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Sunday, January 17, 2021

Smart tests must go on

Vaccination drive will begin in less than a week. But we should not let down our guard against the virus.

Updated: January 11, 2021 12:03:09 pm
coronavirus news, covid-19 latest update, covid-19 india news, covid vaccine india, coronavirus india dry run, covishield covaxin india vaccine,Dry run for coronavirus vaccine at a Noida hospital (Express photo by Abhinav Saha)

Written by Amar Patnaik

After nearly a year of struggle, the world seems to finally be entering the conclusive phase of battling the coronavirus. We have collectively learnt and improved a lot along the way, as evidenced by the sharp drop-in mortality rates despite high rates of hospitalisation in most countries. We also have multiple vaccine candidates with very high claims of efficacy, applying for emergency use authorisations with regulators globally, including in India. Countries have started approving the use of these vaccines as well, and some like the UK have already launched mass vaccination campaigns. Two vaccine candidates have been approved in India, and the vaccination drive is set to begin in the country on January 16.

However, as optimistic as the times to come may seem, it is crucial that we do not take our focus off the task at hand — minimising the spread of the infection by rigorous testing and contact tracing. Instead of letting our guard down, now is the time for the country to increase vigil and consolidate all the gains that we have achieved thus far. Our premier scientific research institution, the ICMR, has gained a lot more information and experience with the novel coronavirus and expecting clearer and more decisive strategies is natural. Already several states are leading by examples and offering critical lessons to formulate strategies for the country.

Odisha, for instance, has exceeded expectations in its management of the pandemic considering all the odds that were stacked against it. The state powered through the challenges of infrastructure inadequacy, existing health burden and also survived destructions brought by Cyclone Amphan solely because of the state government’s resolve and timely action. The administration followed a scientific and data-driven decision-making process to keep the virus under check within the region. They ensured equity and accessibility of testing, backed by a smart tracing strategy to keep check on the spread of the virus. In early December, the cost of RT-PCR tests at private labs was capped at Rs 400 in the state, the lowest in India, to make testing for COVID-19 vastly more accessible and affordable. This was done keeping the local context in mind — that a large population of the state is economically vulnerable and has one of the lowest per capita earnings in the country. Additionally, to ensure that people can get themselves tested without having to travel afar, in the last nine months, more than 55 COVID-19 testing labs have been operationalised in the state.

These steps have yielded some positive results already. From nearly 1,500 cases daily in the first week of November, the numbers have reduced by more than two-thirds to less than 400 in just the month since. This is while the number of daily tests conducted has remained stable, despite the sharp fall in positivity. Such a remarkable testing strategy has also been well complemented by equally important measures such as door-to-door health screening so as to be able to actively scout for those with symptoms. Keeping in view the above, it is not surprising that Odisha has among the lower rates of test positivity as well as fatality among states in India. There is now a need to emulate this successful model of testing and tracing at a national scale.

With the arrival of vaccines for COVID-19, the importance of putting in place a smart testing and tracing strategy for the entire country has gone up manifold, contrary to popular perceptions. Despite best efforts from all stakeholders, it will take several months to reach the critical mass of population necessary to break the chain of transmission under a national vaccination strategy, especially since most vaccines require the initial dose to be followed up with a second dose after an interval of three to four weeks. Moreover, there are groups which are being prioritised (healthcare workers, frontline workers, persons above age of 50 and those below 50 with associated comorbidities) and a graded plan of access will have to be drawn up. Given India’s sheer population size, relatively underdeveloped infrastructure (like, existing cold chain systems) as well as the logistical considerations associated with different vaccine candidates, it may prove to be a challenge to cover a majority of the population immediately. At this time, tools like testing and testing have to continue to be leveraged, especially among populations that do not feature in the priority order. This is not the time for complacency.

It is evident from Haryana’s home minister Anil Vij’s case that testing will continue to occupy centre-stage even after the vaccine is administered. Shortly after receiving the first dose of Bharat Biotech’s Covaxin trial vaccine, he announced that he had tested positive. This does not sufficiently allude to the low efficacy or utility of the vaccine, given that this was a double-blinded trial where he may have been administered with a placebo. By his own admission, he had not received the booster dose of the vaccine, which was a necessary component. But fact remains that it is entirely possible to get infected in the interval between the two doses since the body does not develop sufficient immunity and testing in the interim is the only way to detect such cases.

Similarly, for drawing up a national vaccination strategy, it is crucial to gauge the spread of the virus and check for those with antibodies through previous infection to further filter the prioritisation list and reserve the initial set of vaccines for those in need of higher protection. Despite having an impressive indigenous vaccine manufacturing capacity, there are several limitations which will hinder the universal coverage of the vaccine for a substantial amount of time. It is important that the country and all institutions spearheading the response against the pandemic explores a smart testing and tracing roadmap, alongside designing strategies for vaccination.

The writer is national spokesperson of BJD and a Rajya Sabha MP.

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