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Test by choice: On rising coronavirus cases in India

DELHI:

On September 4, India crossed four million novelcoronavirus cases, 13 days after crossing three million onAugust 22. On Saturday, the fresh cases reported surpassed China’s total recordedcases (90,070) so far. On Sunday, India surpassed Brazil to record the second highestnumber of cases in the world. Since August, India has beenreporting the highest numberof cases each day, which has been steadily increasing— from over 50,000 in the last week of July to over 60,000in the first week of August, over 70,000 in the fourth week, before jumping toover 80,000 cases in September. Though the number of tests doneeach day has been over one million for the past week, the test positivity ratenationally is still high at 7.7%, indicating that testing has to be ramped up.Though the testing done each day by many States has been growing, nearly 50% ofthem are rapid antigen, of only about 50-60% sensitivity. Unfortunately, withno repeat testing of negative cases and only a small percentage of people withsymptoms but negative results being validated with a RT-PCR, many of theinfected are not being diagnosed.

The ICMR’s latest advisory provides for testing on demandto “ensure higher levels of testing”. While ramping up testing is needed,testing on demand by anyone might not be the correct approach to adopt. TheICMR is theoretically making India’s 1.3 billion people eligible for a test,even when there is no capacity to undertake this. While it is a welcomemeasure, especially in the private sector, the general fear about infectionmight result in diverting some of the government’s stretched health resourcesif it has to test those who do not, on the face of it, require a test. WithStates not validating the negative results from rapid antigen tests withRT-PCR, non-directed tests on demand might help more in increasing the numberof tests done each day and hence in reducing the test positivity rate than inearly detection and containment. The focus must remain on diagnosing the mostprobable cases listed out by the ICMR — those with symptoms or at high risk.Since many of those infected have mild or no symptoms, tests on demand might beparticularly helpful in detecting cases that might otherwise have been missed.But such a strategy should be restricted to clusters, hotspots, and containmentzones, besides dense urban areas with anticipated high transmission in the unlockphase. Else, States might be forced to use their discretionary power to denytests for people not exhibiting symptoms or in low-risk categories, orselectively charge for testing to pay for procurement of testing kits and toavoid more pressure on the testing infrastructure. There is also thepossibility of an over-reliance on antigen testing to cope with the growingdemand for testing. A more nuanced approach to testing guidelines is thereforenecessary.