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Testing must be done on war footing

PUBLISHED ON MAR 15, 2020 12:34 AM IST

New Delhi: Experts are calling for an aggressive ramping up of testing in India to stave off the deadly infection that has claimed at least 5,500 lives across the world, pointing out that the current capacity to screen people may prove to be inadequate in case of a sudden surge in infections.

India has made arrangements to nearly double its capacity to test for the novel coronavirus and started random screening of samples, but in a country this large, the dangerous community transmission phase of the disease, when it spreads to people who have neither been to a global hot spot nor been in direct contact with someone testing positive, could have deadly ramifications.

India reported two deaths in the past week, and 84 confirmed infections, far lower than disease hot spots in China, Italy, Iran and South Korea. Medical authorities have, until Saturday, tested 6,700 samples.

India’s top medical body, the Indian Council for Medical Research, said it is ready for a sudden surge in cases, by adding to its network of laboratories capable of testing for Covid-19, and by procuring more testing reagents. “We have added the number of labs to about 65 and at this point we can perform 100,000 tests, effectively about 10,000 tests in a day. We have made further arrangements to procure reagents to be able to do about 200,000 more tests, if required,” said Dr Balram Bhargava, director general of the ICMR.

However, at the moment, only those with a history of travel to 12 countries designated as high-risk, or those who have come in contact with anyone testing positive for the coronavirus, or showing symptoms of the disease, are being tested.

Dr Lalit Kant, an expert in infectious diseases, said: “The South Korea model [of aggressive testing] is good, as it worked well. It can be tried in India also as because of the high population we may soon be expecting large numbers to test.”

In South Korea, which is experiencing the largest outbreak of the epidemic outside mainland China where the virus originated late last year, authorities have enforced a unique and aggressive testing regimen.

The country of 51 million people has devised rapid tests and told medical authorities to not deny screening to anyone, even if they are not citizens or residents. The administration worked with biotech firms to develop rapid tests and sanctioned local governments to test people at drive-through stations – where people pull up in cars and get tested for the virus.

Experts link these strategies with a fall in the number of new infections, and have now called for similar methods to be employed in the US, where authorities have drawn flak for slow rates of testing.

Other countries such as Vietnam and Singapore have also followed the model of South Korea, which has tested the highest number of people per capita in the world.

“Some countries have been very aggressive and have actually done quite a good job. Other countries have been quite lackadaisical and, I think, have suffered immensely from it. And I think there are lessons to be learned for all of us,” Ashish Jha, who runs the Harvard Global Health Institute, told NPR on Friday.

India has been able to manage the infection until now, but some experts worry that in the next few weeks, the country will be at risk of a dramatic rise in numbers – as has been seen in countries such as Italy, Iran, China and US. Bhargava admitted to reporters that the next month will be crucial to monitor and stop community transmissions.

“We need to look at all alternatives, even rapid tests to be able to manage the numbers in future,” said Kant.

A second expert said on condition of anonymity that it was unclear if India was testing enough people.

“But look at the country’s population, and the numbers that have tested positive, it appears to be we aren’t testing enough. One of the reasons could be not all contacts are being traced adequately and that could lead in sudden jump in numbers,” the expert said.

ICMR said it was ready for the challenge.

“We are adequately prepared; however, we have not yet reached a stage where we get more samples than we can test. As opposed to the capacity of performing 90 tests per day in all our laboratories, we are getting about 60-70 samples daily in all the labs put together,” Bhargava told HT.

ICMR has also begun lifting random samples of influenza-like illnesses from its network of viral research and diagnostic laboratories across India, to see if there is transmission in community.

The first batch of random samples (about 20 from each of its 13 laboratories) was tested between February 15 and 29. All the tests were negative for coronavirus. Another batch of sample lifting is to start on March 15.

A number of states have also enforced a partial shutdown of public places. Almost all visas have been suspended for a month, and the government has invoked the Epidemic Disease Act 1897, and Disaster Management Act, 2005, even though it maintained that there was no community transmission of the disease in India yet.

“Invoking these acts does not mean there is Covid-19 epidemic in India. It means the government is working proactively to ensure the situation does not reach epidemic proportions. There is no community transmission in India so far,” said Lav Aggarwal, joint secretary of the health ministry.

According to World Health Organization (WHO), countries should test suspect cases, contacts of confirmed cases; test patients identified through respiratory disease surveillance, if there is local cluster transmission. In case of community transmission, the UN body calls for aggressive testing.

A section of experts, however, disagree on the need for aggressive testing.

“Only symptomatic people, especially those with a travel history or contact of a laboratory positive case, need to get tested as there is a risk of getting false negative results in the early stages of disease. When there are no symptoms, that means viral load in the body is very low and it may not show up,” said Dr Lalit Dar, professor of microbiology at the All India Institute of Medical Sciences.

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