India May See Avalanche of Cases By April, Why Are We Not Testing?

Experts criticise India's restrictive testing for COVID-19, saying it doesn't paint a real picture of the spread.

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Health News
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COVID-19 testing in India: India could hit an avalanche of cases by mid-April, but testing remains very restrictive.
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“India could see an avalanche of case by mid-April,” said Dr Jacob T John, former head of ICMR’s Centre for Advanced Research in Virology.

But will be even know if the testing for the novel coronavirus remains where it is.

Negligible?

In a press briefing on 17 March, Indian Council of Medical Research said that they were testing just 600 coronavirus samples in a day. Compare this to South Korea, that is testing 20,000 samples a day, and even the US, beleaguered by criticism for not testing enough, is still testing more samples a day.

On India’s testing capacity, the ICMR said they can scale up tests to 6000 samples a day across ICMR labs, and currently has 100,000 testing kits.

By all definitions, India is just not testing enough.

India has adopted a surveillance approach to testing. See the flow chart below posted by ICMR. If you are a close personal contact of a COVID-19 patient or have a travel history to a coronavirus-hit country, you still can’t get a test. You have to first home quarantine for 14 days.

During home quarantine, IF you show symptoms, you will have to call Ministry of Health helplines and get a laboratory testing done. If you don’t show symptoms during quarantine period, you won’t be tested.

India May See Avalanche of Cases By April, Why Are We Not Testing?
(Photo: ICMR)

This highly restrictive criteria explains the only 600 tests being done in a day. Among states, this number varies even more, with Kerala sending in maximum samples for testing, and isolating a far larger number of people.

At a press conference on 17 March, the Joint Secretary of Health, Lav Agarwal played down India’s ‘lack’ of testing. ICMR has been at pains to say that India remains in stage 2 of the disease, meaning it is limited to ‘local transmission,’ and hence there is no need for aggressive testing. ‘Local transmission means it is limited to immediate contacts of a COVID-19 patient. (You can read about stages of the coronavirus epidemic here.)

India May See Avalanche of Cases By April, Why Are We Not Testing?
(Photo: FIT)

FIT reached out to Dr Jacob T John, the former head of the Indian Council for Medical Research’s Centre for Advanced Research in Virology, a government-funded institution. In his words, “India will hit an avalanche of cases.” “India’s current testing policy may have been correct in February, even say in early March before WHO declared coronavirus a pandemic. Beyond it is is just not adequate,” he says, adding,

“The government policy is defined by the leadership. Currently the policy seems to be to wish away the disease,”

Who Will Ensure Quality of Private Labs?

After repeated questioning, the ICMR on 17 March “appealed to private laboratories accredited by the National Accreditation Board to offer tests to the public for free.” The labs will have to procure their own reagent, primer, probes etc and use commercial kits after gaining validation from ICMR, and National Institute of Virology. They will also have to ensure immediate real time reporting to the Ministry of Health.

“It’s like digging a well when the house is on fire,” says Dr John.

In an earlier presser, ICMR had said that they have to ensure that the private labs meet quality control standards.

“But who’s job is it to ensure these standards? We let private labs flourish for 30, 40 years without checks and suddenly we want to ensure quality. From modern, scientific point of view, many private labs just don’t meet the QC standards.”
Dr Jacob T John

ICMR has disputed the need to test aggressive, even as the World Health Organisation has been asking countries to ramp up testing. “We have a simple message to all countries test, test, test,” WHO Director General Tedros Adhanom Ghebreyesus told a news conference in Geneva.

ICMR’s approach though, is to do randomised testing of the vulnerable population. So far, their results say there is no ‘community wide’ infection in the country.

But the norms have been so limited that a senior government doctor in Mumbai tweeted his frustration.

As of 18 March, ICMR has not released the list of private accredited labs that will be roped in for testing. There is also limited understanding of whether these tests will be free or affordable.

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