Over the past few weeks, India has been dreading the possibility that the novel coronavirus outbreak will move to the stage of community transmission.

What are the stages of a pandemic?

Stage I

• In the first stage of a disease epidemic that eventually takes the form of a pandemic sweeping the globe, cases are imported into a country in which the infection did not originate.
• An infection whose spread is contained within the boundaries of one or a few countries is obviously not a pandemic.

Stage II

• The second stage is when the virus starts being transmitted locally.
• Local transmission means that the source of the infection is from within a particular area and the trajectory the virus has taken from one person to the next is clearly established.

Stage III

• The third stage is that of community transmission. It is usually localised.
• According to the WHO community transmission is evidenced by the inability to relate confirmed cases through chains of transmission for a large number of cases, or by increasing positive tests through sentinel samples.
• In layman terms, it means that the virus is now circulating in the community, and can infect people with no history either of travel to affected areas or of contact with an infected person.
• If and when community transmission happens, there might arise the need for a full lockdown because in that situation it is theoretically possible for every person, regardless of where they are from and who they have been in contact with, to spread the disease.

Stage IV

• There is also a fourth stage in every pandemic. It is when the disease, COVID-19 in this case, becomes endemic in some countries.
• The Indian government’s containment plan takes this possibility into account.
• Among diseases that are currently endemic in India — meaning they occur round the year across the country — are malaria and dengue.

How does categorising an outbreak in this manner help?

• The stages of a pandemic are uniform the world over.
• This is so because, in today’s interconnected world, it is important to have a standardised phraseology that conveys the same thing to every person around the world, and helps countries prepare better.
• The categorization helps countries take specific actions that are necessary to target just that particular scenario.
• For example, India imposed travel restrictions to China from very early on as the cases they were all imported from China.
• Later, as cases started being imported from other European countries, flight and visa restrictions were put in place for those countries.
• India has now shut itself to individuals coming from all countries — this is because the virus is now confirmed as circulating in at least 177 countries and territories.

Worldwide, in which stage is the COVID-19 pandemic now?

• The pandemic has spread to nearly every country on the planet. In most, though, it is in the stage of either imported cases or local transmission.
• Among the countries where community transmission seems to be operating are China, Italy, Iran, South Korea and Japan.
• China adopted a graded approach in dealing with the infection but the epicentre, Hubei, was in a state of complete lockdown at the peak of the infection.
• It something that Italy has now effected in a bid to stop the virus from wreaking more havoc, given the country’s ageing population.

How long before India enters community transmission?

• It is totally unpredictable. Some doctors perceive that community transmission is inevitable; other experts feel it may have already happened.
• There are some reports of one strain having less mortality. If indeed a milder strain has come to India, it could change the course of the epidemic.
• There is another theory that all the various viruses circulating in South Asia and the generally lower levels of hygiene may give us some immunity.

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