Covid-19: Testing times

India should make up for lost time in involving private labs

Rapid growth in the number of COVID-19 cases to more than 400 on Monday underlines the shortcomings of the Indian government and health establishment’s response to the global pandemic. Nothing underlines this better than the under-resourced policy towards testing, which runs counter to what many countries are doing. For example, more than lockdowns, the key to South Korea’s success has been a large, well-organised testing programme, combined with extensive efforts to isolate infected people and trace and quarantine their contacts. Also, unlike Singapore, which has been able to contain the disease via a liberal testing policy, India’s policy of testing only individuals with symptoms and relying on chain-of-contact detection to quarantine others is proving to be ineffective. This limited response is also the result of the poor state of the public health system, where testing laboratories, restricted initially to 11 government institutes, have been rapidly overwhelmed. Since the private health system accounts for the bulk of India’s healthcare delivery, it would have made sense to have co-opted it much earlier. Yet, the 50-odd private labs that sought permission to test had to jump through the hoops of red tape that infect the ease of doing business in India.

On Saturday, the government finally issued guidelines allowing private laboratories to test. These labs must have specific certification from the National Accreditation Board for Testing and Calibration Laboratories (NABL) to test for Covid-19, using US Food and Drug Administration or European standard tests. It has also capped the cost of the test at Rs 4,500. The guidelines require a registration number from the Indian Council of Medical Research and coordination with its database. This involves transporting positive samples to the ICMR’s National Institute of Virology (NIV). The government has also allowed all its national laboratories to carry out clinical testing of Covid-19 based on self-assessment. 

This shift in policy is unlikely to counter the threat of India falling into Stage 3 — community transmission. First, it is unclear whether the 2,500-odd NABL-accredited labs have such testing capabilities. For example, in Maharashtra, which has recorded one of the highest outbreaks of the disease, only four private laboratories have the capabilities to conduct Covid-19 tests. Second, stipulating the use of specific imported kits, which are also expensive, is self-limiting. The government should be focusing in parallel on producing more testing kits in India. So far, the only initiative in this direction has come from the Indian Institute of Technology, Delhi, which says it has developed a method to detect Covid-19 at a significantly reduced cost. This kit is being validated at the NIV but the timeline from lab to critical-mass manufacture is unclear.

The bigger question is whether the government recognises the extreme urgency of the crisis at hand, as India, the world’s second-most populous country, remains among the world’s most under-tested countries. The problem lies in the approach. Where the World Health Organization is stressing “test, test, test”, the health ministry stresses “isolation, isolation, isolation”. Since it is now evident that there is a positive correlation between tests performed and cases confirmed, it is impossible to view with any complacency the low rate of the outbreak relative to its population (as opposed to, say, the US or Italy). It is time India made up for the lost time.