India has now got fifth place in the world for coronavirus cases with 2,76,583 cases reported so far. For the first time yesterday number of recovered cases in India overtook number of active cases, however this good news will be short lived as it is expected that cases are going to see massive surge in the coming months as lockdowns are eased and social distancing relaxed. Already big cities are struggling.
Mumbai now has 51,100 cases, 1,760 patients are dead. The national capital alone has more than 30,000 cases and is now struggling with paucity of beds and the difficulty of getting a test done. Number of containment zones in Delhi has risen to 237 and Deputy Chief Minister said the national capital might see its own case count reach 5.5 lakh by July 31 at the current rate of doubling of cases of 12.6 days.
India witnessed one of the most draconian lockdowns in the world. Apart from extensive economic damage the lockdown saw tragic plight of migrants trudging back thousands of kilometres without food or water and belated Shramik trains losing their tracks leaving many dead due to starvation. Factories closed down and thousands lost their jobs. Job cuts and salary cuts were witnessed in almost every sector and situation is not expected to improve anytime soon. Mismanagement, very low testing and containment, and inefficient contact tracing have led to huge surge in cases despite a tough lockdown. Most countries witnessed a flattening of the curve by the time they took first steps to reopening, however India is yet to even peak.
Experts have opined that India’s testing capacity must grow by a factor of ten and India’s testing capacity is still drastically insufficient for the needs of the population. In fact India’s testing rates are one of the lowest in the world. India has conducted approximately 3.8 million tests since it began testing in February. Daily COVID-19 tests per 1,000 people are only 0.08 in India compared with 1.16 in the United States and 1.02 in Italy (as of May 30, 2020).
Delhi, which is one of the worst hit, has a tightfisted testing strategy. Delhi CMhas tightened the norms for testing asymptomatic persons. ICMR also has restrictive guidelines that mandate anyone wanting to be tested must have been exposed to someone with COVID-19. In fact, according to Ministry of Health’s revised discharged policy, COVID-19 patients with mild and moderate symptoms need not be tested before discharge if they don’t have fever and don’t need oxygen therapy. This is when there is no shortage of testing kits. In fact anyone should be allowed to get tested for COVID-19. After all most labs all over India allow people to get tested for most ailments and routine health parameters without prescriptions. There are a number of PILs in court on this issue. It is being alleged that testing is being kept deliberately low as a political strategy.
However limited testing is a self-defeating move. Around 20 percent of people tested, test positive. That is a high enough percentage to warrant more tests. This is the only way to quickly contain the disease and do efficient contact tracing and containment. Countries that have managed to control the spread of infection like Taiwan, South Korea, New Zealand have one of the highest rates of testing. In fact New Zealand, where the last COVID patient has recovered, did 2,190 tests per 100,000 people higher than even South Korea (which had drive through testing centres) and conducted 1,140 tests per 100,000 people. Higher testing becomes all the more vital in India since it has a high population density, extremely large area and has just witnessed a mass internal migration. Moreover our health system is poor with one of the worst doctor patient ratio and extremely low bed capacity. However India does have a decent spread of labs and has seen a proliferation of the private diagnostic centres, especially in smaller cities. The governments can utilize these for increasing testing coverage.
Testing extensively will not just help in containment but also aid the government in identifying asymptomatic patients active or the ones who have recovered and are carrying anti bodies. This can give an estimate of population disease burden, and an idea about spread according to geography, age etc. This can help in designing better strategies, more suited to Indian population with all the prevalent co morbidities, to combat the spread. A better long-term policy will be essential for a nation with such high population density. Even when vaccine becomes available, immunization programme will be greatly benefitted by this data for more efficient targeting.
The views expressed are author’s own.