Since the onset of the Covid-19 pandemic in 2020, India's testing rates and capacities have been discussed at length. With the onslaught of the third wave, low testing rates have become a point of concern. Recent guidelines by the Indian Council of Medical Research (ICMR) recommended no testing for asymptomatic people who have come in contact with Covid patients. This decision has come amid a severe rise in cases across the country.
Based on the analysis done during the second wave, we could only detect one case out of thirty positive patients. The new guidelines have exacerbated the inefficiencies of our fighting strategies. Furthermore, testing rates in many states have become stagnant. With positivity rates touching 30 per cent in some cities as against the World Health Organisation (WHO)'s recommended five per cent, we do not see a proportional rise in the number of cases. This low number contributes to the narrative about the meekness of the Omicron variant hindering our implementation of the 3T strategy of testing, tracking and treatment. Two years down into this pandemic, we have not scaled up our testing capabilities and are dealing with Omicron as if we were caught by surprise.
Also read: Mask up India, Omicron is far from benign
Data shows that the test positivity ratio is increasing all over the country, with this week's numbers for India being 12.8 per cent. The test positivity ratio over the past seven days for Goa, West Bengal and Delhi is 36.1 per cent, 32 per cent, and 27.8 per cent, respectively. For Maharashtra, it has been 20.5 per cent, while for Kerala, the test positivity ratio is 19 per cent. Some regions, such as Delhi, have even shown a decrease in testing with a reduction of tests from one lakh on January 12 with 27,500 cases to 65,000 on January 15 with 20,700 cases.
Why is an increase in testing important
Testing is vital as we cannot isolate everyone and stop all contact between people. More testing means that more people are aware that they are positive, allowing them to isolate themselves and reduce the spread of the virus. When the positivity rate rises, it indicates that more people need to be tested. A number that is frequently recommended by the WHO is five per cent. There are two approaches to reduce that figure to five per cent. First, by reducing the number of cases; second, by increasing the number of tests performed. We are already attempting to slow the spread of the virus, but the number of tests is not increasing as quickly as it should. An increase in the number of cases should be matched by a corresponding increase in tests.
Impact on 3T strategy
Testing, tracking, and treatment have proven to be an efficient and successful means of halting the virus's spread. A lag in the first step will almost certainly affect the other two and create a barrier in our ability to respond. A significant decline in the number of cases will eventually result in worse tracking and impact essential analyses such as genomic surveillance. If we are going to fight the present surge, we will need to use all three Ts.
Consequences of the failure in 3T strategy
We will not be able to reduce the spread of infections if we are unable to isolate infected people. Morbidity and mortality will shoot up as the number of cases rise. This increase in damage and deaths will force the government to restrict people's movement further to decrease contact between people. The government will be forced to impose a lockdown that will harm our already broken economy.
Communication failure and misinformation
One of the primary reasons people are not getting themselves tested for Covid-19 is the narrative of Omicron being clinically mild. Moreover, the new ICMR guidelines have made people even more lenient and oblivious to risk. This narrative has also led people to become lax about public health measures such as hand hygiene, social distancing and masking up. Effective communication in such situations is a powerful tool that the government can leverage to its advantage.
What the government needs to do
The first move is to increase the number of tests done and keep the test positivity number below five per cent. This can be done by making it easier for people to get tested. We also need to correct the narrative about the "mild" variant. It may be mild for some people, but it can prove deadly for the elderly, the immunocompromised. The Omicron variant also infects a far larger number of people; thus, even if it is clinically milder, it can still cause many deaths. More cases also increase post-Covid complications such as long Covid, which causes brain fog, fatigue, shortness of breath, etc. The state also needs to increase genomic surveillance to identify new changes in the virus and be prepared for them.
India is not testing enough. The situation has become even more worrisome due to the 'meek Omicron' narrative and the latest ICMR guidelines. We have had enough experience in the past 20 months to understand that we need to test to contain the spread. We should have the capacity to upscale our testing in response to an increase in cases. However, we still have time to act. The wave is yet to reach rural parts of the country, and testing can help.
(Mahek Nankani is an Assistant Programme Manager at the Takshashila Institution. Harshit Kukreja, MBBS, is a Research Analyst with the Takshashila Institution)
Disclaimer: The views expressed above are the author's own. They do not necessarily reflect the views of DH.
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