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Testing matters

Directive to ramp up tests is welcome. Testing regimens must heed epidemiological realities, make best use of resources.

By: Editorial |
April 11, 2020 12:20:26 am
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On Friday, Punjab became the second state, after Odisha on Thursday, to announce a fortnight’s extension of the lockdown in the state — the 21-day nationwide lockdown is scheduled to end on April 14. Karnataka, Telangana and Maharashtra have also expressed their reluctance to lift the restrictions. With the country’s COVID-19 caseload surging past 6,000, some states are, reportedly, unsure about the spread of the virus. The challenges of community transmission have also increased after an Indian Council of Medical Research (ICMR) study reported COVID-19 in patients of severe acute respiratory illness (SARI) in 36 districts, given that these patients had no history of international travel or contact with a COVID-19 positive person. In such a situation, the salience of the Union Ministry of Health and Family Welfare’s directive to all states and Union Territories to ramp up testing cannot be overstated. On Friday, it asked all states to increase the number of samples for testing to at least 2.5 lakh by April 14 — so far, about 1.6 lakh tests have been conducted in the country.

India has, so far, and rightly, scaled up testing gradually. Rather than follow WHO’s test-test-test advice, the ICMR held that selective testing would ensure optimum utilisation of test kits. The health ministry’s Friday directive seems to signal a timely recalibration. For, it fits in well with the strategy, framed last week, to target the virus aggressively in hotspots. Epidemiologists have warned, however, that India doesn’t yet have an accurate picture of COVID-19 hotspots. As Harvard Global Health Institute’s Faculty Director, Ashish Jha, told this paper, “If a place is not doing a lot of testing and doesn’t have a lot of cases, that doesn’t mean it’s not a hotspot.” It is welcome, therefore, that the government intends to conduct tests in the 430-odd districts that do not have a single COVID-19 case. Its plan to use the pooling method for this purpose is also apt. The method uses the highly accurate real-time polymerase chain reaction (RT-PCR) test in a combined sample from several people. If this sample tests positive, each person in the group is tested separately. These tests could reduce the time, cost and resources required in identifying infected people — a negative test rules out the necessity for further tests in a cluster while a positive sample helps identify areas for targeted public health intervention. This could also be a powerful tool to screen labour so that economic activity can start coming back on track.

Last week, the ICMR released guidelines for serological tests, which deliver results in 15 minutes, work on blood samples and tell whether a patient has ever been exposed to the virus. But these tests cannot detect the virus at an early stage of the infection. As India brings more people under the ambit of testing, it is critical that testing regimens and the surveillance mechanisms of healthcare authorities take into account the epidemiological, social and demographic realities, while making the best use of stretched resources.

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