As the world grapples with the coronavirus pandemic, the World Health Organisation(WHO) was clear in its message to all countries - to test every suspected case of the virus.
"We have a simple message to all countries - test, test, test," WHO head Tedros Adhanom Ghebreyesus had told reporters in Geneva last month.
"All countries should be able to test all suspected cases, they cannot fight this pandemic blindfolded," he had said.
India, as of Friday, April 4, has reported 2,301 cases of COVID-19. Of this, there are 2088 active cases, 156 have recovered, and 56 have died. To curb the spread of the virus, the country is now under a 21-day nationwide lockdown.
However, despite WHO's advisory on rampant testing, is India testing enough?
According to ICMR guidelines, the current testing strategy(updated on March 20) is as follows:
- *All symptomatic individuals who have undertaken international travel in the last 14 days.
- *All symptomatic contacts of laboratory confirmed cases.
- *All symptomatic health care workers.
- *All hospitalized patients with Severe Acute Respiratory Illness (fever AND cough and/or shortness of breath).
- *Asymptomatic direct and high-risk contacts of a confirmed case should be tested once between day 5 and day 14 of coming in his/her contact.
"Once community transmission is documented, the above testing strategy will undergo changes to evolve into stage appropriate testing strategy," ICMR says in its guidelines.
Till March 19, however, India was testing only symptomatic patients with international travel history and those who had come in contact with people who had tested positive for the virus. But, with the rise in the number of cases, the guidelines were extended to all hospitalised patients with pneumonia-like symptoms.
According to the central government, India is still in the local transmission phase and has not entered Stage 3 of COVID 19 - the community transmission of the virus. As per WHO, stage 3 is when the source of the infection for a large number of cases remain unidentified.
"No community transmission has taken place so far. Only local transmission of COVID 19 is seen in India, "Luv Aggarwal, Joint Secretary, Health Ministry, said at a press briefing on Monday, March 30.
Alarmingly, at the same press conference, Dr Raman R Gangakhedkar, head of epidemiology and communicable diseases at ICMR said, "We are still at less than 30% of our testing capacity."
As of Wednesday, April 1, India has tested 47,951 samples - only a mere 34.67 tests per million people. Compared to other countries affected by the virus outbreak, India's testing rates are extremely low. While Italy has conducted 9,156.16 tests per million, the figure stands at 8,184.27 for South Korea, according to Our World in Data.
A major reason for India's low testing figures is that the country has only 178 laboratories that have been approved by ICMR for COVID-19 testing. Of this, 126 are government laboratories and 52 are private.
"Covid-19 testing and its trajectory cannot be decided until we have adequate testing facilities. In my view, we have more cases than are being reported, and we are not testing enough people," Dr Kunal Sharma, oncopathologist and section head, pathology, SRL Reference Lab, Bengaluru, was quoted by Live Mint.
While public health experts have said that India does not have enough testing kits, ICMR has said otherwise. On March 17, ICMR scientists said India had 1.5 lakh testing kits. Meanwhile, one million probes – an integral part of the testing kit – had been ordered from Germany. They had also requested one million probes from WHO. However, the current numbers are unclear.
Furthermore, testing in India is also being limited to avoid overburdening the already under capacitated healthcare system. India has only one doctor per 10,000 people, while WHO recommends at least one doctor per 1,000 people.
Steps To Scale Up Testing
In order to scale up testing, states can now use rapid testing kits to screen large numbers of people in hotspots for the virus, ICMR said on Thursday. Furthermore, ICMR has expanded testing capacity by allowing all national research laboratories, including those under the Council of Scientific and Industrial Research (CSIR), to screen suspected patients.
The new rapid testing kits will involve two levels of testing - a serological test conducted on blood samples to detect whether the person has been exposed to coronavirus, and the second test uses real time-polymerase chain reaction (RT-PCR) by taking a throat or nasal swab.
"The changes in testing protocol are being discussed. The final protocols will be out by Friday morning," Dr Gangakhedkar was quoted as saying by Live Mint.
Also Read: Coronavirus More Active In Countries Without TB Vaccine Policy: Study