Nearing a month after the wave of Covid-19 infections began in India, testing in the country is a 60th of that in the UK, a 82th of that in the US, and a 241th of that in South Korea, highlighting an area where India continues to lag.
Although India has opened up testing to private laboratories — 47 of them — in addition to 127 government laboratories, questions remain about the availability of testing kits. On March 28, Dr Navin Dang, who runs Dr Dangs Labs, one of the private laboratories allowed to conduct Covid-19 tests, highlighted this gap.
Worryingly, questions also remain about whether the Indian Council of Medical Research (ICMR) has set unrealistic standards for testing kits. According to its guidelines, ICMR allows US FDA approved kits and European CE-mark kits to be used after due approvals; for other commercial kits, it said that approval would be granted only to those who have a 100% condordance among both true positive and true negative samples (sensitivity and specificity) — a condition that several experts have described as unrealistic and restrictive.
Of the 17 commercial kits sent for approval so far, only four have cleared the parameters.
Dr KK Aggarwal, head of the Confederations of Medical Associations of Asia and Oceania (CMAAO), said the ICMR has said that only symptomatic patients should be tested for Covid-19. “If the asymptomatic persons are tested, the number of Covid cases, as in Kerala and Maharashtra, can increase. But, one should understand that the entire population can’t be tested,” he said.
R Gangekhedkar of ICMR said on Sunday that the capacity utilisation of the body’s network of labs is only 30% — indicating that states can scale up tests. Gangekhedkar also said there were enough kits to conduct additional tests.
Till March 30, India has conducted 38,442 tests for Covid-19.
That works out to one in around 34,000 people, or roughly 32 in a million being tested. Germany, now the benchmark in testing, is testing 500,000 people a week, according to data analysis website ourworldindata.org. Germany, as of Monday, had nearly 63,000 cases, but managed to keep the number of deaths to 560, a fatality rate of under 0.9.
As of March 29 and March 30 respectively, the UK and the US, both widely criticised for their testing ratios, had tested around 127,737 and 851,578 people — roughly 1,921 per million and 2,600 per million. Dr Aggarwal said countries like Germany and South Korea, which conducted mass tests, don’t adopt complete lockdown strategy like India.
India’s testing protocol for Covid-19 has evolved, but remains restrictive: Until March 20,only symptomatic health care workers treating Covid-19 patients, or symptomatic individuals, with either a history of travel or who had contact with an infected person, could be tested. This was then changed to include asymptomatic health care workers caring for Covid-19 patients, and also asymptomatic individuals with a history of travel or contact with an infected person.
The most tests in India have been conducted in Kerala. The state, which accounts for 3% of India’s population, has conducted around 7,000 tests. As of Monday night, Kerala has reported 234 Covid-19 cases, the highest after Maharashtra.
To be sure, the testing criteria is likely responsible for this — the earliest cases were in Kerala as were some of the later ones where contact tracing showed that an infected person had been in touch with a large number of people.
Still, data collected from state government health bulletins shows that the more populated states such as Uttar Pradesh, Bihar, West Bengal, Jharkhand, Madhya Pradesh and Odisha have conducted fewer Covid-19 tests in absolute numbers as well as tests per million population — a strong argument for relaxing the testing criteria even more.
While Kerala has the ratio of 200.3 tests per million population, the numbers are as low as 5.3 for West Bengal, 8.3 for Madhya Pradesh, 5.95 for Rajasthan and 12.2 for Uttar Pradesh (for all states, please see graphic).
The health officials of these states maintain that the situation is not as alarming as in Kerala and Maharashtra, which together account for about 40% of total Covid-19 positive cases in the country. Unlike Kerala, which started testing in February, most other states started conducting tests after March 20, when they started reporting their first cases. Both Kerala and Maharashtra have also been aggressive with contact tracing, where all people an infected person has been in touch with are traced — and tested.
“We have increased the number of laboratories; 113 have been made functional and 47 private laboratories have been given the approval to conduct Covid-19 tests,” Gangekhedkar said.
Independent health experts continue to recommend more widespread testing.
“Tests, tests and tests is the only solution. We need to go for the rapid screening test to cover maximum people,” said Dr Sumon Poddar, associate professor, Institute of Child Health, Kolkata.
Dr Ajay Kumar, former national president of the Medical Council of India, said tests are must to identify the spread of the disease, especially in the context of the large-scale migration of workers from cities to rural parts of India in Uttar Pradesh, Bihar, Odisha, Jharkhand and West Bengal. “More tests may mean higher Covid-19 cases, but they will help to contain the spread before it is too late.”