Ongoing Strengthening of COVID-19 Testing Key for Containment of Pandemic

The year 2020 has proven to be one of unimaginable disruption and challenges for almost everyone. When the COVID-19 pandemic first started spreading across the world, India, like all other countries, was unprepared to deal with a disaster of this scale and size. With the second largest population in the world, we stood to lose the most, both in terms of life and economic impact.

However, thanks to the nation-wide lockdown and swift action taken by the Indian government in the early days of the pandemic, we were successful in slowing the spread of the virus and bought the country sufficient time to ramp up our testing and treatment capabilities. This also allowed us to lessen the load on our public health infrastructure, ensuring that hospitals and healthcare centres were not overburdened and had the capacity to care for every single COVID-19 patient.

Management of the pandemic has been a steep learning curve, given that it is a novel virus, but both the government and the country's health experts lost no time in initiating research and development to steadily improve testing, treatment, and management of the disease. The number of ICMR-approved laboratories for COVID-19 testing in the country is increasing by the day, and as of 18th November, there are 1157 government laboratories and 956 private laboratories. Resultantly, the cumulative daily test numbers have ranged between 10 lakhs to 12 lakhs throughout the month.

While steadily increasing the number of tests is a laudable feat, the accuracy of tests being conducted also needs to be kept in mind. The government's premier scientific research body, ICMR, had in the early months of the pandemic advised that Rapid Antigen Tests, which are known to be less reliable due to their tendency to occasionally give false negative results, not be used as the only means of testing. ICMR strongly recommended that individuals testing negative using Rapid Antigen Tests be re-tested using RT-PCR tests, which are more accurate.

However, in India, matters pertaining to health fall under the purview of the states, and in their endeavour to scale testing, many states have been relying heavily on Rapid Antigen Tests. The appeal of Rapid Antigen Tests is clear - the cost of these tests is nearly 1/5th that of RT-PCR tests, and they deliver results in less than an hour, compared to the average 48 hours required for RT-PCR tests. On the flip side, their accuracy rate can be as low as 50%, which would mean that half the people testing negative might in fact have COVID-19, and might continue to further infect people they come in contact with instead of quarantining.

This is not to say that Rapid Antigen Tests should be discontinued, but states should ensure that they are duly followed up by RT-PCR tests. To make this possible, states will need to ramp up use of both tests in order to get a reliable picture of the situation. Moreover, as advised by the World Health Organization (WHO), states should make efforts to separate test numbers and results data from the two different types of tests, so that the Centre has a clear understanding of the positivity rate and caseload in different regions, and can also compare the two datasets to assess the accuracy of the Rapid Antigen Tests and estimate total burden of the disease in the country. This accurate data is crucial for proper management of the pandemic and will allow the Centre and State Governments to be adequately prepared for spikes in numbers and subsequent waves of the infection. 

While most states have undoubtedly made tremendous strides in testing and COVID-19 management, it is safe to say that the battle is not won until every single citizen of the country is assured access to reliable testing and treatment. It has been made abundantly clear that geographical borders and distance can do little to stop this viral rampage. There is a need to increase the reach of our testing facilities and ensure that healthcare centres in even the remotest rural parts of the country have the resources and capacity to cater to the people in the region.

Testing and management alone are not sufficient to stop the pandemic in its tracks, and contact tracing will continue to play a key role in the containment of COVID-19. The Government’s Aarogya Setu app, an open-source contact tracing and symptom mapping platform, was a significant step in this direction. With more than 15 crore registered users, there is immense potential in leveraging this resource for contact tracing at a national level. However, since it is a self-assessment app, state governments will need to encourage and educate people about using it effectively. States should also make efforts to undertake independent contact tracing, by means of detailed interviews, etc., to identify people who might be at risk of contracting and spreading the virus. By quickly identifying and isolating/quarantining those who come in contact with individuals who test positive for COVID-19, states can not only slow the spread of the virus and protect thousands of people but also avoid another nation-wide lockdown and the economic slump that follows.