The health ministry, in its containment plan to tackle outbreaks, said the current geographic distribution of covid-19 mimics the distribution of H1N1 pandemic influenza. This suggests that though the spread of the deadly virus among India's population could be high, it is unlikely that it will uniformly affect all parts of the country, the ministry added.
This calls for differential approach to various regions of the country, while mounting a strong containment effort at hotspots.
While the Centre had already identified 22 potential hotspots last week, officials said it would be a herculean task to quickly zero down on the emerging centres and seclude new patients as it would require heavy deployment of health workers and resources.
So far, there is no evidence of widespread community transmission, according to the ministry.
“The containment measures to break the cycle of transmission and clinical management of those affected would require large human resource," said Arun Singhal, special secretary, health ministry.
While Noida, Mysore, Bengaluru, Mumbai, Pune, Kerala and Bhilwara have reported significant number of positive cases and are under scanner, the religious congregation held at Delhi’s Nizamuddin mid-March has emerged as a major hotspot for the virus, with over 1,100 cases and several deaths linked to the event.
Authorities fear that the event organised by Tablighi Jamaat in Nizamuddin led to the surge in covid-19 cases in India, contributing to more than 65% of fresh cases.
“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. People may not be family members, therefore, 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 of the virus spread," he added, referring to the mass exodus of migrant workers from Delhi and elsewhere.
Public health experts also said substantial number of cases, especially in rural India will go undetected with 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 consultancy.
“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%."
Statisticians, too, echoed similar views on the difficulty of identifying hotspots, considering India’s population.
“At 130 crore people, India has disorganised social structures with enormous density in most districts," said Samit Bhattacharyya, associate professor, mathematics, Shiv Nadar University.
The health ministry has accepted that people’s cooperation is minimal, with most avoiding to report symptoms or travel history.
India’s preparedness and covid-19 response measures include identification of hotspots, implementation of regional containment plans and undertaking contact tracing on a war-footing, isolation and treatment, the ministry said.
“All of these are a logistical nightmare in a country like India. Contact tracing can perhaps be the most promising identification and mitigation measure if it brings the digital capability and reach of our public sector combined with the technological might and reliability of the private sector together," said Ashish Bharadwaj, dean, Jindal School of Banking and Finance.
Bharadwaj said it is impossible to identify all covid-19 hotspots in India due to paucity of data. “However, any restriction on the use of the internet by citizens, and regular interruptions in data transmission due to whatever reason, can render this technology-led tracing solution purposeless," Bharadwaj added.
Ankit Chaudhari, chief executive officer (CEO), Aiisma, a data management tech company, said a weak contact-tracing mechanism and limited downloads of anonymous location-sharing mediums, such as government’s Arogyasetu app for covid-19, make identification of hotspots challenging.
And, if the government decides to lift the 21-day lockdown on 14 April, contact tracing will become even more difficult, public health experts said.
“People are extremely mobile. Considering inter-district, interstate and rural to urban mobility, once borders crossed, tracking will be difficult. Dense population with formal addresses is unavailable many times. Technology is either not being used or has limited use such as CCTV, face recognition, smart phone or GPS to track or trace," said Dr Preeti Kumar, vice-president, health system support, Public Health Foundation of India.