Is India testing enough for coronavirus cases?

The Indian government has confirmed 83 cases of coronavirus infections in the country. The health ministry has claimed these are either “imported cases” – people who have recently travelled abroad – or “local transmission” – those who came in touch with them. The ministry denies India has experienced any “community transmission” or cases that cannot be traced to known patients.

But experts point out that this conclusion is based on a narrow testing of cases.

Here is what we know so far.

How many cases have been tested for coronavirus in India?

The first coronavirus case was confirmed in India on January 30. Since then, 6,500 samples of 5,900 individuals have been tested in the country, the Indian Council of Medical Research, the testing agency for the virus, said in a press release on Friday, March 13.

Coronavirus testing is currently confined to 65 government-run centres. “The secondary test for reconfirmation of the virus which was earlier conducted only at the National Institute of Virology has also been expanded to 31 labs,” the ICMR press release said.

What is the testing protocol?

Many Indians who have returned from international travel have complained that they were unable to get themselves tested for coronavirus. This is because the government’s protocol, as health officials confirmed on Thursday, limits coronavirus tests in India to people who have travelled to affected countries recently or who have contact history with known confirmed cases – and have symptoms of the disease.

This means if you have travelled to an affected country recently and do not have symptoms of the disease, you cannot get yourself tested.

“It is very important we should not create panic, only people who need to be tested should be tested,” said Lav Agarwal, joint secretary in the health ministry.

How does this compare with other countries?

Not very well, as the numbers for other coronavirus-affected countries show.

South Korea has tested over 140,000 people so far, and has frequently seen more than 10,000 tests per day. People can even get tested at drive-through counters, where the whole process is done in a matter of minutes.

Apart from India, the other country where the number of tests is low in relation to the population is the United States. Vox reported on health professionals in the US who have wanted to be tested because of worries that they might have been exposed to Covid-19. Yet they are still waiting, in part because of government guidelines that limited tests to people under very specific categories or because commercial tests are not yet available.

In some countries, however, the easy availability of tests has itself become a problem. The Guardian reported on a global shortage of Covid-19 tests hitting Australia, with one official saying that health authorities were in some cases testing unnecessarily and a new policy was being put together to ensure only those at risk would get tests.

Why has the Indian government restricted coronavirus testing?

It is unclear why the government is not scaling up coronavirus testing in India.

When asked by reporters on Thursday whether India has adequate testing facilities, health officials claimed the country has more testing centres than required for an outbreak of the current size. Health ministry officials also claimed there was no need to involve private laboratories in the testing.

The National Institute of Virology can test 2,500 samples in a day, said Gangakhedkar of the Indian Council of Medical Research.

“We are taking a graded approach,” he told reporters. “First, we started centres wherever international airports are there. Second, we quickly ramped it up to 52 centres because we realised transportation may take some time and there could be delays.” He said the government was “going slow” in opening centres “because we need to have quality assurance procedures”.

Health officials also said India has an adequate number of coronavirus testing kits.

“We already have one lakh testing kits,” said Lav Agarwal, the health ministry’s joint secretary on Thursday. “Additional kits have already been ordered. They are in procurement.” On Friday, officials said the number of available testing kits was two lakh.

Would two lakh testing kits be enough for a country the size of India? Experts estimate 40% of the population of a country could be infected with coronavirus.

What are the concerns around limited testing?

Experts say that without mass testing, India might not be able to detect community transmission and take effective measures to contain infection and mortality.

T Sundararaman, the former director of the National Health Systems Resource Centre, an advisory body to the health ministry, said: “To detect community transmission one has to test many more persons with symptoms of flu – even though most of them will turn out to be seasonal flu and not the coronavirus. Nations that have been unable to institute such mass testing detect less cases – and therefore have apparently higher case mortality rates – and are unable to detect or curb community transmission.”

An epidemiologist working with a global-health organisation told the Caravan magazine on the condition of anonymity: “There is a real concern that the government is not expanding testing parameters to include everyone, because they want to keep the numbers low. If you are not looking for cases, you are not going to find any cases. How can the government know that there is no community transmission, when they are not testing enough people?”

On March 13, the Indian Council of Medical Research announced plans to test over 1,000 samples every week of influenza or pneumonia-like illnesses taken from people without any travel history or contact with coronavirus-infected people. “We don’t want to do indiscriminate testing, but it is also important we are not missing on community transmission,” ICMR scientist Nivedita Gupta told the Indian Express. “If we find a positive case anywhere then the strategies would be completely different.”

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