India tested more than 1 million samples for the coronavirus disease (Covid-19) in a day, official data showed on Saturday, achieving a target that could be instrumental in controlling the pandemic even as infections of the viral disease continue to mount steadily and spread to emerging hot spots in the country.
On Friday, 1,023,836 tests to detect Covid-19 were conducted across the country, the Union health ministry said.
India conducted an average 889,935 tests in the previous five days, testing around 74.7 people per 100,000 population, much higher than the World Health Organization’s guidelines of testing 14 people per 100,000 population, according to the Indian Council of Medical Research (ICMR).
While reverse transcription polymerase chain reaction (RT-PCR) tests remain the gold standard for diagnosing Covid-19, rapid antigen testing has also played a key role in scaling up diagnoses of the disease at a larger scale.
According to an ICMR official who spoke on condition of anonymity, since rapid antigen testing was approved for diagnosis in India on June 14, about 40% of the overall tests were done using this method.
In total, India has performed 34.4 million (34,491,073) tests since January 22 when Covid-19 testing started with one lab at ICMR’s National Institute of Virology in Pune. As of Saturday, testing was being done at 1,511 labs across the country. Of them, 983 labs are in the government sector and 528 are private labs.
{{/usCountry}}In total, India has performed 34.4 million (34,491,073) tests since January 22 when Covid-19 testing started with one lab at ICMR’s National Institute of Virology in Pune. As of Saturday, testing was being done at 1,511 labs across the country. Of them, 983 labs are in the government sector and 528 are private labs.
{{/usCountry}}The data from states such as Chhattisgarh, West Bengal and Madhya Pradesh showed the percentage of antigen tests was lower than the national average.
Experts say that to control the outbreak, aggressive testing is crucial. In this case, the number of Covid-19 cases diagnosed in the country is likely to see an increase before it starts seeing a dip, indicating that the spread is slowing. Until Saturday, India recorded 3,041,463 cases and 56,837 deaths.
“To curtail an infectious disease from spreading, one must be able to identify, through testing, as many infected individuals as possible in time so that they are isolated and put on treatment,” T Jacob John, former head of virology department, Christian Medical College, Vellore, Tamil Nadu, had said.
A July 7 column in this newspaper suggested a target of a million tests a day.
Much of the recent increase in testing can be attributed to the growing role of antigen tests in the states. Antigen, or rapid, tests usually provide results within hours and are relatively cheap. These kits are designed to detect antigens (substances in our bodies that stimulate an immune response) and can be performed in mobile stations and don’t necessarily need labs. The downside is that they have a far higher chance of returning false negatives (showing infected people as uninfected), and thus can let cases slide under the radar.
The real-time reverse transcription polymerase chain reaction (RT-PCR) test, on the other hand, is the gold-standard for Covid-19 testing and is the most definitive test available. It is used for the detection of nucleic acid from Sars-CoV-2 and is based on PCR, a process that duplicates and amplifies genetic fragments of the virus, so that it becomes easily detectable. The downside is that the process, from samples collection to results, for these can generally take 24-48 hours and needs dedicated machines.
HT has repeatedly pointed out that antigen tests are best used when time is a constraint and results are needed quickly – in a containment zone or a hot spot, for instance.
In terms of states, the wide disparity in testing rates remains as higher-than-average testing states have continued to fuel the nationwide boost to testing numbers in the past weeks. While Delhi has tested 70,300 people per million of its population, Madhya Pradesh has tested 13,788. All Indian states are testing above the 140-per-million daily benchmark recommended by the World Health Organization, but this is an inadequate number. The national average of tests is currently 580 per day per million population.
“Through our ardent efforts, it was ensured that specific testing platforms are made available addressing general testing (RT-PCR), High-throughput testing (COBAS), testing at remotest places and Primary Health Centres (TrueNAT, CBNAAT), in containment areas (rapid antigen testing) and for large number & migrant population testing (pooled sample testing)… The ultimate goal is that testing should be available to everyone in need and no one should be left behind,” ICMR said in a statement. The Union health ministry tweeted on Saturday: “Early identification through testing, prompt and effective treatment through supervised home isolation and quality medical care, and innovative graded policy measures have resulted in almost 100% increase in recovered cases in the last 21 days.”
In an interview with Hindustan Times, Union health minister Harsh Vardhan underscored how the government was aggressively pursuing its targets. “We have met our goal of doing one million Covid-19 tests a day at least six weeks ahead of target – just as we have done in the past for other goals. When we promised to take testing up to 100,000 a day by May 31, we achieved that target by May 10. A few weeks ago, I had promised to reach the one million a day mark in 12 weeks. And now look at our progress,” he said.
ICMR director general Balram Bhargava, in a recent briefing, said the research body adopted an intelligent and calibrated approach to meet the testing requirement based on requirements on ground, with greater focus on regions where there was lack of testing facilities. “In a diverse country like India, for equitable access to testing, optimization of resources based on the evolving epidemic was an essential part of the sustainable scaling up. Due to the concerted, focused and collaborative efforts of the Centre, State/UT government along with dedicated support of lakhs of front-line workers we have ensured the successful implementation of testing aggressively, tracking comprehensively and treating efficiently which has enabled us to rapidly increase the number of tests done per day,” he said on meeting the one-million target.
Dr Shobha Broor, former head, microbiology department, All India Institute of Medical Sciences (AIIMS), Delhi, said: “To be able to do one million tests in a day is a big achievement not just for a developing country like India but also by the standards of a developed country. Since I was actively involved in the field and know how difficult it is to set up infrastructure for this scale of testing, including adequately trained manpower. Before the H1N1 pandemic hit us in 2009, hardly five labs were doing RT-PCR testing, and we began ramping up since then but one-million tests in over 1,500 labs capable of RT-PCR is indeed a great achievement, and is going to hold us in good stead in dealing with such outbreaks in future also.”