Misstep on testing

Reducing Covid tests will not help

The director of the Indian Council for Medical Research, Balram Bhargava, has recently pointed out lateral flow tests such as rapid antigen tests and home antigen tests have become the mainstay of testing during the Omicron surge. Dr Bhargava has argued there is no shortage of testing kits in the country, given that 15 million a day are produced, including RT-PCR tests. Yet there are questions that can rightly be asked about the prevalence of proper testing, particularly in hotspots like Delhi and Mumbai. After a record number of tests on January 12, the number of tests a day in these cities has been falling. In Delhi, the test positivity rate has reached over 30 per cent even as the number of tests administered has been falling. This is clearly not the right approach. It is vital for policymakers to ensure that there are enough tests conducted and reported in order to understand where the wave is peaking and where it still has time to run. While fatalities in the Omicron wave continue to be well under the equivalent number in the Delta wave, Mumbai’s death toll on Friday was nevertheless the highest in five months and it is important for health care planners to know if pressure on health facilities is likely to further increase.
 

Confusion over testing protocols has increased following the ICMR’s recommendation that asymptomatic contacts of confirmed positive cases need not be tested. It is unclear what the purpose of this suggestion is, given that Dr Bhargava has also claimed that there is no supply constraint for testing kits. The Delhi government has also stopped random testing at Metro stations, markets, and so on, apparently following the ICMR guidelines issued on January 10 that deprecate the testing of “asymptomatic individuals in community settings”. Some officials have been reported in the media as saying the purposeful decrease in testing has been to “reduce panic”. This cannot be a considered reason, since India’s response to Omicron has been notable for a complete absence of panic.

There are multiple negative consequences to this ill-thought-out guidance to reduce testing by the ICMR. It is not just the case that this leaves state and municipal authorities in the dark as to whether the wave is arriving, cresting, or declining in their region. It is also the case that reducing the habit of testing may serve India poorly in any future wave. There is no reason to suppose that Omicron is the last variant. Getting into the habit of regular testing is vital if India is to live effectively with Covid. In highly vaccinated but open countries such as the United Kingdom, tests have hitherto been freely available under the health service and people are encouraged to test themselves prior to attending events that may be crowded or have vulnerable individuals. India should also be encouraging and inculcating such behaviour, not disincentivising it. It is also unclear why protocols are being ignored when it comes to large-scale religious events, such as the Gangasagar Mela in West Bengal and others. Omicron may be less harmful than Delta, but there is no doubt that it could also stress the health care system beyond capacity. The authorities are being far too sanguine by reducing tests and allowing vast religious gatherings.