Coronavirus: doctors slam India’s limited testing as fears of community spread grow

Ravi Kumar, a taxi driver in Bangalore, keeps frantically checking his smartphone messages to check the latest updates on coronavirus testing in India.

The 32-year-old, who made more than a dozen trips to the international airport in February, is worried he could have picked up the Covid-19 infection, but he has no way of confirming it.

Kumar is perhaps among thousands of worried individuals in India who are not eligible to undergo tests for the coronavirus because of restrictive measures imposed by the government.

The country has recorded 151 cases, three deaths and 13 recoveries as of Wednesday. But experts are concerned these numbers do not give a true picture of the situation, as the number of tests conducted in India is worryingly low compared with that of other nations.

Public health experts have urged the government to rapidly boost the number of tests so as to accurately assess the situation and catch people at the stage of community transmission – a pre-epidemic stage where an individual with no known travel to affected countries or direct contact with another patient is infected.

Since February, some 12,513 tests have been conducted, accounting for about an average of nine tests per million people. This compares with about 25,000 tests conducted in the United States, 134,000 in Italy, and 274,000 in South Korea, which has been lauded for its aggressive testing policy.

South Korea’s model of comprehensive screening has seen roughly 3,700 tests per million people conducted, offering potentially the clearest picture of the threat posed by the Covid-19 outbreak.

But officials in India say they will not take South Korea’s lead, insisting that the scenario in the country does not warrant such drastic measures.

India, the world’s second-most populous country with 1.3 billion people, has set up 72 coronavirus testing facilities across the nation, mainly in the cities which have an international airport. By the end of this week, 49 more labs are set to open, with the government bearing all costs of testing.

However, only individuals with a recent travel history to a coronavirus-affected location, those suffering from severe symptoms, or people who have come in direct contact with confirmed patients are allowed to take the tests. Those like Kumar who do not fall under these categories will be turned away even if testing is recommended by a doctor.

“The government is following a circular logic, saying, ‘We will only test travellers and their contacts when they develop symptoms’. When they find a positive case they say, ‘See, it was imported – so there’s no community transmission’,” said public health specialist Manjunath Shankar.

“We are likely to miss community spread unless we start sentinel surveillance sites to catch it or start testing widely,” he said.

Gagandeep Kang, director of the autonomous body Translational Health Science and Technology Institute, and an expert in community health, said India should be testing as widely as possible.

“There is an argument to be made for restricted testing if the resources are limited. But the stronger argument is: let’s invest what it takes to do the testing so we get a better handle on the problem, and we decide what to do with the data,” he said.

“Right now, we have no evidence of community transmission because we have not tested enough,” Kang said.

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Some critics of the government have suggested the authorities are not conducting enough tests out of fear of repercussions for its political image.

The Indian Council of Medical Research (ICMR), the apex health research body spearheading the testing efforts, said authorities could process 10,000 test samples a day when all the labs were fully operational and enough test kits were available.

The agency, which has ordered 1 million probes for the testing kits to boost its capacity, has said the rationale for restricted testing is to prevent inciting public panic, but it admitted that medical resources were being under-utilised. The agency is increasing the number of random tests, but this is amounting to just dozens.

It added that test results would take up to two days to be confirmed, although changes to bureaucratic protocols has since reduced the turnaround time to six hours.

The Indian Medical Association on Wednesday urged the government against sharing daily updates on the coronavirus, saying it would cause unnecessary panic.

“Sharing of data on a daily basis with the public, who are clueless as to what is expected out of them, has created panic,” the IMA said in a statement.

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“Given where we are right now with the spread and the numbers rising, one would think we should make a more expansive testing strategy,” said Anant Bhan, a researcher in global health and policy.

“There is a strong possibility that there could be community transmission happening right now, and the only way to find out is through expansive tests. If you’re being too restrictive in the way you test, you’re missing out on a lot of cases who are on the move and spreading the infection,” he said.

“We call ourselves the pharmacy for the developing world,” Bhan said. “Why should we not leverage our pharma capacity for manufacturing or our biotech capacity for innovation?”