Jammu and Kashmir continues to record a spike in the novel coronavirus disease (COVID-19) cases — almost two months after the nationwide lockdown was imposed on March 25.
VIRAL cases with no travel history or contact with a COVID-19 positive person have baffled the medical fraternity, with some doctors hinting at localised community transmission in the union territory.
For example, on May 16, a 65-year-old woman from South Kashmir’s Kulgam was admitted at the Surgical Intensive Care unit of Srinagar’s Sri Maharaja Hari Singh Hospital (SMHS).
Two days later, she tested positive for SARS-CoV-2 virus and was shifted to the city’s Chest Diseases Hospital, where she suffered cardiac arrest and died.
She had no travel history and did not come in contact with a COVID-19 patient, according to doctors.
On the same day, a 75-year-old man from South Kashmir’s Hilar died.
Both, however, had underlying medical conditions, said doctors.
The UT recorded around 1500 positive cases and 20 deaths, as on May 22, 2020.
“There are indications of some community transmission,” says Nisarul Hassan, president of a faction of Doctors Association of Kashmir.
“But we can say it is still localized.”
Valley’s Viral Trajectory
Kashmir’s first case, a 61-year-old woman from Khanyar area of downtown Srinagar, had returned from Saudi Arabia after performing Umrah (pilgrimage) in Mecca. She has since recovered.
Her case was followed by that of a cleric from uptown Srinagar who had returned from New Delhi after attending the Tablighi Jamaat conference at Nizamuddin. He died shortly after.
Ever since cases have steadily mounted as the number of tests rose.
Testing and contact tracing system is being carried out in the UT, as elsewhere.
But the process has also spawned a chain reaction and it has become increasingly difficult to trace the infection to already identified cases, more so as new cases keep coming up, said doctors.
A Startling Surge
“Many fresh cases have startled us,” said a doctor, a nodal officer for COVID-19 control.
“But at the same time transmission remains modest and is well within control.”
Another doctor said the ensuing testing regime couldn’t by itself determine community transmission.
“We are tracing contacts of COVID-19 positive patients. So any fresh case has a traceable cause and source,” the doctor said.
“To determine the community transmission, we have to go for an aggressive, random testing in specific areas and that too of people who don’t show any symptoms.”
Serologic Test as a Solution
The doctors are advocating serological testing against Polymerase Chain Reaction (PCR) to determine community transmission of the virus.
“The PCR test is done when someone is actively infected. The test detects the genetic information of the virus. That’s only possible if the virus is there,” said Hassan.
“And serologic test, also called the antibody test, tells us what proportion of the population has been infected. So we know who has been infected and who should be immune to the virus.”
A Suspicion Surfaces
But it is the cases being detected outside of contact tracing that have prompted community transmission suspicion.
“Some cases have started surfacing outside the ongoing testing regime and they are causing suspicion,” said a doctor.
For example, 12 pregnant women from South Kashmir were diagnosed positive for the virus when the government made testing mandatory for pregnant women in Kashmir.
Earlier, two had died in Anantnag, allegedly because of medical negligence. Over the last week, healthcare officials have tested more than 500 pregnant women in Anantnag district alone.
Similarly, in April, in a case of a localised community transmission, at least 64 positive cases were reported over 10 days at Gund Jahangir hamlet in North Kashmir’s Bandipora district.
The government, however, has so far ruled out community transmission in the Valley.
In a recent statement, the divisional commissioner, Kashmir, K Pandurang Pole, asserted that the government knew the source of every detected case.
“There has not been a single case where we faced difficulty in tracing the source,” Pole told reporters. “We are not in the community transmission phase.”
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