- Target to conduct 1 lakh tests per day by May 31
- Change criteria for testing; test to reduce mortality, says expert
- Pooling approach for testing is being used, but sample size is still kept at five
- Despite rise in testing, under-testing concerns remain
Going by Prime Minister Narendra Modi's speech on Tuesday, Lockdown 4.0 will take a fresh form with new rules even as coronavirus caseload has been rising in India despite three phases of the lockdown. Another key area that may witness some changes is coronavirus testing. The government is considering a change in testing strategy and working on a more calibrated approach. The idea is to look at high risk groups and deploy means, such as pooling approach, to achieve PMO-target of 1 lakh tests per day by May 31 from around 85,000 at the moment.
A senior official in ICMR (Indian Council of Medical Research) tells Business Today that the process is on to review the testing strategy. The changes will be shared in the public domain over the next two to three days. The official, however, cautioned that these details have to be carefully observed to devise a strategy without leading to a situation where private hospitals, taking umbrage under the government guidelines, start refusing to admit certain set of cases.
While details of the plan will be clearer soon, experts feel the testing is still low. Given the size of the population and the rising caseload, change in testing strategy is the only way forward. "Anybody above the age of 60 with even slight symptoms must be tested. We need to change our criteria for testing, which has remained too rigid and limited to only those who have severe and acute respiratory illness. Around 85,000 tests per day for 1.4 billion people is a drop in the ocean and not going to be enough, so we need to think about how to target testing strategically," says Professor Ramanan Laxminarayan, senior researcher at the Princeton University, who has been following developments in India quite closely.
According to Laxminarayan, identifying the case is not an issue because it really does not help in counting of the tests. "The 20-year and 30-year olds are not going to have a bad outcome as mortality in this age group is low. Instead, we need to focus on cases with highest risk of mortality".
"Testing has increased in India but it needs to keep pace with the rate at which the cases are increasing. While the number of tests has increased, this is a vast country and there are so many cases that are not getting detected by the system," he says, explaining that the focus now should be on testing to reduce mortality rather than doing it only for containment. Besides, we are unlikely to track cases once they get to hundreds of thousands, he says. 'We are undercounting deaths at this point of time because there are people dying of COVID but not getting the test to begin with. The government is figuring this out and trying to count deaths better. One measure in this direction is the view to count a death as a probable COVID-19 death even if the patient was not tested but had symptoms".
So far, testing has been done to see how the pandemic is growing. Now we need to use it to reduce mortality and depend more on pool testing and anti-body testing. Pooling approach to testing is where several samples are tested at one go. If the outcome is negative then all are cleared but if it is positive, each sample is tested individually. He feels some states are already using pooling method of testing, but the ICMR guidelines are still unclear and the criteria of pooling of five samples is also insufficient. Some experts have pointed to other countries where 16 samples or more have been successfully tested at one go. However, government officials say since the purpose of pooling is to speed up testing, for efficient use of resources the ICMR guidelines focus on using it where there is low prevalence of injection (less than 2 per cent). For instance, it could be done for a large group of healthy migrant workers where five samples can be pooled together. So, in low prevalence zones, rapid testing is possible as chances of positive cases will be low and will not require individual testing. On the number of tests done so far using the pooling method, the ICMR officials say the numbers are still being collated.
Another challenge at the moment is lack of uniformity across states on testing. Central officials call it a state issue with central agencies having limited mandate though sources say even the director general of ICMR has written to states to get testing done by the approved private laboratories, which is still not happening in some states.