Testing must be done on war footing
India has made arrangements to nearly double the capacity to test for Covid-19 and random screening of samples
NEWDELHI: Experts are calling for an aggressive ramping up of testing in India to stave off the deadly infection that has claimed at least 5,500 lives across the world, pointing out that the current capacity to screen people may prove to be inadequate in case of a sudden surge in infections.
India has made arrangements to nearly double its capacity to test for the novel coronavirus and started random screening of samples, but in a country this large, the dangerous community transmission phase of the disease, when it spreads to people who have neither been to a global hot spot nor been in direct contact with someone testing positive, could have deadly ramifications.
India reported two deaths in the past week, and 84 confirmed infections, far lower than disease hot spots in China, Italy, Iran and South Korea. Medical authorities have, until Saturday, tested 6,700 samples.
India’s top medical body, the Indian Council for Medical Research, said it is ready for a sudden surge in cases, by adding to its network of laboratories capable of testing for Covid-19, and by procuring more testing reagents. “We have added the number of labs to about 65 and at this point we can perform 100,000 tests, effectively about 10,000 tests in a day. We have made further arrangements to procure reagents to be able to do about 200,000 more tests, if required,” said Dr Balram Bhargava, director general of the ICMR.
However, at the moment, only those with a history of travel to 12 countries designated as highrisk, or those who have come in contact with anyone testing positive for the coronavirus, or showing symptoms of the disease, are being tested.
Dr Lalit Kant, an expert in infectious diseases, said: “The South Korea model [of aggressive testing] is good, as it worked well. It can be tried in India also as because of the high population we may soon be expecting large numbers to test.”
In South Korea, which is expe
DR LALIT KANT, an expert in infectious diseases
riencing the largest outbreak of the epidemic outside mainland China where the virus originated late last year, authorities have enforced a unique and aggressive testing regimen.
The country of 51 million people has devised rapid tests and told medical authorities to not deny screening to anyone, even if they are not citizens or residents. The administration worked with biotech firms to develop rapid tests and sanctioned local governments to test people at drivethrough stations – where people pull up in cars and get tested for the virus.
Experts link these strategies with a fall in the number of new infections, and have now called f o r s i mil a r methods t o be employed in the US, where authorities have drawn flak for slow rates of testing. Other countries such as Vietnam and Singapore have also followed the model of South Korea, which has tested the highest number of people per capita in the world.
“Some countries have been very aggressive and have actually done quite a good job. Other countries have been quite lackadaisical and, I think, have suffered immensely from it...,” Ashish Jha, who runs the Harvard Global Health Institute, told NPR on Friday.
India has been able to manage the infection until now, but some experts worry that in the next few weeks, the country will be at risk of a dramatic rise in numbers. “We need to look at all alternatives, even rapid tests to be able to manage the numbers in future,” said Kant.
A second expert said on condition of anonymity that it was unclear if India was testing enough people.
“But look at the country’s population, and the numbers that have tested positive, it appears to be we aren’t testing enough. One of the reasons could be not all contacts are being traced adequately and that could lead in sudden jump in numbers,” the expert said.
ICMR said it was ready for the challenge. “We are adequately prepared; however, we have not yet reached a stage where we get more samples than we can test. As opposed to the capacity of performing 90 tests per day in all our laboratories, we are getting about 60-70 samples daily in all the labs put together,” Bhargava told HT. ICMR has also begun lifting random samples of influenza-like illnesses from its network of viral research and diagnostic laboratories across India, to see if there is transmission in community. The first batch of random samples (about 20 from each of its 13 labs) was tested between February 15 and 29. All the tests were negative for coronavirus. Another batch of sample lifting is to start on March 15.
A number of states have also enforced a partial shutdown of public places. Almost all visas have been suspended f or a month, and the government has invoked the Epidemic Disease Act 1897, and Disaster Management Act, 2005. “Invoking these acts does not mean there is Covid-19 epidemic... It means the government is working proactively...” said Lav Aggarwal, joint secretary of the health ministry.
According to World Health Organization (WHO), countries should test suspect cases, contacts of confirmed cases; test patients identified through respiratory disease surveillance, if there is local cluster transmission. A section of experts, however, disagree on the need for aggressive testing.
“Only symptomatic people, especially those with a travel history or contact of a laboratory positive case, need to get tested as there is a risk of getting false negative results in the early stages of disease...,” said Dr Lalit Dar, professor of microbiology at the All India Institute of Medical Sciences.
IF SYMPTOMS ARISE
In case you becomes symptomatic, all your close contacts must be home quarantined. You should immediately call the govt helplines so officials can have you rushed to a hospital as soon as possible
ORDERING FOOD
In case you order food or item while under quarantine, you must pay for it online so you don’t swap currency bills with anyone. Ask the delivery person to leave the item outside your door to minimise the risk of infecting the deliveryperson
DISPOSING MASKS, LINENS
Any linen or clothes worn by you should never come in direct contact with anyone else. Disposable gloves must be used when washing utensils. Utensils such as dishes, drinking glasses, cups etc should not be shared with others in the family
The South Korea model [of aggressive testing] is good... It can be tried here also as because of the high population we may soon be expecting large numbers to test
UNDER A CLOSE WATCH
Number of people who are currently under home quarantine based on latest central government data
IN ISOLATION WARDS
People who are admitted to hospitals across the country in isolation wards as of Saturday evening
Used masks during quarantine should be disinfected and then disposed by either burning or deep burial
OTHER FAMILY MEMBERS
Elderly, pregnant women, children and persons with co-morbidities within the household should be kept at maximum possible distance from you. They should come in contact with your living space
ONE-ROOM CONFINEMENT
Your movement should be strictly limited to a single room in the house, preferably with an attached toilet that no one else should use. No visitors should be allowed Wear a surgical mask all the time and it should be changed every 6-8 hours. These masks must never be reused, and be treated as if they are infected
SINGLE PERSON CONTACT
If another family member must enter your room, they should maintain at least 1 to 3m distance from you. Only one family member should be assigned to care for you in this period
The ‘contact person’ should always wear a mask around you, wear gloves and never let their skin come in contact with any surface touched by you. They must also wash their hands after removing their gloves
Everyone in the house must wash their hands as often as possible thoroughly with soap and water or frequently use an alcohol-based hand sanitiser