Ensure equitable access to Covid-19 testing, says Rockefeller Foundation report
The Rockefeller foundation, in consultation with experts, has developed a comprehensive document on Covid-19 tests that outlines who should be tested using what method, equitable availability of testing even in rural areas and to those who are socio-economically disadvantaged, and conducting repeated well-designed sero-surveys to guide policy matters.
The document also says a streamlined regulatory pathway must be created for newer diagnostics and a mechanism should be put in place for post marketing survey of the kits.
The Road Ahead for Smart Covid-19 Testing and Tracing in India report developed in collaboration with the Rockerfeller foundation and in consultation with researchers such as virologist Dr Shahid Jameel states that almost half of the tests conducted so far have been using less accurate Rapid Antigen Test (RAT), with single tests being considered confirmatory in several states.
It suggests a dual pathway for testing, which the document refers to as the Cafeteria Approach. For confirmatory diagnosis, only molecular tests such as RT-PCR, CBNAAT, and TrueNat must be used. If unavailable, multiple RAT tests should be done sequentially three to four days apart so that the infection is detected once the viral load in the body goes up.
In addition, there must be testing to conduct surveillance in places such as schools, offices, shops, travel, and social gatherings. For this, RAT test, pooled RT-PCR test (where several samples are mixed and tested as one), and saliva-based tests that are yet to be approved in India should be used as per the report.
The document also calls for equitable access of the tests – providing those willing to pay for a home-based testing at a premium while allowing special provisions for the economically disadvantaged such as the government paying for the tests whether it is done at a government or a private sector.
Covid-19 testing should be made a part of existing disease control programme, the report suggests. A good step by the government was to make testing free under Ayushman Bharat, however, only 400,000 to 500,000 test were conducted under the scheme till January this year, which is less than half of the number of tests India conducted in a day at the peak. The report says it could be so because people did not know of the provision or they were already accessing free services provided by state governments.
The report also states that vaccinated individuals must be tested if they develop symptoms or come in contact with a Covid-19 positive person till the time there is good evidence to suggest that vaccination also cuts transmission.
In addition, the report calls for the government to conduct a study to see the immune response of those who have natural infection and those who have been vaccinated to further inform the vaccination strategy.
The report calls for scaling up of newer technologies such as FELUDA tests, home based lateral flow tests, another variant of molecular testing called LAMP (Loop-mediated isothermal amplification) tests. And, create a mechanism for post marketing survey of all new kits.
The report also calls for adequate sequencing to detect new variants as well as constantly updating the RT PCR primers to ensure that newer variants do not escape the test.