India saw a dramatic rise in self-tests during the third Covid-19 wave

In the first 20 days of January, two lakh people reported results of their home-based Covid-19 self-tests to the Indian Council of Medical Research, compared to just 3,000 tests reported in the whole of 2021.

This manifold jump, which coincides with the third wave of the pandemic, suggests a major shift in testing preferences in urban India.

Self-test kits are rapid antigen tests that look for viral proteins in the nasal swab of a person to confirm the presence of the SARS-CoV-2 virus. A self-test takes less than 15 minutes to produce results, although its sensitivity is lower than RT-PCR, or reverse transcription polymerase chain reaction test, considered the gold standard for Covid-19 detection. This means a self-test has a higher chance of missing an infection.

Despite this, the health ministry recommended the use of self-tests for the first time in its December 31 guidelines. Anticipating the rapid spread of the highly transmissible Omicron variant, it said these tests could aid faster detection of Covid-19 and quick isolation.

India conducted 3.1 crore Covid-19 tests between January 1 to January 20. Data shows two lakh people reported their self-test result to the ICMR, forming 0.6% of total tests conducted.

But, based on their sales data, manufacturers of the self-test kits say the actual count of self-tests is likely to be several times higher.

Issues with data capturing

There is a reason why the true number of home-based self-tests may not have been captured on the ICMR portal.

Unlike RT-PCR or rapid antigen tests that are reported directly by the laboratory or hospital to the ICMR through an online portal, self-tests can only be reported by the patient through a mobile application that each manufacturer has prepared for their kits.

In a self test, a person has to insert a nasal swab deep into their nostrils. The swab is then mixed in an extraction tube and a few drops of the solution are put onto a testing card. The results can be seen within minutes.

On the mobile application, the user is supposed to feed their personal details, including symptoms, address, identification proof, and then upload a picture of the test card result. This is synced with the ICMR Covid-19 testing portal.

But manufacturers said several users do not report their test results on the application.

Dr Srinath Reddy, epidemiologist and president of Public Health Foundation of India, said “a small fraction of people report their results”. Most people who test negative are not likely to report their test results and those who test positive prefer to go into isolation instead of reporting the result, he said.

This had implications for the overall testing numbers in the country. “The true positivity rate of self tests will not be known,” Reddy said. “Ideally this data should be collected. It will help the government know the number of cases, their spread.”

Association of chemists and retailers in Maharashtra have now started maintaining records with contact details and identification documents of customers who buy self-test kits. The practice is, however, not followed in all states.

Manufacturers look at production scale up

According to the Indian Council of Medical Research, seven kits have so far been approved for self-tests. Together, the seven manufacturers can produce 1.2 crore kits per week.

With the growth in demand for self-test kits, some manufacturers say they have increased their production capacity. The spike in demand, however, may prove short-lived, looking at the current trends of rapid rise followed by an equally rapid dip in caseload in several metro cities. But companies say they are eyeing the global market.

When it launched its test kit in June 2021, Meril Life Sciences was producing 25 lakh kits per week. Now, it has scaled up weekly production to 35 lakhs.

“We have seen close to a 500% increase in daily sales volumes between December 2021 and January 2022,” a spokesperson of the company said.

Data shared by the company shows 35-40% of the sales were made in eight metro cities – Mumbai, Delhi, Chennai, Kolkata, Hyderabad, Bengaluru, Pune and Ahmedabad – while the remaining 60-65% demand came from Tier II and III cities.

“We are now equipped to scale up for any demand to increase the supply,” the spokesperson said.

Pune-based Mylab, the first manufacturer to receive approval for its home-based self test, is manufacturing 70 lakh kits per week. It is prepared to scale up 1.5 crore per week, a spokesperson said.

“From last month, the percentage rise in sales is 15 times and we are increasing our production base further just in case we have to cater to global demand. We are getting a lot of queries from overseas markets,” Mylab spokesperson said. Within India, the highest demand for the company’s kits has come from Kolkata, Mumbai, Bangalore and Delhi, the company data shows.

Meril officials said they are “educating people on self-tests and encouraging them to upload the results”. As a result, Meril said they noted “an increasing number of people uploading the results on the app”.

Mylab officials said the government needs to raise awareness on the reporting of self test results.

This reporting was supported by a grant from the Thakur Family Foundation. Thakur Family Foundation has not exercised any editorial control over the contents of this article.