Time for a testing strategy

Private sector must also step up and contribute to effort

Re-opening the economy without having controlled the spread of the novel coronavirus was always going to be a gamble — albeit one that India cannot afford to lose. Ideally, a country should achieve such control through lockdowns, border closures, and contact tracing prior to re-opening. This is what has been achieved by some countries in Oceania and Europe, which have the advantage of being considerably smaller and better off than India. In this country, the government has clearly decided to go with another strategy, given that re-opening was determined to be necessary. But the only other alternative strategy available is one of widespread testing and selective quarantining so as to manage the spread. Partial and localised lockdowns might be imposed as and when a hotspot or a super-spreader event is identified.

This strategy, however, requires widespread testing — both through the RT-PCR test, which determines if an individual is infected, as well as through serology and antibody tests, which provide information as to whether an individual has already been infected. On this count, the Union and state governments have clearly failed to scale up testing to the degree necessary. Several indications of this are now available. First, there continues to be some confusion as to who is eligible for a test — in spite of an impressively high test production capacity, of 5 million test kits a day, the number of tests a day nationwide remains around 150,000. In hotspot cities like Mumbai, the number of tests a day is 4,000. Compare this with Beijing, where a single super-spreader event at a seafood market over the weekend caused the authorities to test 70,000 people in a single day. 

Second, some government estimates, through larger-scale serosurveys, have been reported. One suggests that the number of infections in India might be 20 times as many as the number of confirmed cases through testing. And another report — albeit underplayed by the authorities — suggests that a third of individuals in containment zones might have been infected. If these are the numbers at the beginning of the re-opening, then a lack of widespread testing begins to look like a recipe for disaster.

It is clearly necessary to scale up testing widely. If the government is struggling to manage, then other players will also have to step up. Certainly, there is no reason for companies and large organisations to not have a role to play in this effort. Larger companies should regularly test their employees, at their own expense — this will aid their operations. Training skilled health care workers in the administration and analysis of tests must be stepped up, and the regulations that constrain the expansion of testing must be relaxed for the duration. Education regarding proper mask usage and hand hygiene is also essential — many Indians are wearing masks without covering their nostrils, which renders the effort pointless. Too much energy is being expended on passing the political buck among various levels of government. Also, there is a lot of variance across states. While states such as Telangana have been rather opaque in the release of the testing data, Maharashtra and Gujarat have not increased overall testing to account for the relative rise in the size of the outbreak. This must end, and a comprehensive nationwide testing strategy should be developed and include a prominent role for the private sector. There is no other alternative. Limited testing will only delay the normalisation of economic activities.