To arrest rising Covid-19 toll, govt plans to expand rapid testing
The government’s focus so far has been on keeping the Covid-19 death rate down, but with the surge in numbers, it is exploring all possible alternatives to track every single infected person in the country.
India is scaling up diagnosis using rapid tests across the country to track, trace and treat all cases of the coronavirus disease (Covid-19) to contain its spread and bring down the number of deaths, as the number of fatalities caused by the virus in the past 24 hours on Wednesday crossed 2,000 nationally.
The government’s focus so far has been on keeping the death rate down, but with the surge in numbers, it is exploring all possible alternatives to track every single infected person in the country, and re-strategising disease management to ensure no serious patient is left untreated.
For testing, the antigen-based rapid test recommended by the Indian Council of Medical Research (ICMR) will be expanded in a big way across the states with a high disease burden, especially in containment zones and hotspots and hospitals.
In a letter to health secretary Preeti Sudan on Sunday, Dr Balram Bhargava, director general of the ICMR said, “…Testing remains a cornerstone in our fight against Covid-19, and therefore ramping up testing is essentially critical to track, trace, and treat all cases of Covid-19. Since the gold standard RT-PCR test has essential requirements in terms of biosafety and biosecurity as well as specialized equipment, ICMR had been exploring alternate quick and reliable options for diagnosis of Covid-19.”
The antigen-based testing will begin with Delhi that has been reporting about 50 deaths daily on average over the past few weeks, to prevent the spread of infection.
“To prevent the disease spread, aggressive testing is the only solution. All states will have to strictly enhance their testing capacity as more you test, the more number of people you will be able to treat in time. Not everyone needs hospitalization but we must be able to identify those who do to save lives. Testing is the only way. The states have been advised to take up antigen based testing as it will be able to cover a large population in a short span of time that will give us quick results and modify strategies accordingly,” said an ICMR official, who did not wish to be identified.
Community engagement is another key area that the government is focusing on to avoid people stigmatizing people suspecting either to have been infected by Covid-19 or have recovered from it.
The ministry of health has drafted an elaborate awareness campaign material to be circulated within the community to educate people. The document highlights the issue of stigma being the one of the reasons why many people conceal symptoms, and don’t seek medical care, thus reporting late to hospital.
“To some extent late reporting to hospital of Covid patients due to stigma attached is still a concern, and one of the reasons for patients turning serious,” says, Dr Randeep Guleria, director, All India Institute of Medical Sciences, New Delhi.
When assessing rising deaths in Gujarat recently, Dr Guleria had found that along with comorbidities, people were succumbing to Covid in the state because they were reporting their symptoms late for fear of stigma; and by the time they were tested and put on treatment it was already too late.
“Community engagement to ensure people don’t face stigma in society that will be the ultimate key to help people come forward and report symptoms. And people who interact with the public, making door-to-door visits need to adequately trained to communicate the message well. It’s important for these people to connect with the masses well only then the mind-set will change,” said Dr Jugal Kishore, head, community medicine department, Safdarjung Hospital.
Another focus area is to enhance the health infrastructure across the country in terms of beds, especially Intensive Care Unit beds with oxygen support for serious patients, to treat all those serious enough to require hospital care.
“We have added thousands of beds, especially increased ICU beds, labs and are procuring more ventilators. Even though our capacity isn’t fully utilized, both in terms of testing and hospitalization, the country is fully prepared to deal with the surge. This is all a part of the overall strategy to save lives. Cases may increase but we shouldn’t be losing lives, and we have been lucky that our death rate is the lowest in the world,” said a health ministry official.
“As for rising deaths one must remember that it is reporting of deaths in past 24 hours; not really these many deaths in a day.”
As of now India has 958 dedicated Covid-19 hospitals, with 167,883 isolation beds, 21,614 ICU beds and 73,469 oxygen supported beds. There are 2,313 dedicated Covid health centres with 133,037 isolation beds; 10,748 ICU beds and 46,635 oxygen supported beds have also been operationalised.
In 7,525 Covid care centres there are 7,10,642 beds now available in the country. There are currently 21,494 ventilators available for Covid beds.
Experts say that for better utilization of hospital beds, the strategy should be to prioritise admissions.
“We should prioritise admission to hospitals with critical care for elderly and those with co-morbidities irrespective of age. Early identification of poor O2 saturation, faster transit to facilities with high-flow oxygen is important for those isolated at home. Planning can save lives. Allocation of critical care beds through centralised risk scoring and automatic allotment based on region/risk category can prevent confusion & promotes equity. Trust and partnerships with private hospitals and community are integral to reduce overall mortality,” says Dr Giridhara Babu, head, epidemiology, Indian Institute of Public Health, Public Health Foundation of India.