A case against random COVID test

Updated: 07 September, 2020 07:21 IST | Ajaz Ashraf | Mumbai

Indiscriminate testing is identifying only a minuscule number of infected citizens and is bleeding the state dry. An alternative school suggests targetted testing, treatment and refocussing on immunisation programmes and other neglected ailments inst

The alternative school wants authorities to focus on the symptomatic, the elderly, those who have co-morbidities or are to undergo surgeries, and areas with low COVID load. Pic/Ashish Raje
The alternative school wants authorities to focus on the symptomatic, the elderly, those who have co-morbidities or are to undergo surgeries, and areas with low COVID load. Pic/Ashish Raje

Ajaz AshrafAn alternative school of thought has emerged to challenge the efficacy of continuously scaling up testing, one of the three Ts comprising the Union government's strategy of "test, track, treat" for controlling the spread of the Novel Coronavirus or SARS-CoV-2, which has infected over 40 lakh people and already claimed over 70,000 lives in India. This school believes the quest to conduct at least 10 lakh tests a day, crossed on August 21, has turned this exercise indiscriminate and is bleeding the state dry.

The alternative school's view overturns the rationale behind the government's testing strategy, which seeks to identify and isolate those infected for controlling the community transmission of SARS-CoV-2. Since large parts of India are already in community transmission, this school says that large-scale testing for isolating the infected is as good as taking out a few buckets of water from a swimming pool.

The alternative school, obviously, does not think testing should cease. Rather, it wants the authorities to focus on the symptomatic, the elderly, those who have co-morbidities or are to undergo surgeries, and areas with low Coronavirus load. Focussed testing will not only save money, but will enable the health infrastructure to refocus on immunisation programmes and those sick with other diseases.

This school of thought cannot be dismissed offhand, as its votaries are epidemiologists with decades of experience and belong to reputed institutes like the All India Institute of Medical Sciences. The school consists of members of three organisations — the Indian Public Health Association, the Indian Association of Preventive and Social Medicine and the Indian Association of Epidemiologists.

The presidents of the first two organisations were invited, on March 24, to a meeting between medical professionals and Prime Minister Narendra Modi, to discuss methods for controlling the virus. The three organisations subsequently released three joint statements over time, suggesting changes in the government's strategy for controlling SARS-CoV-2 as new evidence of its nature of spread emerged.

The alternative school's logic can be discerned in COVID-19 statistics. Between August 3 and September 3, India conducted 2.46 crore tests, of which 20.77 lakh, or 8.43 per cent, reported positive. Now, recall the Indian Council of Medical Research director Balram Bhargava's disclosure, on June 11, regarding a countrywide serological survey, a blood test designed to monitor the presence of antibodies in a person who has or had the SARS-CoV-2 infection. Bhargava said the sero-survey showed that 0.73 per cent of Indians had already contracted the infection.

Taking the 2011 census figure of India's population of 121.02 crore, the 0.73 per cent implies that 88.34 lakh Indians were already infected before June 11. So, the tests between August 3 and September 3 enabled identification of just one-fourth of the people who had already been infected by June. India's total caseload, on September 3, stood at 39.40 lakh, or less than half of the people infected four months ago. Quite obviously, the sero-survey figures of June would have grown exponentially since then.

The alternative school's logic seems solid for cities through which the virus has barrelled. Take the number of tests and positive cases identified in Mumbai, Pune and Delhi, between August 3 and September 3. Mumbai conducted 2.24 lakh tests, of which 32,689 were positive. By contrast, a late July sero-survey found that 57 per cent of its slum and 16 per cent of its building population possessed antibodies. This means 41.19 lakh of the city's 1.24 crore population had already been infected.

Pune conducted 3.25 lakh tests and found 89,453 cases, yielding a high positivity rate of 27.49 per cent. Yet a sero-survey in Pune, in August, showed that half of its 94.29 lakh population had already been infected. Delhi identified 43,824 cases through 5.96 lakh tests. The two rounds of sero-survey showed that 28.3 per cent of its population, or 47.41 lakh people, had already contracted the virus by July-end. As these are percentages of the 2011 population, the absolute number of people with antibodies today will be even higher.

These data points show that a million tests a day can only capture an infinitesimal fraction of those infected. Unofficially, the conservative estimate of the cost of a million tests, including RT-PCR and rapid tests, is a whopping Rs 100 crore. The school asks: Does it not make sense to divert a substantial portion of this money to better treat COVID-19 patients? Or use the test as a surveillance tool where there are "zero or very few cases"?

The alternative school thinks a million tests a day is a continuation of that original mistake of locking down the country, the decision presumably taken, as its second statement had said, on the advice of "clinicians and academic epidemiologists with limited field training and skills." It says that had the migrant population been allowed to return home before the lockdown, the virus would not have spread countrywide, among crores of people, whom even large-scale testing can never identify.

Therein lies the irony: even as the tests identify a negligible fraction of those actually infected, the rising figure of cases on the COVID-19 dashboard has spawned an epidemic of fear, inimical to the economy already hurtling south.

The writer is a senior journalist

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First Published: 07 September, 2020 06:17 IST

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