Augment testing capacity

This is vital to prevent further surges in Covid cases

India is struggling to contain the impact of the second wave of Covid-19 due to the lack of oxygen and ICU beds at hospitals. While the situation is dire, it is important that testing for Covid-19 is not neglected. Our research shows that a serology-aided testing policy can prevent lockdowns while not overwhelming hospital capacity. The weekly cost of such a policy would be less than 2 per cent of the weekly economic loss due to a lockdown.

Yet, the testing capacity in the country has stagnated after the rapid scale-up seen in 2020. India’s positivity rate has increased nine-fold from 2 per cent on March 1 to 22 per cent on May 10.

While there are no short-term fixes to help the country out of the second wave, the administration needs to focus on augmenting India’s testing capacity to prevent future surges . What follows are some recommendations, which are elaborated in the report ‘The Road Ahead for Smart Covid-19 Testing and Tracing in India’.

In the eyes of the media and the people, higher case numbers are perceived as a fallout of poor administration. It is important to contextualise and communicate the case identification trend in light of the number of tests conducted, positivity rates, and proportion of cases identified through contact tracing.

These parameters provide important insights into the administration’s performance and can reduce disincentives to test more and identify the missing cases.

The placement of testing centres within Covid hospitals and lack of home collection can create hesitation amongst individuals to go in for testing. Placing sample collection centres outside the premises of Covid hospitals and expanding home collection and drive-in facilities can help increase testing volumes.

The public sector, which provides free tests, can coordinate with the private sector for sample collection in exchange for a predetermined fee. Similar agreements have shown promising results in TB diagnosis by RNTCP.

Pooled testing has been employed by both developed nations (including the US and Germany) and low- and middle-income countries to increase testing capacity, especially to screen and conduct surveillance among a homogeneous subset of populations. However, the States, barring a few (Punjab, Kerala and Tamil Nadu), have not adopted this approach thereby severely hampering their testing programmes.

Pooled testing can quickly scale up testing capacity without capital investment. Our research suggests that pooled testing can reduce unit testing costs by 40-50 per cent and increase capacity between 15 and 145 per cent depending on the positivity rate of samples. Also, it was found that even if the aggregate positivity rate in a State is high, there are patient groups that have low enough positivity rates to reap the benefits of pooled testing.

Genomic sequencing

The mutant variant B.1.617 of the SARS-CoV-2 virus, designated as variant of concern by the WHO, is the main driver behind the second wave. Although the variant was first detected in October 2020, the low volume of genomic sequencing blind-sided us to its spread — India sequenced less than 1 per cent of all positive cases between December 2020 and March 2021; UK, for instance, sequenced 44 per cent of its positive cases. Such low levels in India stemmed from an absence of a structured system.

While the creation of the Indian SARS-CoV-2 Genomics Consortium (INSACOG) is a step in the right direction, the issues faced by the consortium (lack of funding and equipped labs, procurement of consumables, and the logistics to provide the labs with samples) need to be addressed immediately.

In the long-term, States must invest in their own sequencing technology and reduce reliance on centralised laboratories as these technologies can be used to inform the response to other outbreaks and pandemics in the future.

While the current situation is grim, and authorities rightly focus on immediate measures to minimise the impact of the third wave, efforts must be initiated in parallel to further strengthen the testing ecosystem to prevent the third wave.

The writers are with Max Institute of Healthcare Management, Indian School of Business

Published on May 26, 2021

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