Covid-19 - Importance of Testing

What is the issue?

As the world is faced with the challenge of Covid-19, here is a look at the role of ‘silent spreaders’ and the importance of testing in tackling the pandemic.

Who are the silent spreaders?

• Silent spreaders are people who spread the disease unknowingly or to avoid the social stigma.
• The silent spreaders include asymptomatic, pre-symptomatic and undocumented symptomatic cases.
• Asymptomatic cases: These are people who carry the active virus in their body, but never develop any symptoms.
• They, however, shed virus and can infect others.
• Studies show that as many as one in four people infected with Covid-19 could be asymptomatic.
• Pre-symptomatic cases: These include those who are incubating the virus and would show symptoms only after a few days or even weeks.
• They also transmit the virus to others.
• Undocumented symptomatic cases: These cover people who have mild symptoms, but did not get tested.
• The reasons may be lack of access to testing or the stigma attached to the disease.
• They have a very high potential to spread the disease.

What is the current level of testing in India?

• Presently, the Covid-19 positive cases as reported in India are relatively low.
• However, this is said to be much due to the low level of testing.
• Getting a test for Covid-19 is still an arduous task for common people in India.
• The data on the number of tests reveal that India is just focusing on symptomatic cases as the Indian Council of Medical Research (ICMR) guidelines recommend so.
• Other than that, only asymptomatic family members of infected people, and asymptomatic healthcare workers are being tested.
• Certainly, the prescribed regime leaves a large number of potential cases untested.
• Also, with a stigma now attached to this disease, people are even less forthcoming to get tested.

What are the shortfalls?

• For a long time, ICMR only recommended RT-PCR method for testing individuals. Click here to know more on the testing methods.
• RT-PCR, while accurate, takes a lot of time in testing and limits the capability in doing large-scale tests.
• Only 20,000-25,000 tests are done in a day, which is a minuscule, compared to what is required.
• Private labs were allowed to test only 7 weeks after the first case was detected in India.
• So, a large pool of resources at our disposal was not used for quite some time.
• The ICMR issued guidelines for the rapid antibody blood test only 9 weeks after the first reported case.
• The Kerala government’s plans for rapid testing got ICMR approval much later than the proposal was made.
• It was after full 10 weeks since the first confirmed case that ICMR issued an advisory on pooled testing using RT-PCR.
• Even this advisory limits the number of samples to five and only for areas where the prevalence rate is low.
• For comparison, Israel has allowed pooled testing of as many as 64 samples using the standard PCR testing procedure.
• Clearly, ICMR advisories, therefore, are at least a month behind global developments.
• While the desire for accuracy is understandable, there has to be a balance between accuracy and speed, where India seems to be missing out.

What is to be done?

• There is an urgent need for massively enhancing rapid tests and pooled tests to increase the number of tests, and bring some balance in the testing strategy.
• India should fully utilise all the testing capabilities in the country.
• There are at least 600 colleges in the country that are handling biotechnology courses and which would have a PCR, if not RT-PCR. 
• Besides, there is a large number of RT-PCR/PCR with private research centres.
• These colleges and research centres should be involved in testing.
• More importantly, there is a need for starting large-scale community testing in India.
• In this regard, pooled tests can be done and mobile centres can be used to collect samples.
• Though hotspots can be prioritised, community testing should not be restricted to only hotspots.
• These measures can go a long way in capturing undocumented cases and halting the spread of this virulent disease.

Source: Financial Express