Some patients suffering from severe acute respiratory illness (SARI) without any history of international travel or contact with anybody infected by the novel coronavirus (SARS-CoV-2) have tested positive for the virus, the government said on March 28, 2020.

The comments by Raman Gangakhedkar, head of the Indian Council of Medical Research (ICMR)’s epidemiology division, at a press conference in New Delhi were the first official indication that the novel coronavirus disease, COVID-19, may have infected patients outside the limited criterion of overseas travel history.

Gangakhedkar did not divulge the number of such patients who had tested positive but only said that they were “sporadic”. He downplayed that this could indicate community transmission of COVID-19.

Out of nearly 110-120 samples tested for SARI, as many as 10% had been confirmed positive for COVID-19, sources from ICMR said.

Stage 3 of the coronavirus epidemic in India, known as community transmission, is the phase in which the source of infection cannot not be known or traced either to international travel or contact history.

“Even if the number is small, this is an indicator that India is likely in stage 3,” T. Sundararaman, former head of the Union Ministry of Health and Family Welfare’s National Health Systems Resource Centre, said.

It was wrong on the part of the government to deny such a ‘reality’ by taking refuge in the fact that such positive cases were less in number, he added.

“Absence of evidence is being used as evidence of absence. When one links it with our very [low] sampling, it is worrying,” he said.

“Despite being expanded on paper, the testing criteria remains limited in practice. It is difficult for an acute respiratory illness patient to be tested for COVID-19 in reality, despite guidelines saying so. I think it is no longer a matter of discussion in which stage we are but rather channelise all our resources in preparing hospitals for stage-3,” he told Down To Earth.

Emergency preparations afoot

Meanwhile, officials across India’s states seem to scrambling in order to prepare the health infrastructure for stage-3.

A WhatsApp message late on the night of March 27 to a senior official of Chhattisgarh jolted him out of his slumber. “Book all private hospitals, clear all roads from remote areas to district hospitals, count and clean all ICU instruments and please put all available ventilators at your direct control,” the message read.

The official is among those managing the state’s response to the pandemic. Within five minutes of him receiving the message, he also received a call from a senior official in neighbouring Odisha. “How many ventilators are there in Raipur? And how many affected people?”

In the next 20 minutes, senior officials directly in charge of the fight against COVID-19 in nine states, including Kerala, Odisha, Madhya Pradesh and Uttar Pradesh, undertook an extensive assessment of the situation.

“Unofficially, Delhi [shorthand for ICMR, which comes under the government] has confirmed community transmission occurring at a speed and reach higher and wider than expected,” an official from UP said.

Also read: Four Reasons It’s Hard to Believe India Doesn’t Have Community Transmission

The influx of thousands of migrants to and from these above states since March 26 has added to the panic.

By the evening of March 28, official spokespersons of Odisha and Chhattisgarh hinted that community transmission was imminent.

Activities at the village-level in states like Odisha and Uttar Pradesh point to enhanced alertness. Odisha has granted panchayats Rs 5 lakh each for isolation exercises and critical medical expenditure. Focus on mapping out infrastructure has heightened.

While all these are standard practices of preparedness, the message originating from Delhi and being officially communicated with urgency to district collectors has added to the fear that government assessment of the situation is different than what it has been projecting.

“We all know stage 3 is a reality. With or without declaration, we have to prepare,” a senior official dealing with the Chhattisgarh chief minister’s team on COVID-19, said. “But the official internal communications of the last 24 hours are pointing to certainty about it.”

Delhi’s Chief Minister Arvind Kejriwal had also posted a tweet to this effect: “I have received the report from the panel of doctors headed by Dr [S.K.] Sareen recommending measures to prepare for a potential stage-3 outbreak of COVID-19 in Delhi.”

The state government was ramping up capacity for an eventuality of 1,000 daily positive cases for testing, treatment and isolation, he added.

Also read: ICMR Study Suggests Its Testing Strategy Was Flawed

Thus far, India has had quite a few instances of people testing positive for COVID-19 without any prior international or contact history.

A 20-year-old man from Tamil Nadu had tested positive for SARS-CoV-2 on March 18.

The state’s health minister C. Vijaya Bhaskar described his case as “domestic”. The patient had a travel history of Delhi. “We have not been able to find any other contact or international travel history,” Sampath Palani from the state’s health department told Down To Earth on March 28.

Madhya Pradesh’s Indore, Chhattisgarh’s Raipur and Odisha’s Raipur have also reported such cases.

Banjot Kaur and Richard Mahapatra are reporters at Down To Earth magazine. This article was originally published on Down To Earth and has been republished here with permission.