phase despite an earlier admission to the contrary in March.
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‘Can’t live in denial’
Containment zones are areas that have reported clusters of Covid-19 cases — two-three or more — and are thus sealed as a precaution to restrict the movement of its residents and check further transmission.
Isolated cases would be those that are reported from outside this area.
By 15 July, Delhi had reported 1,16,993 Covid-19 cases. Going by the lowest estimates, at least 29,248 of these were reported from outside containment zones.
“The figures vary on a daily basis from 17 per cent to 25 per cent but the number of isolated cases has been on the rise and, hence, we can say that 25 per cent of the total cases are isolated or outside containment zones,” DGHS Nutan Mundeja said.
Officials say contact-tracing in isolated cases is complicated, and the original source of infection is not known in most instances.
“Ever since the number of cases started rising once we unlocked, it hasn’t been easy to do contact-tracing for such cases,” said a district magistrate requesting anonymity.
Mundeja claimed they were “facing great difficulty in situations where people in areas with one odd case here and there turn around and say they don’t recall who all they met in that period or how they don’t want to share details”.
People, she said, should cooperate with the authorities in helping trace contacts.
Nine of Delhi’s 11 district magistrates said the number of isolated cases was higher than those within containment zones in their jurisdiction.
In Shahdara, district magistrate Sanjeev Kumar said as many as 7,804 of the 8,312 cases reported by 13 July were “isolated”. In South Delhi district, the number was pegged at 1,293 of the 1,799 active cases reported by 13 July.
In East district, DM Arun Kumar Mishra said, out of over 1,400 active cases reported by 13 July, at least 700 were those where infection couldn’t be traced back to a containment zone.
“In this case, we are now speeding up the number of rapid antigen tests by tying up with dispensaries in such catchment areas,” Mishra told ThePrint.
In central Delhi, district magistrate Nidhi Srivastava said at least 60-70 per cent of the cases are from outside containment zones.
In the district, as of Monday, around 700 of the 1,499 cases reported were isolated, officials said.
Dr Sanjay Sagar, district surveillance officer (DSO) of North Delhi, said at least 800 of 1,000 active cases were outside of Covid-19 containment zones.
In South-west Delhi, officials said 80 per cent of the total active cases do not lie in containment zones.
“This has been the trend right from the beginning of the pandemic but it only increased once the lockdown was over… How can one control people stepping out?” district magistrate Rahul Singh said, adding that they had bolstered testing to keep the situation under control.
A district magistrate who chose to remain unidentified said “it becomes difficult to do contact-tracing in a lot of these cases although we are trying our level best”.
“Say, a shopkeeper tests positive… While one can test his family members, his co-shopkeepers, and other such high-risk categories, how does one trace each customer who came to his shop? There is no list maintained for that,” the district magistrate said.
Asked if the vast number of cases with unknown sources suggested community transmission in Delhi, DGHS Mundeja said it wasn’t something she could comment on.
“It is a scientific term and something that epidemiologists look into. It is not for me to say whether it is occurring or not, it is for the Government of India to declare that, as the Ministry of Health and Family Welfare is monitoring the situation daily,” she added.
However, experts say Delhi can no longer live in denial.
“We cannot live in denial. Community transmission started long ago in Delhi, and the matter pertaining to the cases where source cannot be traced despite the government’s effort only proves it,” said Jugal Kishore, head of community medicine at Safdarjung Hospital, Delhi.
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Increased surveillance
The revised Delhi Covid response plan released earlier this month weighs in on Covid incidence reported outside containment zones, saying “it is a matter of concern” that “needs to be addressed”.
“These are areas in which cluster cases were never recorded and were not sealed as containment zones,” said an official of the Delhi health department.
According to the revised plan, a standard operating procedure (SOP) needs to be devised for “effective surveillance” with respect to isolated cases.
Geospatial Delhi Limited (GSDL), a public sector undertaking under the Delhi government that maintains a vast repository of spatial data, has consequently been tasked with mapping areas where isolated Covid cases have been found frequently over the last one month.
“For now, GSDL will help us identify such neighbourhoods. Later, based on requirements, such areas could also be converted into containment zones,” a Delhi government official said.
Additionally, the district surveillance officers or DSOs appointed by the government have come up with strategies to demarcate areas with isolated cases based not just on GSDL mapping, but also the daily cluster reports prepared by the Union Ministry of Health and Family Welfare.
Once the locations concerning isolated Covid-19 cases are identified, the district officials will put together details of high-risk individuals and special surveillance groups in the areas.
The SOP issued by the Delhi government in this regard describes high-risk individuals as residents aged over 60 years, pregnant women, people with influenza-like symptoms and those with comorbidities.
Special surveillance groups would cover domestic workers, self-employed individuals such as plumbers, electricians, mechanics, etc, those engaged in sale and supply of essential commodities, and taxi, rickshaw, autorickshaw, and lorry drivers operating in the area.
After a long struggle with coronavirus that stoked fears the national capital was losing control, and forced the central government to step in, Delhi appears to be making promising strides.
For the past few days, recoveries have been outnumbering the number of fresh cases reported in the daily health bulletin. For example, Delhi recorded 1,647 new Covid-19 cases Wednesday and 2,463 recoveries. On Tuesday, there were 1,924 recoveries versus 1,606 new cases, with the numbers for Monday recorded at 1,344 and 1,246, respectively.
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