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Updated: Apr 07, 2020 20:50 IST

Health authorities say they are focusing on four areas within a 4km radius in northeast Delhi’s Dilshad Garden that appear to be reporting a bunch of coronavirus disease (Covid-19) cases. Experts suggest limited community spread has begun in the area, after reports that in many of these cases the source of the patient’s infection is unclear.

Officials have declared these four places as containment areas. Each of them has a focal patient (the person who might have infected others). Three of these containment areas were declared on Monday – two separate blocks of GTB Enclave and one in Dilshad Colony. Officials have been unable to establish travel or contact history of the focal patients in these areas.

The developments come amid a debate on whether India has entered the community transmission stage of the pandemic, in which the source of a patient’s infection could not be traced or isolated.

“One of the blocks (in GTB Enclave) is linked to a nurse from Delhi State Cancer Institute who tested positive and the other is linked to an old man. We are not sure where he got the infection from,” a senior Delhi government official said, requesting anonymity.

On Monday, 10 nurses from the Delhi State Cancer Institute in GTB enclave tested positive for Covid-19, taking the hospital’s tally to 18 (of which two are doctors and 16 nursing staff). After this, the cancer institute decided to test all 48 of its patients.

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“We have sent all samples for Covid-19 testing. If they test negative, patients will be moved to various private hospitals. However, if they test positive, they will be taken to the nearby Rajiv Gandhi Superspeciality Hospital, which is a dedicated Covid-19 centre,” said an official from the Delhi State Cancer Institute.

Rajiv Gandhi Superspeciality Hospital is one of the two Delhi government hospitals completely dedicated for treatment of the deadly infection caused by the Sars-Cov-2 virus. At present, there are 85 Covid-19 positive and 164 suspected patients admitted to the hospital.

Separately, in the Dilshad Colony containment area, a middle-aged man (the focal patient) with unclear history (meaning no foreign travel or no established contact with a Covid-19 positive case) tested positive for Covid-19.

The fourth containment area is linked to two mohalla clinic doctors who practise in Dilshad Garden. (So far, 34 health care workers and hospital sanitation staff have tested positive for the viral infection across Delhi).

The J and K blocks of Dilshad Garden were declared containment areas after a 38-year-old woman (the focal patient), who returned from Saudi Arabia on March 10, passed on the infection to at least 11 people, including the two mohalla clinic doctors. Six of them are from the Dilshad Garden area. In the same cluster, officials were not able to establish the source of infection of a patient in Maujpur. This patient did not have any direct contact with the woman who returned from Saudi or the two doctors.

“In hot spots, some community spread may be occurring,” said Randeep Guleria, director, the All India Institute of Medical Sciences (AIIMS) and a member of the national task force on Covid-19.

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Although a Union health ministry document late last month said limited community transmission of the Covid-19 disease has begun in India, authorities maintain that the country is not witnessing large-scale community spread.

Jacob John, professor emeritus and former head of virology at Christian Medical College, Vellore, said community transmission was happening in the Dilshad Garden containment areas.

“Now, we should not focus so much on getting the history of the patient and figuring out where they might have got the infection from…We must focus on keeping people out of hospitals. And, to slow the community spread, everyone must wear masks,” he said.

There are four main stages of disease outbreak. Stage I is usually when cases are imported and are not of local origin. Stage II is when there is local transmission, which means a section of people testing positive have come in contact with a positive patient having a travel history. Stage III is community transmission. Stage IV is an epidemic, when there several clusters of the infection.