Covid-19: Delhi’s testing strategy is endangering lives

Between June 18 and July 29, the Delhi government undertook 4.78 lakh RAT tests against 1.8 lakh PCR tests, despite the fact that nearly half the PCR testing capacity in Delhi was not being utilised by the Delhi government.

By Gajendra Haldea

In their recent order of July 27, Justice Hima Kohli and Justice Subramonium Prasad of the Delhi High Court have—with the assistance of the ICMR (Indian Council of Medical Research) and the NCDC (National Centre for Disease Control)—given a very lucid explanation of the flawed Covid-19 testing practices prevailing in Delhi. Reading between the lines, this order amounts to a severe indictment of the testing strategy of the Delhi government.

For ease of comprehension, it may be noted that the principal test for detecting Covid-19 is and has been the RT-PCR test (PCR) which is widely recognised, including by the ICMR and the NCDC, as the gold standard among tests. However, the Delhi government has repeatedly displayed its indifference towards PCR.

After the onset of the pandemic, the Delhi government was slow to adopt PCR despite all experts emphasising the need for more testing. Under constant pressure, the number of tests gradually rose to a level of about 6,000 per day during May. Then, for reasons unknown, this number was reduced to about 5,000 per day for several weeks until mid-June, despite a rapid spread of the pandemic.

Then came the severe indictment of the Apex Court and the intervention of the Union home ministry. Thereupon, PCR tests in Delhi were raised to about 9,000 per day. However, as the said order of the Delhi High Court states, it is currently at a level of only 6,000 tests per day, which is almost 50% of the testing capacity available in Delhi. Why does the Delhi government keep restricting this ‘gold standard’ test is anyone’s guess.

The latest reduction in PCR has been accompanied by a sharp rise in rapid antigen test (RAT). This is a new test introduced by the ICMR vide its DG’s letter of June 14, 2020. The letter recognises that RAT gives a substantial proportion of false negative results, and in one of the two surveys mentioned in this letter, only 50.6% positives were detected correctly. In other words, if a hundred persons were positive in a particular group, about one half would be reported as negative. In a recent TV interview, the chief scientist of the WHO also stated that the reliability of RAT ranged between 50% and 70%.

Low reliability means that those declared falsely negative would freely mingle in their respective communities and inadvertently act as spreaders of the infection. For this reason, no other country is relying on RAT the way India is.
To safeguard its position while recommending RAT in its said letter of June 14, the ICMR did say that RAT must be undertaken in combination with PCR. It also stressed that those who tested negative under RAT should definitely undergo PCR. But as we all know, such fine print is often ignored by those who are enthusiastic and superficial, and also those who are desirous of managing perceptions and not the pandemic.

So, the Delhi government went whole hog for RAT. Between June 18 and July 29, it undertook 4.78 lakh RAT tests against 1.8 lakh PCR tests, the latter being 46% of the former, despite the fact that nearly half the PCR testing capacity in Delhi was not being utilised by the Delhi government.

The ICMR had, on its part, also fixed the price of RAT kits and specified the name and particulars of the sole manufacturer in India. In the past, too, the ICMR had fixed a rate of `4,500 for PCR tests, but within a few weeks a high-level committee of the central government fixed the rate at `2,400 per test with the Maharashtra government fixing it at `2,200. One wonders what methodology or procedure is followed by the ICMR for fixing such rates and under what authority. Fixing the rate of RAT kits to be supplied by a monopoly producer and thus enabling it to sell lakhs of a product that is widely regarded as unreliable is, indeed, open to question.

As for the Delhi government, it has shown great enthusiasm for purchasing testing kits. First came the purchase of sub-standard China-made kits, which fell apart due to an expose in the Delhi High Court. Now is the case of large-scale purchases of unreliable kits from a Manesar-based firm, which has also come under scrutiny of the same court. The preference for purchasing kits while relegating the laboratory-based gold standard tests seems beyond comprehension.

The Union health ministry and the ICMR appear to be complicit in this RAT race since every Covid-19 test is required to be entered on the ICMR portal on a real-time basis. As such, the ICMR and the health ministry have full knowledge of the testing particulars on a day-to-day basis. Indeed, the issues raised by the Delhi High Court should have been addressed by the central authorities at least a month ago. Further, the ICMR has clubbed PCR and RAT together in its daily updates. This is virtually like adding apples (or gold) and oranges (or copper) to give a total figure—clearly a misrepresentation that needs to be addressed.

I would not labour so much on these issues if it were only a matter of money. The problem is that wrong testing strategies have adversely affected the well-being and lives of our people. There can be little doubt that several hundred lives would have been saved in Delhi if only an appropriate testing strategy had been adopted. Indeed, this is a fit subject for an impartial probe.

During the past one month, I have sent several communications to the relevant authorities in the central government and the Delhi government raising the above issues. However, as I have written earlier, they seem to have no place for suggestions of experienced and well-meaning persons; they only respond to persons in power or to court orders.
I am not relying here on my personal opinion. If the strategies adopted by the government were in order, why would they attract the wrath of the Apex Court or the interventions of the home ministry? Why yet again is the Delhi government found wanting by the Delhi High Court?

With the addition of a new ICMR laboratory in Delhi NCR last week, the PCR testing capacity may soon reach about 15,000 per day. One hopes that the Delhi government will rely on this ‘gold standard’ optimally and avoid short-changing the people of Delhi any further.

Covid-19 is no less than a world war. It has to be fought with all the capacity and seriousness at our command. It can certainly not be conquered by propaganda alone. What it needs is expert consultation, concerted action and people’s participation. One can only hope that past mistakes are not repeated. This is a long-haul war and developments across the globe suggest that the pandemic is likely to get worse. So let us not take chances with the lives of people—every life matters. Sadly, Delhi has already lost over 4,000 lives and its death rate per lakh population is the highest in the country.

The author was principal adviser in the erstwhile Planning Commission.

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