Experts press on need for increased testing as Gurugram sees relative success with contact tracing, vigilance

Dr Punia added that a total of 5,000 people with recent international travel history were monitored aggressively to contain the spread of Covid-19 in Gurugram.

Despite a surge in the number of Covid-19 (coronavirus disease) cases from 10 to 15 on Thursday, following a week’s lull when the city did not report any new cases, Gurugram’s numbers remain lower than that of Delhi and Noida-- 386 in NCT and 54 in Gautam Budh Nagar, respectively. While this trend has been of some comfort for residents, experts and officials cautioned that Gurugram has, conversely, reported the highest number of cases in Haryana. They added that it also has all the makings of an infection ‘cluster’, given its jet setting population, connectivity with the IGI Airport and the national capital.

A deserted view of the Golf Course Road, near Genpact Chowk in DLF-5, on Friday, Day 10 of the 21-day nationwide lockdown to curb the spread of coronavirus.

As uncertainty looms over the spread of Covid-19 in the district, experts said they can only ascertain a clearer picture of an outbreak, if any, in the region by rapidly scaling up testing. But, for now, India is only testing symptomatic cases because of a shortage in the number of kits, which are in high demand globally, said the Indian Council for Medical Research.

Though the country has sought to buy more testing kits from the international market and the Central government is mulling adopting a new method of testing, an expert HT spoke with said a large number of cases in Gurugram simply may not have been captured as they remain asymptomatic and, thus, have not been tested.

Health officials, however, said the low numbers were because of the containment measures adopted. “It is due to efficient contact tracing and isolation of suspected cases and foreign travellers that we have not seen the numbers go up,” chief medical officer Dr Jaswant Singh Punia said.

SCALING UP TESTING

Testing capabilities in Haryana, like the rest of the country, are low. Only about 150 samples are being tested per day in a state with an estimated population of at least 25 million. From Gurugram, which has an estimated a population of about 15 lakh people, anything between 30 and 80 samples are sent for testing per day.

“However, by April 10, the state will increase its testing capacity to 500 samples per day,” said Dr Dhruv Chaudhary, the nodal officer for Covid-19 in Haryana and the head of the department of pulmonary and critical care at PGIMS-Rohtak.

On Wednesday, April 1, Dr Chaudhary had said the state has enough kits to last it 10 days, but could not provide the number of PCR kits it would receive from the ICMR.

He added that availability of kits aside, the lab in Rohtak can only process 70 samples a day due to limited resources. Similarly, a government lab in a Sonepat medical college has been testing about 70 samples per day.

“While we have adequate resources for the next 10 days, we have ordered additional machinery and resources to speed up testing in the days to come. The Haryana government is also tying up with a private company to manufacture reagents required for testing,” he said.

In Haryana, two government labs (PGIMS-Rohtak and Bhagat Phool Singh Medical College in Sonepat) and five private labs have been allowed to take samples for Covid-19 testing. Of the latter, only SRL Limited and Core Diagnostic have started taking 20-30 samples per day starting March 31.

On March 29, state health minister Anil Vij had said new labs would be opened in Karnal, Nalhad, Agroha, Hisar and Panchkula to increase the testing rates for Haryana. However, officials did not clarify by when would these labs become operational.

HOW MANY SHOULD WE TEST?

Given the limited capacity to test for Covid-19, Dr Chaudhary said, “We have to be reasonable about whom we test. A specific group has to be identified as having high probability of contracting the virus, such as health workers or direct contacts of those who have already tested positive.” He added that most samples in Haryana are coming from Gurugram since it is one of the most affected districts compared to others.

From Gurugram, each day 30 to 80 samples are being sent to the Rohtak lab. Since February, 647 samples (about 10% of total persons screened) have been sent for testing. “Initially, we were sending samples to AIIMS-Delhi. But from March 14, we shifted testing to the Rohtak lab. We get test results within a day now instead of the Two-day waiting time earlier,” the CMO said, adding that presently, results are awaited for 48 samples from Gururgam.

By comparison, Delhi has sent over 2,000 samples for testing, while Noida has sent over 700.

Other experts, too, were in agreement with Dr Chaudhary about the need to test cautiously.

Dr Prabhakaran Dorairaj, an epidemiologist at the Public Health Foundation of India, said, “Indiscriminate testing is simply not feasible, but we must test more liberally while continuing to ensure prevention. Health workers and people showing mild symptoms must be tested on priority instead of waiting for their symptoms to become severe. Even some asymptomatic patients linked to positive or suspected cases can be included to widen the net.”

However, experts were reluctant to prescribe an ideal rate of testing.

A community health specialist affiliated with a university in Delhi, seeking anonymity, said, “In Korea, 6,000 people per million have been tested, while in Japan only 100 people per million have been tested. Despite the difference, both countries have seen similar patterns of outbreak and ‘flattening of the curve’, so it is difficult to prescribe an ideal rate of testing. But yes, testing needs to be more.”

ASYMPTOMATIC CASES

Another possible reason for Gurugram’s low number of Covid-19 cases, so far, is that most people who may have contracted the novel coronavirus remain asymptomatic.

“It is entirely possible that these cases have not been tested and therefore, not been found. This is yet another reason to ramp up testing, to include even those who may not be showing signs of illness,” said Dr Dorairaj.

It must be noted that most cases of Covid-19 from Gurugram are not repoted to have not shown any major symptoms.

VIGILANCE AND SPREAD

Meanwhile, health officials were also quick to point out the absence of any Covid-19 hotspots in Gurugram as opposed to Delhi and Noida, where the Tablighi Jamaat and a fire-safety company have become hot spots.

Of the 15 cases reported among Gurugram residents, nine have recovered and been discharged from hospitals, leaving six active cases. Of these, only one is linked to the Tableeghi Jamat congregation in Delhi.

Speaking to HT on Thursday, CMO Dr Punia said, “The first two positive cases we saw in Gurgram were linked to people travelling from Delhi, who were working in MNCs. We immediately ordered all MNCs to let employees work from home to curb the inflow of people from Delhi. Gurugram became vigilant even before the lockdown began.”

However, the search for potential infection clusters in Gurugram is underway.

Health officials said they have collected samples from slums to check the extent of the spread. “In one of the Covid-19 cases (reported March 20) we were suspecting a maid to be Covid-19 positive. Thankfully, she was not. But we visited the area where she lives and took some 50 samples from the community to check to see if any cases emerged from there,” said an official, who preferred not to be named.