After battering big cities such as Delhi and Mumbai, the pandemic has made its way to 73 additional districts since 4 April, adding strain on the government’s Cluster Containment Strategy that seeks to contain the disease within a defined geographic area through early detection.
New clusters have started appearing in states such as Kerala, Maharashtra, Rajasthan, Uttar Pradesh, Delhi, Punjab, Karnataka and Telangana.
Government officials said that the risk of further spread of the disease remains very high. However, Bhilwara in Rajasthan, which emerged as one of the 10 major hotspots in the country, has now contained the spread of the virus, officials said, citing it as an example of how a determined administration can limit the expanding reach of covid-19.
The challenge is that the cases have now started flaring up in new districts, including Dehradun in Uttarakhand, Meerut in Uttar Pradesh, Jaipur in Rajasthan and Indore in Madhya Pradesh.
The spread of the virus is not likely to be uniform across the country, said Lav Agarwal, a joint secretary at the Union health ministry.
“We are looking at strong containment efforts in hotspots. Each and every case for us is a new hotspot. We are also starting double testing and stringent monitoring in these areas,” he said.
Agarwal added that authorities in all hotspots are taking appropriate steps to stop the contagion. Noida, Mysore, Bengaluru, Mumbai, Pune, Kerala and Bhilwara have reported significant number of covid-19 cases and are under the scanner.
“A hotspot is an area of elevated disease burden or high level of transmission or small area of 1/2 km with elevated incidence of covid-19. It has the possibility of community transmission,” said Dr Jugal Kishore, professor and head, department of community medicine, Safdarjung Hospital.
“Reverse migration of people from metros to rural India has further increased the risk,” he added, referring to the exodus of migrant workers from Delhi, and elsewhere.
The government has already identified 22 potential hotspots in the country to quickly zero down and seclude patients, though this is straining government resources as the strategy requires heavy deployment of health workers and resources.
While the government is striving to identify the emerging covid-19 hotspots, India’s large population is also posing a challenge.
Dr Preeti Kumar, vice-president of health system support at Public Health Foundation of India, said that as the epidemic progresses, even the best-prepared countries will continue to see clusters emerging in different parts.
“The epidemic transmission is a complex play of health system interventions, (the ability to track suspects, test, do contact tracing and isolate) the ability to have effective lockdown and lastly, how well the community and citizens respond to it, she said.
Public health experts also said that a substantial number of cases, especially in rural India, may remain undetected because some people show minimal or no symptoms.
“These people will still remain carriers of covid-19 even though they are not listed among the reported cases. As a result, these areas will not be listed as hotspots,” said Ashwajit Singh, managing director, IPE Global, an international health development consultant.
“Globally, there is evidence that many covid-19 cases do not show strong symptoms and, therefore, are not reported. This figure of non-reported cases is as high as 80%.”