Coronavirus testing in India: Ignorance is not bliss
‘Are we testing enough?’ is a question that we have perhaps not asked enough. Comparing the number of tests per confirmed case can help us understand if a state is testing enough, in relation to its outbreak size. And in some Indian states, numbers reveal that much is left to chance.
The inevitability of lapses in social distancing coupled with the asymptomatic nature of the infection in some patients and a low testing capability could mean that the presence of the virus remains undetected for a longer duration. And in a country where personal and geographical boundaries are often blurred, this could prove a recipe for disaster
The infamous family WhatsApp groups are flooded with jokes and ‘information’ about India’s way ahead in the COVID-19 battle. One of the most popular jokes is how the country went into lockdown when the number of cases were less than 100 but has relaxed norms when the numbers hit one lakh. With the economy taking a hit, businesses vanishing into oblivion, and public patience hanging by a thread, the relaxation is not surprising.
Some healthcare personnel and citizens are wary that the relaxation of norms will lead to an unprecedented spike in the number of cases. Several states have a relaxed lockdown, albeit with conditions such as social distancing, an odd-even scheme for establishments and services, and continued suspension of activities in containment zones. But experts opine that even well-intentioned moves such as mandatory social distancing could do little to eliminate the risk of contagion.
The real test
The number of cases in India (as on May 21, 9.30 am IST) is at 1,12,335; the world tally is perched at over 5 million. To say that the numbers are rising exponentially by the hour would be an understatement. But experts say that the country has not yet addressed the elephant in the room - India’s testing capabilities.
‘Are we testing enough?’ is a question that we have perhaps not asked enough. Comparing the number of tests per confirmed case can help us understand if a state is testing enough, in relation to its outbreak size. And in some Indian states, numbers reveal that much is left to chance. On May 3, India ranked 24th in the world, in terms of tests per million with 758 tests per million people. According to the Indian Council of Medical Research (ICMR), there are over 396 government and 174 private laboratories that are involved in COVID-19 testing.
India has conducted over 25 lakh COVID-19 tests till 12.30 pm on May 20, said R Gangakhedkar, the head scientist at ICMR. "The daily figure of testing since the past two days is going above one lakh," he said at a press briefing, pointing at a surge in the number of tests across the country. But is this enough? Experts and healthcare personnel say no.
A look at the two Telugu states in Southern India would give one a quick understanding of the uneven testing practices across the country. Telangana, which recorded 1,661 cases as on March 30, carried out tests on close to 23,000 samples only. Andhra Pradesh, on the other hand, has to its credit 2.5 lakh tests, of which 2,602 were positive.
Need to ramp-up testing capabilities
A paper titled ‘Testing capacity for COVID-19: How ready are we for the battle?’ authored by experts at the Indian School of Business’s Max Institute of Business Management said that there is an immediate need to ramp up the testing capabilities. The study suggested that while states like Kerala may be equipped to handle its testing volume - given the fewer number of reported cases - states such as Maharashtra and Haryana will need to increase their testing capabilities by nearly 450% and 600% respectively.
The need to further increase testing capabilities becomes more pronounced as we relax lockdown curbs in an attempt to craft a new normalcy. As several states get ready to begin bus services and open up shops and establishments, monitoring the implementation of social distancing and other precautionary measures is going to an uphill task. This inevitability, coupled with the asymptomatic nature of the infection in some patients and a low testing capability, could mean that the presence of the virus remains undetected for longer durations. And in a country as densely populated as ours, this is a red flag one needs to spot from a distance. The migrant exodus that the country is witnessing as well as the resumption of train and air services are all potential portals of further spread.
Some studies have suggested 'doing things differently' to control the pandemic. A staggered lockdown approach of alternating between 50-day lockdown and a 30-day relaxation could prove to be the perfect foil for the spread of the virus, says a research paper published in the European Journal of Epidemiology
“Our models predict that dynamic cycles of 50-day suppression followed by a 30-day relaxation are effective at lowering the number of deaths significantly for all countries throughout the 18 months,” said Dr Rajiv Chowdhury, a global health epidemiologist at the University of Cambridge, UK, and lead author on the paper in a statement.
While the solutions to tackle the pandemic continue to pour in from around the world, experts say that in this scenario, knowledge in all its forms is power. Lower numbers need not mean an absence of the virus necessarily unless backed by a robust testing system that ensures that we are catching the bull by its horns and not burying our heads in the sand.