Testing times

Without correct data, policy decisions will be difficult

For a major country with one of the world’s highest population densities, India appears to be an outlier in the Covid-19 pandemic with just over 1,100 cases till March 30. The country appears, as far as it is feasible to know, to have evaded community transmission so far. A new Standard Operating Procedure, issued by the health ministry for transporting a Covid-19 case on Sunday, refers to India’s current phase of the pandemic as “local transmission and limited community transmission”. When compared with the world’s hotspots — the US (over 140,000), Italy (over 97,000), and Spain (over 80,000) — or others such as Iran (38,309) or even Pakistan (1,625) — India appears to have fared well. The rate of growth of reported cases, too, seems to have tapered. After spiking more than 40 per cent on March 11, 10 days before the nationwide lockdown, the daily growth rate of new cases has dropped, though the absolute numbers have risen. An interesting debate follows: If India genuinely has low numbers, the lockdown was unnecessary because it has wrought human and economic havoc. On the other hand, it could be claimed that it is the lockdown that has kept the numbers low. With just under a week into the lockdown, however, it is impossible to judge its impact. Equally, given the variable nature of statistical reporting in India, the numbers themselves may be open to question. 

The short point is that without more universal and rigorous testing, it is difficult to gauge the next step: Whether to extend the lockdown or end it. This decision can be taken once the government has definitive test results to work with, since reports have shown that the states that have tested more people have reported more cases. Currently, however, the Centre’s testing policy is limited to those showing symptoms or those with a travel history. Updated knowledge of the nature of the virus suggests that it is not enough, since it is possible for infected people to remain asymptomatic and yet become carriers in the absence of testing. According to the Indian Council of Medical Research (ICMR), only 34,931 tests had been conducted as of Sunday, representing about 30 per cent of the capacity utilisation. Last week, the ICMR sought quotations from suppliers for a million antibody kits (for screening via blood tests) and 700,000 RNA extraction kits (or the swab test) and expanding the number of government and private labs to conduct these tests. This is not nearly enough for a population of 1.3 billion, a good chunk of whom — urban migratory workers — have been forced to jettison social distancing to head back to their villages.

Access to tests is one part of the problem. According to the ICMR, only 113 government labs have been made functional and 47 private labs have been given approval to test for Covid-19, the bulk of them in urban areas. The social stigma of being tested is acting as a deterrent too, according to accredited private labs. This apart, the relatively high cost of testing — the government has capped it at Rs 4,500 per test — is sure to deter most Indians from opting for it anyway. In this situation, it is vital for the government to not only exponentially expand testing facilities but also foot the bill. This looks like an expensive proposition for a government battling a mounting fiscal burden. But when compared with the consequences of bringing the Indian economy to its knees, it is a small price to pay.