No ICMR update on random testing
NEW DELHI: The ICMR did not disclose the final results of random sample testing for coronavirus disease (Covid-19) that were expected by Wednesday evening, fuelling speculation there might be a positive case suggesting community transmission.
Indian Council of Medical Research (ICMR) director general Balram Bhargava has credited India’s pre-emptive and proactive steps for relatively lesser number of coronavirus (Covid-19) cases in the country. He spoke to Rhythma Kaul about these steps and issues like community transmission. Edited excerpts:
What is the reason for the relatively low cases? Many speculate the numbers may not be true?
People can speculate about whatever they want, but the fact is India has managed to keep the numbers low because of several pre-emptive and proactive steps. Since almost all our positive cases are travel related, it was effective to close international borders at early stages of the outbreak. We started screening of passengers at airports from January 17 when the World Health Organisation [WHO] declared the outbreak a public health emergency of international concern on January 30. Our contact tracing protocol has also been very effective, because of which about 70,000 people are under community surveillance. All these measures have worked well.
Why are not we testing more? Some say if we do not test more, we would not know the magnitude of problem...
We are testing every single person that needs to be tested. There is a testing protocol put in place by a high-level expert committee chaired by the director of the All India Institute of Medical Sciences, Delhi, Dr Randeep Guleria. The committee reviews the protocol regularly keeping in mind local and global developments as it is an evolving situation. The protocol can be revised depending on the country-specific requirement. The committee has met twice and decided that only symptomatic people with travel history or contact history with a laboratory positive Covid-19 case should be tested. People suspected to having Covid-19, without symptoms, must keep themselves quarantined at home for 14 days. They should watch out for symptoms such as fever, dry cough and difficulty in breathing. Those who develop symptoms must seek testing at a designated government hospital. Not everyone needs to get tested as we have not reached the stage of community transmission. There is no need to panic.
How can you be so sure we have not reached the community transmission stage?
Our scientists have been monitoring the outbreak even before the disease came to India. We were assessing the data the WHO was sharing from China and other affected countries and also our local situation based on that. We got ample time to put in place a robust surveillance mechanism that we have been using for community surveillance since day 1. The first batch of random testing was done in February and the second on March 15. All samples so far have tested negative, indicating there is no community transmission yet. These are 20 samples each from intensive care unit patients admitted over past two weeks to 51 hospitals across India that work as ICMR test sites also for acute respiratory tract infections that are similar to what Covid-19 patients also experience. These are severely ill people with no travel history or contact history with any of the laboratory positive Covid-19 patients. So it will provide the researchers an indication of the disease pattern within community.
Countries like South Korea have begun aggressive testing and even the WHO has emphasised on aggressive testing of suspected cases. Why cannot India adopt the same strategy?
The WHO did emphasise on testing, and many affected countries did begin aggressive testing. But that is only when community transmission has been established within a country. You do not start indiscriminately testing people at the stage of local transmission, where India is at the moment. We cannot predict the course of the disease in future which is why we are staying prepared to deal with any eventuality. The mainstay of our strategy at the moment should be to stay under quarantine for suspected cases or those with travel history to help break the transmission cycle. A lockdown will actually help in achieving that. However, if we get a positive case from these random samples that we are testing, then it would indicate infection has reached the community, and that will change the entire disease screening, testing and management strategy.
There are several commercial diagnostic kits’ manufacturers. Is the ICMR looking at their products that will help in fast increasing the stockpile?
Many manufacturers have approached us and the ICMR’S apex laboratory— National Institute of Virology [NIV] in Pune—is in the process of evaluating a few antibodies based commercial testing kits as well as realtime based PCR [polymerase chain reaction] test kits for testing. For any test kit, sensitivity and specificity is important. Only after the
NIV validates those kits will the government be using them for testing.