COVID-19 crisis: Testing still key to containing outbreak

By: |
April 15, 2020 6:15 AM

An Armed Forces Medical College research projected a drastic fall in cases if the lockdown also saw even 50% effective quarantining and isolation of infected cases.

The argument for widespread testing is strong—in the early stages of an outbreak of the Covid-19 kind, higher detection could mean more effective clamping down, and, in the current stage, pooled testing could help detect asymptomatic cases and identify clusters.The argument for widespread testing is strong—in the early stages of an outbreak of the Covid-19 kind, higher detection could mean more effective clamping down, and, in the current stage, pooled testing could help detect asymptomatic cases and identify clusters.

The extension of the nationwide lockdown till May 3 should help India control COVID-19 spread—a team of researchers at University of Cambridge had talked of the need to extend the duration of the lockdown if the infections are to be reduced to a level where isolation and contact tracing is feasible. But, researchers, including some from government institutions, have also pointed out, that lockdowns will have a more meaningful effect if effective isolation can be ensured, which, in turn, will require adequate testing to identify cases. An Armed Forces Medical College research projected a drastic fall in cases if the lockdown also saw even 50% effective quarantining and isolation of infected cases.

The argument for widespread testing is strong—in the early stages of an outbreak of the COVID-19 kind, higher detection could mean more effective clamping down, and, in the current stage, pooled testing could help detect asymptomatic cases and identify clusters. But, it is also crucial not to lose sight of key shortcomings. As Dr K Srinath Reddy has pointed out in these pages, testing can’t be a silver bullet for a host of reasons, including individual details such as intensity of exposure to viral shedding etc sometimes resulting in false positives or negatives. Also, continued testing of large swathes of the population—which will be needed in a scenario where no drug or vaccine proves successful—may not be sustainable, even for developed nations. Perhaps, it would then be prudent to also look at symptoms as markers for initiating isolation/quarantining, though this leaves out asymptomatic cases.

That said, India is not doing as many tests as it should be doing—this is something many experts have voiced concerns regarding—given its high risk factors, like underlying co-morbidities, high population density, and the impossibility, for certain sections of the population, of practising social distancing and hygiene measures. As of 9pm on Monday, 217,554 samples from 202,551 individuals had been tested. As per data on testing analysed by ourworldindata.com, from the University of Oxford, India has one of the lowest levels of testing per 1,000 population; nations that have reported much higher numbers are conducting tests at much higher levels. A recent study by scientists at the Indian Council of Medical Research shows that changing the testing strategy to include testing of hospitalised cases of Severe Acute Respiratory Illness helped identify more cases, and even indicate what could be community transmission. Testing is an issue that both the Centre, and the states must look at carefully—West Bengal, for instance, is reporting very low levels of testing, and till April 13, had tested only 2,793 samples, as per official data, while it reported 190 cases, and 7 deaths. Kerala, in contrast, has tested over 15,000 samples so far, and has managed to flatten the curve of infection by marrying early detection through testing with effective monitoring of quarantining. Tests alone are not going to help control the outbreak, but the government must still carefully examine how best to deploy this during the extended lockdown, even as it uses the window to ramp up the country’s healthcare capacity. If a staggered exit from the lockdown is imagined—the government has talked about lifting restrictions on certain economic activity in low-risk areas from April 20, after carefully studying the situation—testing, to make sure that the gains of the lockdown are not frittered away by letting asymptomatics go to work, is to be a made a must.

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