Smart testing strategy needed to tackle the pandemic

Hope is a strong currency to survive this pandemic which has clutched the world with terror, uncertainties, and distress. Covid-19 has been a real test of resilience and the national response has been nothing short of impressive. We have seen a strong cooperation and collaboration between the government, private sector and civil society organisations to prioritise collective action against this pandemic.

Evolving developments

India has done a phenomenal job of ramping up daily testing from 30,000 (in April) to the current average of 11 lakh tests a day. This is indeed a great achievement which has been possible due to the swiftness of the government in on-boarding 961 private labs (as of November 20) and increasing testing capacity.

The tireless labour of the entire medical fraternity has also complemented the intensified testing efforts. Over the past few months, we have seen the best in our people — the healthcare staff, all the essential workers and those deployed to collect samples — who have risked their lives and that of their families to serve the nation.

However, a few weaknesses persist, and a little nuance may offer better guidance.

First, most Covid-19 testing labs are concentrated in the urban cities, depriving about two-thirds of our population that resides in rural areas of easily accessible testing facilities. Even though their touch-point to healthcare is the public health system, less than half of the district hospitals in the country are currently equipped with testing labs. It would be important to strengthen the existing public health infrastructure in the hinterlands to ensure access to tests in these regions.

Next, the RT-PCR v. Rapid Antigen Detection Test (RADT) conundrum is not as straightforward as it seems. RT-PCR is a molecular test, considered the gold standard because of its high analytical sensitivity, but it is notorious for its longer turnaround time and high cost.

At the same time, the much cheaper option of RADTs is criticised for its low accuracy which often leads to false negative results. But for mass testing drives to succeed in our densely populated country, RADTs — that are scalable and done repeatedly on the same person — are a necessity. RADTs can only be substituted by introducing highly accurate point-of-care molecular tests in India, similar to the Abbott ID-NOW tests in the US, which was also used for testing of President Trump.

Lastly, the current testing landscape is not viable for the private sector and is detrimental to their long-term sustainability. The price of tests has been capped by different State governments and, as a result, private labs are struggling to recover even the bare costs of tests. As a last-ditch effort to stay afloat, private labs are unable to invest in expanding capacity as it requires specialised infrastructure, expensive equipment, trained manpower and space — all of which are expensive.

Evidently, even though the objective of preventing the private sector from profiteering at the cost of people’s misery is truly noble, this approach might need to be reconsidered for the betterment of all. Less testing at this stage of the pandemic poses a graver and higher cost on public health.

Identifying these shortcomings takes us a step closer to comprehending what the country needs. It would be ideal to bring a smart testing strategy that bolsters the public health infrastructure, explores a wide combination of suitable testing technology and pivots around effective collaboration between the government and private sector to streamline efforts against Covid-19.

Concealed costs

The havoc wreaked by the pandemic on our economy is well established, and its impact has been likely felt by industries and households, albeit to different degrees. The RBI recently published a nowcast showing that in the first half of this financial year, India entered a technical recession. It is a certainty that those in the lowest strata of our society are the worst affected by this economic slump.

But there are some cloaked costs which are set to plague us in an even larger way due to our restrictive testing guidelines. Until now, the testing strategy has evolved to respond to immediate issues and largely lacked foresight to tackle future challenges. The government’s singular focus on increasing the quantum of Covid-19 tests has created a ripple effect with dire consequences. Redirecting all resources (including funds, hospital beds, ICUs and healthcare staff) for Covid-19 care has drawn away attention from other critical health interventions and has set off a deluge of shadow pandemics.

Most notably, devices meant for tuberculosis (TB) screening like CBNAAT and TrueNat are increasingly being re-purposed for Covid-19 testing. An estimated 3,00,000 TB cases went unrecorded during the initial period of lockdown and the pandemic has impertinently reversed countless gains made towards the TB National Strategic Plan for elimination by 2025. Less number of people are receiving early intervention and there will be an exponential increase in disease transmission, suffering and economic hardships. Neglecting this burden of TB would be catastrophic for India in terms of health outcomes as well as financial burden.

At this juncture, it is crucial not to lose sight of the plurality of India’s health burden by putting all eggs in one basket. Instead of only redirecting existing resources, we should look at expanding our resources to develop diagnostics which screen a variety of diseases together.

Future is our people

An effective vaccine will be a victory in itself and bring great relief, but it will not be our ticket out of the pandemic. We will continue using the tools that we already have at our disposal — masks, physical distancing, wide and smart testing, and aggressive contact tracing — and these should be encouraged through mass education drives. Efforts should be made to equip the people with complete information, shape healthy behaviours through robust policies and then trust them to make the right decisions.

The only way for us to succeed is by remembering what is at stake here and getting our act together. This is the time to collaborate and cooperate to leverage on strengths of different stakeholders in the ecosystem to help mitigate the health and economic crisis caused by this pandemic.

The writer is Founder and Managing Director, Dr Dang’s Labs

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