‘Rapid antigen test’, though simpler, cheaper and quicker, has very high false –ve rate. Mumbai Municipal Corporation has warned the country recently that it gives a 60-65% false -ve results.
By Dr Th. Suresh
Recently India witnessed unwanted spikes in many cities/places resulting in panicky reactions both at the centre and state level. Recent examples are – bi-weekly lockdown in Bengal, Tamil Nadu lockdown extending till August 31, complete lockdown in four main areas of Lucknow, in selected areas in Assam, Kerala, Chennai, Bangalore, my own state of Manipur etc. These are of varying periods decided by states as per their needs. These lockdowns are in addition to the already implemented lockdowns in many containment zones of various states.
On the +ve side
One Union health official claimed on July 30 India having the lowest fatality rate in the word with 2.21%, recovery rate up to 64.5% with 18 states having higher than the national average. Delhi tops the list with more than 80% recovery rate. 2/3rd of a total of 15.83 lakh cases have now recovered a very heartening prospect indeed.
On the -ve side
Though fatality rate is lowest – India continues on 5th spot of highest COVID death country of the world. Maharashtra, Delhi, Gujarat, Rajasthan, Madhya Pradesh and Karnataka continue to be worrying states. Huge surge is also witnessed in Tamil Nadu, Karnataka and Andhra Pradesh. On July 30 there was the highest spike with 52,123 new cases. Though Delhi seems to be under control, many new spikes are seen in new places.
I am of the view that pan-India lockdown is not required at all. However, a 14 day complete lockdown of major troubled cities – Bombay, Pune, Bangalore, Chennai etc. (to name a few) in addition to the already declared containment zones are now becoming a necessity.
Patchy lockdowns, like alternate day, 3/4 days, 1 week etc. are seen in many states. I can’t fathom the reason behind it. What are the benefits of these patchy lockdowns is the million-dollar question a public health specialist, like me, has to put.
The need of the hour is:
1. Complete 14-day lockdown of major troubled cities/areas mentioned above in addition to the already declared containment zones. The lockdown is strictly enforced.
2. Once the lockdown is enforced, 3 Mantras of 2 Total Survey, 2 Total testing and treatment at proper place be executed at Containment zones (areas and Quarantine Centres).
What does this mean?
Total Survey – 2 times house to house survey of all containment areas, 10 days apart, be enforced to find out any remnants of COVID cases.
Total Testing – Similarly, 2 times testing, 5-7 days apart, be done. ICMR and Central COVID Team require certain inputs here though they are more knowledgeable than the writer. The widely practised RT PCR testing called “Gold Standard”, gives 100% accurate results in 1 week after infection and then declines gradually. Too early and too late can give false +ve results. That’s why ICMR gives directive to test within 7 days of the appearance of symptoms. The other ‘Rapid antigen test’, though simpler, cheaper and quicker, has very high false –ve rate. Mumbai Municipal Corporation has warned the country recently that it gives a 60-65% false -ve results and very unreliable.
Hence, my recommendation for 2 times testing to avoid false –ve test results. Preferably, 1st test be done by the more reliable RT PCR test and 2nd one by Rapid antigen test 1 week apart. Even 2 times testing by Rapid Antigen Test would do.
No home treatment and no home quarantine for the poor
There is no point of home treatment and home quarantine for the poor who don’t have proper facilities at home like – no separate bathroom, no separate living rooms, no proper water supply etc. For the well-to-do, it is alright, but not for the poor. I am very firm that this home treatment and home quarantine is a source of spread to the community and be discarded immediately. Though it is a difficult proposition, India has to implement it to save many future spikes. These people can be treated either in a hospital or in a designated QC.
3. 14+14 day quarantine
All returnees + suspected persons are kept for 14 days in a QC and be tested. They should not be discharged without test results. Those +ve have to be treated either at hospitals or QCs as per the severity of illness. No home treatment for the poor, except the affordable, as suggested above. For those –ve test results, they are kept for another 14-day quarantine either at a government-designated QC or in a village community QC as done in Ukhrul and Kamjong districts of Manipur. It is worthwhile to emulate our Tangkhul Co-ordination Forum of COVID-19. It is a model worth to study for pan-India application.
4. Epidemiological need for 2nd test
A person is tested –ve in 1st week in a QZ, but later on he contracted the disease by cross-infection in later part (say 10-14 days), the person will become +ve after another one week or so i.e. after discharge from 1st 14 days. Hence, there is the need for another 14-day quarantine to save from these so-called false –ve either from this time factor or from test failure as described in the Testing head above. With India doing more than 4-5 lakhs daily tests now, we can certainly afford 2 times testing as suggested above.
These parameters had neither been mentioned nor analysed by anyone except self till today. India will have many spikes in many new places with improvements in old red zones in view of the vastness of the area. The country will have no 2nd wave. The present 1st wave will continue.
5. Strict enforcement of mask use, 6 feet physical distancing, frequent hand washing along with other hygienic conditions is a must.
We should ourselves impose it in self-interest as well as in the interest of the community. India requires stricter punishment now.
India need not spend even a penny for this campaign, better spend elsewhere in PM’s various welfare schemes. Request the best communicator in the world in the form of our PM to have 3 times TV appeal a month, 10 days apart. That will be far effective and is the need of the hour.
With an increase of around 30-50,000 daily spikes during this fortnight, the fight has to continue. Urgent implementation of the above strategies has become a necessity also in view of recent reporting of many asymptomatic patients in the country. Union Health Minister stated that 80% of our Corona cases are asymptomatic. Recent Mumbai sero-surveillance also indicated 57% of slum population and 16% of the non-slum population in three civic wards having antibodies indicating many infections than the official figure suggest.
Hence, India requires certain changes in the strategy to fight Corona. The changes required have been elucidated briefly to prevent increasing cases from unknown sources and unknown contacts. Panicky Lockdown alone is not the solution, proper strategy at containment zones and QCs is the key.
(The author is MD, WHO Fellow ( UK&Holland ), an Ex-Director Health, Manipur and a Public Health Specialist. Views expressed are personal.)