WHO says test, test, test: India says not for us
KV Prasad Jun 13, 2022, 06:35 AM IST (Published)
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Summary
As COVID-19 confirmed cases rise to 167,515, the World Health Organization’s (WHO) Director-General Tedros Adhanom had only one advice for countries: “Test, test test. countries cannot fight fire blindfolded.”
As COVID-19 confirmed cases rise to 167,515, the World Health Organization’s (WHO) Director-General Tedros Adhanom had only one advice for countries: “Test, test test. countries cannot fight fire blindfolded.”
However, India’s premier research organisation Indian Council of Medical Research says, “WHO’s advise of more testing does not apply to countries like India.”
At a time when India is seeing its ‘reported’ positive cases grow at a fast pace, this statement sounds a bit bizarre. While 139 positive cases (till 7:00 pm on March 16 looks a small fraction, it is growing at a fast pace. The number of positive coronavirus cases has gone up by 26 percent in just two days.
The government cannot be pinned down on its tackling this health crisis. It has been proactive in closing our borders to affected countries, closing down non-essential public place, schools, advising home quarantines, social distancing, work from home but it has been slow in testing.
With 11,500 tests in the last two months, for a country with 1.3 billion population, India stands too far behind in testing for COVID-19. “India is not in a community transmission stage so such statements are not valid for countries like ours. We can’t say that community transmission will not happen.” Experts say we will never know this until we test more people.
A data compiled by Our World in Data suggests India is only testing three per million people. This was based on March 6 figures when India had tested roughly 5,000 samples. The numbers have more than doubled in the last 10 days but is still abysmally lower.
There has been enough global experience to show that all the countries that have been able to mass test people have been better prepared and have been able to substantially slow the spread of the virus.
Case in point South Korea. It has tested over 2.5 lakh people in the last 2.5 month and used extensive surveillance and contact tracing, mass free testing and drive through testing centres to hasten the process. Compare it to those nations who didn’t do mass testing and detect fewer cases and therefore have apparently higher case mortality rates. Like Italy, like the US now.
For India, it is the 2 Cs that are troubling cat this point – COVID-19, Capacity of Testing and Criteria.
Till now the discussions hovered around testing capacity. However, in the last two days, ICMR has explained that we have enough and more testing centres. Currently, 72 government labs are testing COVID-19 samples. The government is adding 49 other government labs and two high rapid throughput systems. ICMR said it is also in talks with accredited private laboratories to start conducting COVID-19 tests, albeit advising them to do it for free.
At the same time, the government says its own government laboratories are not operating at full utilisation. 121 labs, for now, are running at 10-12 percent utilisation. Professor Balram Bhargava, DG, ICMR said the government has a capacity to test 8,000 samples per day. One would wonder why the need to add more private laboratories? And why are we not utilising the capacities?
Trouble is with the second C – Criteria. India’s COVD-19 testing strategy till now is that of risk-based assessment. This criterion of testing for COVID-19 is based on the protocol that only those travellers who have come from affected countries recently and those who have contact history with such travellers and have symptoms of the disease will be tested.
Now that is narrowing down the sample size drastically.
There have been multiple reports of travellers from various countries who wished to be tested but were sent away by the government laboratories as they don’t fit the criteria.
ICMR says we are still in the local transmission stage and there is no need for indiscriminate testing of people. There is no need for community screening. ICMR is basing its assessment on the fact that all the reported, positive cases have been through travellers or their contacts.
There are two inherent flaws with this. One: in the WHO’s daily coronavirus situation report, even Italy with 27,980 positive cases and 2,158 deaths is in the list of Local Transmission. According to WHO, local transmission indicates locations where the source of infection is within the reporting location, but not all locations within a given country/territory/area are equally affected.
Two: In the last 10 days, most of the patients who have been tested positive have had a recent travel history to Dubai (UAE). It was not on the affected countries list and hence no compulsory quarantining or testing. Just yesterday, the government expanded compulsory 14-day quarantine for people coming or transiting through UAE, Qatar, Oman and Kuwait.
As Gagandeep Kang of Translational Health Science Technical Institute puts it, “Closing borders helps in checking the spread of transmission, but will not completely control the spread of infection. Airports are points where people from multiple countries and cities transit through and there is an inherent risk or transmission. Hence we need to expand the pool and test all international travellers entering India – irrespective of the origin of travel or symptoms.”
Experts say relying on risk-based assessment is never a 100 percent and point out that we may have already entered community transmission stage considering asymptomatic patients moving around without testing, the density of population and difficulties in practising social distancing despite guidelines.
The government has started community screening in its own small way. It has now using the influenza surveillance network to test all people with influenza-like illnesses and severe acute respiratory infections. So, 51 laboratories will collect 20 samples each per week, making it about 1,000 samples per week. It’s a welcome start but a small pool.
ICMR says currently 69,500 people are under surveillance, either in quarantine centres or home isolation.
Dr Srinath Reddy of Public Health Foundation of India said, “It might be time now to move to clinical criteria, trace symptoms. China started looking at moving beyond just diagnostic-based screening to also looking at clinical criteria.”
Could the low level of testing be to delay the burden on already understaffed health infrastructure, experts say the majority of those who test positive will show milder symptoms, but we will be able to slow down the transmission with the information.
“Community transmission could’ve happened by now, we wouldn’t be able to put a number to it until we test more people,” adds Dr Kang. “We are not looking at eradicating the disease but to flatten the curve – so that more people we test, better prepared we are.”
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