Coronavirus: Millions of covid-19 tests needed, not going to end soon, says expert Dr Giridhar R Babu
Instead of waiting for people to show up with symptoms, the household of an infected person and those in close contact with him or her should be tested immediately and isolated to contain the spread of the virus, says Dr Giridhar R Babu, professor and head, Lifecourse Epidemiology, Public Health Foundation of India.
Tracking a virus is like a detective work; it needs careful and planned monitoring, says Dr Giridhar R Babu, professor and head, Lifecourse Epidemiology, Public Health Foundation of India. Instead of waiting for people to show up with symptoms, the household of an infected person and those in close contact with him or her should be tested immediately and isolated to contain the spread of the virus. That would mean testing thousands of people but in a planned manner. Now is also the time to prepare for critical care once community transmission is established, said Babu, who has worked on curbing polio transmission, measles surveillance and has studied parental milieu, air pollution and psychosocial environment during pregnancy and how they affect development of non-communicable diseases (NCDs) in childhood. Edited excerpts from an interview with Jayashree Nandi:
Q. Does India need more testing to identify community transmission?
A. The Indian Council for Medical Research (ICMR) is planning to do rapid tests with a few samples from each of their centres. If the fire is in one place and you are looking for damage in another place altogether, you will not find it. For maximum impact, we need to test people within the household where infection has been detected. There is a 15% chance that those in the household may be infected. People the infected person has spent considerable time with [close contacts] need to be tested. Testing allows you to identify and isolate more cases and stop transmission through effective contact tracing. Don’t wait for symptoms to show up, just test.
Q. Should testing parameters be revised from travellers and contacts to include people with symptoms?
A. This is also the flu season. Every person with a viral illness will want to get tested. There will be panic. To test every person with symptoms is definitely not the best strategy. When you want to trace an epidemic you have to work like a detective and follow the virus. In Bangalore, for example, there are seven cases, so we have to monitor 7,000 people including {those} who could be contacts of those seven. Symptoms alone can dictate the criteria for testing. Contact tracing is crucial because it’s like a matrix.
Q. Do you think the private sector should be involved in testing for Covid-19?
A. Yes, it should. But it should follow the World Health Organization (WHO) protocol and the tests should be validated by the National Institute of Virology (NIV), Pune. There shouldn’t be any unverified random testing or people may also be exploited.
Q. The government has been saying there are a limited number of test kits. If we have to track community transmission, how do we increase testing infrastructure in India?
A. The NIV is preparing its own rapid diagnostic tests. Right now, these tests are available from China and South Korea. We can validate those tests for India. The NIV can do it pretty fast. We are talking of millions of tests because this is not going to end now. We don’t know the timeline.
Q. Do we need to import anything to conduct these tests here?
A. There is a primer that is available with WHO. It can provide more of that primer. NIV has isolated 11 viruses. They can standardise their own kits. It’s an administrative decision.
Q. Once we start testing more don’t you think our hospitals will be overburdened?
A. Of all the people infected, not everyone will require hospitalisation. Only about 15% will need hospital care and about 5% will need critical care. We need a strategy now on how we will deal with critical care. There is no point waiting.
(Dr Giridhar R Babu, professor and head, Lifecourse Epidemiology, Public Health Foundation of India.)
