Many experts have called for drastically stepping up community testing concurrently with enforcing social distancing.
Does India have the right SARS CoV-2 testing strategy? If it doesn’t, it is unlikely to contain the Stage III spread in the manner needed to ‘flatten the curve’ of contagion. Many experts have called for drastically stepping up community testing concurrently with enforcing social distancing. The government, though, seems to be relying exclusively on the latter at the moment. The Indian Council of Medical Research (ICMR) argues that the current strategy of testing those who fit the risk profile—individuals with history of international travel, close contact with laboratory-identified positive cases, and healthcare workers managing respiratory distress—when they become symptomatic is meant to prevent panic, and make optimal use of resources by avoiding occurrence of false negatives (when a pre-symptomatic person tests negative because samples don’t yet contain the viral load that can return a positive result).
Reports of infected individuals leaving quarantine facilities, or failing to disclose travel information that may be a marker of risk already make the chances of this approach succeeding seem bleak. To be sure, pictures of choked, overflowing toilets at government isolation facilities, shared on social media, would make jumping quarantine seem justifiable, even by those who are expected to be reasonably aware. But, while the government must ensure hygienic facilities at the very least—to that end, the Delhi government’s decision to rent hotel rooms for isolation is welcome—it must also consider tracking the infected/high-risk cases. If that can’t be done, it must relook its community testing stance urgently. In an interview with journalist Karan Thapar for The Wire, Ramanan Laxminarayan, director of the US-based Center for Disease Dynamics, Economics & Policy, and a faculty at Princeton University, warned that India could be the next SARS CoV-2 hotspot. He says there could be as many as 1,500, or even more, undetected infections in the country, and that, based on US estimates of itself, 60% of India’s population could eventually be infected, though the infection would be mild in a majority of the cases. If India is underestimating the spread, the current levels of community testing—500 tests so far, all negative—simply won’t do. The ICMR has marshalled the Virus Research and Diagnostics Laboratories at 63 of its facilities—there are a total of 106 such facilities—and nine more are on stand-by. It has even allowed private labs accredited by the National Accreditation Board for Laboratories to undertake testing. But, telling them they have to do this for free won’t help bolster capacity.
Some private labs estimate the price of testing, as per Business Standard, at Rs 9,000; the government must completely defray private labs’ costs of testing the poor—and, going by the ICMR reagent-cost-estimate of Rs 5,000, may be by that much for those non-poor who can’t afford the price. ICMR talks of high throughput (testing 1,400 samples per day) facilities at five locations, and reagents for 20 lakh tests in the pipeline. For India, this barely scratches the surface. But, there are limits to what any government can do for this large a population—wider testing, thus, becomes that much more vital.