A short window in the war against Covid-19

Infection rates have to be brought down in the next few weeks. For that, testing and treatment facilities are key

The coronavirus pandemic (Covid-19) has already taken a toll on people’s health care across the world. Forty years ago, the world witnessed the Acquired Immune Deficiency Syndrome (AIDS) pandemic that killed 40 million people and left another 30 million HIV+. While Africa bore the maximum brunt of the pandemic then, the epicentre for Covid-19 appears to be the rich nations of western Europe and the United States (US).

Initially, India’s response to Covid-19 was quick. The government identified the risk in allowing people from China to enter the country, and adopted quarantine procedures for those who were evacuated from Wuhan and other cities in China, and later from Iran and Italy. India could minimise the initial impact because of these timely steps.

However, what followed later was a large influx of people (estimated around two to two-and-a-half million), including students, tourists, pilgrims and residents from India, who returned to the country between January and March 2020 until the borders were closed to international traffic on March 21. They returned from various international destinations and proceeded to Delhi, Mumbai, Bangalore, Hyderabad and airports in northern Kerala, among other places.

The government introduced thermal screening procedures for those coming from abroad, while others who were asymptomatic or not detected by thermal scanners were allowed entry with an advisory to stay at home and observe quarantine procedures. But many did not follow it strictly.

In the intervening period, they have travelled within the country, met people, participated in social functions and infected a large number of people. The rising infections in the last few weeks are mainly reported from among this section of the population and their contacts.

The government has done a fine job of sharing the details of incoming passengers with the state governments and district administrations. But how effectively each of them was followed up on and counselled to stay at home is not clear. Some state governments have now started monitoring these cases but that was only after they tested positive.

Critical time was lost in enforcing the quarantine instructions until the “janata curfew” (people’s curfew) and the subsequent lockdown in high-prevalence districts started taking effect.

The prime minister has now announced an extended lockdown for 21 days which is very timely. It will provide time and a window of opportunity for the central and state governments to mount an intensified response within a short period of identifying people who returned from abroad and their families and testing them.

This testing load is bound to be large and the present testing arrangements will be stretched to their full capacity. The testing procedures until now are built around viral load testing by taking throat swabs. The time taken for the test results is between three to five days. The tests are costly and can be carried out only in specialist institutions.

The key to scale-up testing in a large population is to introduce tests that can give results the same day to enable treatment at an early stage of infection. Such tests are based on detecting antibodies in the infected person. Antibody tests are generally more affordable both for patients and government agencies. In the case of HIV/AIDS, the entire testing programme was centred around making available rapid testing to check HIV status. In a short period of time, a large number of HIV positive persons were identified for providing anti- retroviral treatment (ART) and AIDS-related mortality was substantially reduced.

This is the opportune time for the government to look for rapid antibody testing for Covid-19 for both symptomatic and asymptomatic travellers and their close contacts. South Korea and Singapore effectively used rapid testing to identify positive cases who were quarantined and followed up on. The United States Food and Drug Administration has recently approved a rapid test for Covid-19.

India has the technological capability to produce a high-quality rapid test quickly. In the short-term, the government can import rapid test kits and use them in the testing programmes. This will help in scaling up testing facilities in health care institutions right up to the district level and take the pressure off specialist institutions and laboratories.

The battle for control of Covid-19 can be won if the new infection rates can be brought down substantially in the next two to three weeks. And providing testing and treatment facilities to those who are at risk is the key to success.

We should not make the mistakes some European countries made in not responding rapidly enough. It will prove to be unaffordable in the Indian context.

Prasada Rao is former health secretary, Government of India The views expressed are personal