Still too few tests

A week into the unlocking of India’s economy, and the Covid-19 pandemic has gained momentum. At an emergency meeting chaired by the prime minister over the weekend, it was pointed out that of the more than 320,000 cases of the disease registered, two-thirds are from just five states. These were earliest exposed to the virus, and four of the top five — Maharashtra, Tamil Nadu, Delhi, and Gujarat — are heavily urbanised. With an uncontrolled re-opening, the other states will begin to approach the more urbanised states’ numbers. Worryingly, it is not necessarily true that India’s fatality rate — the number of those who die as a proportion of positive cases — is relatively benign. In Gujarat, for example, 1,449 of the 23,079 cases have been fatal — a fatality rate of 6.3 per cent. This is far higher than in many countries with an age distribution biased towards older, at-risk people — Germany’s fatality rate is less than 5 per cent.

Much of the statistics is excessively dependent upon testing patterns. Delhi, for example, has seen an explosion in the recorded number of cases partly because it has conducted more tests per capita than elsewhere. In Mumbai, only 4,000 tests a day are being conducted — in spite of the fact that the city has a fifth of India’s cases and therefore is obviously at high risk of community spread. This is far short of the number of tests possible in the city. Delhi’s testing rate is far higher, at 10,000-12,000 per million as of last fortnight as compared to just over 3,000 per million in Gujarat and under 1,600 per million in Uttar Pradesh. But even in Delhi, excessive restriction has been placed on who gets tested and why. Delhi is adding over 2,000 cases a day — far too large a proportion (or “positivity rate”) of the tests it conducts. There is simply no reason why the number of tests should not continually be increasing in these geographies — but, instead, in many areas like Delhi and Gujarat, the five-day moving average of tests has in fact decreased on several occasions. Some states have actually chosen to become complacent — Karnataka, which is prematurely comparing itself to Covid-free New Zealand, has seen a decrease of about 40 per cent in its tests per day.

The bottleneck is not in production: India can now make almost 5 million test kits a day, and companies that had made an effort to produce the RT-PCR diagnostic kits find no takers for their kits. It is clear that regulatory restriction on testing must end. It is absurd that people need to go to a doctor’s clinic for a prescription and then a referral form before being allowed to access a test. That is, if nothing else, dangerous. The Delhi government is right to ask why the Indian Council of Medical Research must impose requirements on who is tested, particularly in parts of the country where the epidemic has moved beyond the phase where strict contact tracing is useful or possible. Of course, it can also be asked why the same government had sought to restrict the testing of asymptomatic individuals. Union Home Minister Amit Shah said on Sunday, after meeting Delhi Chief Minister Arvind Kejriwal, that testing in Delhi would be doubled in the next few days and tripled within a week. This must be replicated throughout the country. It should have been done during the lockdown, not wait for the re-opening.

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