GAPS IN DETECTION
India’s testing strategy leaves much to be desired, even as it struggles to procure test kits and assess the progress of the disease to formulate an appropriate response
India’s testing strategy leaves much to be desired, even as it struggles to procure test kits and accurately assess the disease’s spread
Having reconciled to a three-week lockdown, most Indians waited anxiously on the morning of April 14 to hear how the prime minister would lift it—fully or incrementally—only to find that the shutdown had been extended by another 19 days. No one disputes the necessity of a lockdown—according to a study by the Indian Council of Medical Research (ICMR), one person can infect 406 people in 30 days if he or she doesn’t isolate—but at the end of three weeks, everyone is asking if the move did achieve what it had set out to do when it was imposed on March 24. The jury is still out. As India reported 12,338 cases and 420 deaths on April 16, it wasn’t clear if the country had managed to flatten the curve. “We still have to wait 7-10 more days to know if we have flattened the curve,” says K. Srinath Reddy, chairman of the Public Health Initiative of India (PHFI), a not-forprofit public-private initiative. “We can’t assess if the lockdown has been successful till more data is collected and analysed, especially age and state-specific data.” And there is only one way to get that data— through intensive and widespread testing.
Testing in India
India has a long way to go before it can come even close to the 10,550 tests per million that South Korea has conducted—without resorting to a lockdown—to restrict its total number of COVID-related deaths to 229. As on April 16, India had tested 258,730 individuals or 196 tests per million. But with the death rate now doubling every four days, the country has no option but to drastically revise its strategy if it has to limit minimise the number of coronavirus deaths. Extending the lockdown has been one measure; the other will be to ramp up testing.
Towards that end, the government issued new guidelines for testing on April 13. India will now test symptomatic cases not just in areas with high rate of infections, or what are called hotspots, but also in areas with low or no infections, or cold spots, using rapid antibody tests that can alert one to an infection before it can be confirmed with a reverse transcription polymerase chain reaction (RTPCR) test. Asymptomatic high-risk contacts and healthcare workers, on the other hand, can directly go for the RT-PCR test. “There are significant changes to our testing strategy now,” says Raman Gangakhedkar, chief scientist at ICMR. “We are doing all we can to increase our capacity to nearly 100,000 tests a day (from the 24,000 or so per day currently).” Rapid tests for symptomatic cases had