COVID-19: 10 Unanswered Questions on Testing and Tracking Strategy

Important questions for the Indian government on how it is testing and tracking the cases of novel coronavirus.

As the number of COVID-19 positive cases increase in India, India needs to assess the testing and tracking strategies.

(Photo: AP)

As the experience of countries around the world shows, transparency is the best way to fight the coronavirus outbreak. While the Indian government has published several advisories for the public, it has not released enough granular information for journalists, researchers and the larger health community to assess the effectiveness of its strategy to test, detect and track cases of COVID-19, the disease caused by the novel coronavirus.

Public knowledge is essential to contain the spread of the disease.

Here are 10 questions the government must answer:

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1. How Did the Positive Cases Get the Infection?

The Union health ministry was initially releasing information on the source of infection for every case that had tested positive for coronavirus: whether it was through travel to coronavirus-affected countries (imported cases) or through contact with such cases within India (local transmission).

However, it has stopped making such information publicly available for all positive cases.

This information is vital to assess how the virus is spreading within India. If cases begin to surface that can neither be slotted as “imported cases” nor “local transmission”, that could mean the virus has spread more widely within the community, a process called “community transmission”.

(Photo: The Scroll)

2. How Many Coronavirus Tests Have Been Done in India?

The government must give detailed information on the number of COVID-19 tests done in every state, at every lab, both in aggregate and day-wise.

The government must give information on how many samples tested were of people with travel history to coronavirus-affected countries, how many of those who came in contact with them, how many of those without such history.

This information will enable public health experts to draw up a clearer picture of whether India is testing more for “imported cases” or “local transmission” or “community transmission”, and whether this pattern has changed over the last few days.

3. Are Patients Who Meet the ‘Suspect Case’ Definition but Have No Travel or Contact History Being Tested? If Not, Why?

India’s official "suspect case" definition also includes people who don’t have travel or contact history but who have severe acute respiratory illnesses that require hospitalisation and cannot be explained by any other cause.

But the Indian Council of Medical Research has claimed testing is limited to those with travel and contact history, which means such patients are not being tested. There is no official explanation for why such “suspect cases” have been excluded.

The government must explain this contradiction. At the state level, are authorities strictly adhering to this criteria laid down by ICMR or have some states expanded tests to include such “suspect cases” without travel and contact history?

4. How Are Random Samples Being Collected for Community Transmission Testing?

While the ICMR does not allow “suspect cases” without travel and contact history to get themselves tested, it has said 51 labs are testing 20 random samples each of people reporting severe acute respiratory illnesses every week.

It claims this process will help detect “community transmission” – that is, cases that have spread beyond those with travel and contact history. However, it is not clear how those samples have been sourced: Are they coming from a single government hospital?

Experts fear this could be the case, which means the sample won’t be representative. More information is needed on the sampling methods.

5. When Coronavirus Testing Is Opened up to Private Labs, Would They Stick to the Same Testing Criteria as the Government?

The ICMR has announced that 51 private labs with accreditation could soon be allowed to do coronavirus tests. In a statement issued on Tuesday, 17 March, it appealed to the private labs to offer the tests for free.

Laying down guidelines, it has said: “Laboratory test should be only offered when prescribed by a qualified physician as per ICMR guidance for testing.”

But public health activists have expressed concerns over whether the private labs would be allowed to offer tests to people who can pay even if they don’t meet the same strict testing criteria being followed by government labs. This could make for an unequal system. The health ministry must clarify its stance on the matter.

6. What Is the Government’s Plan to Ensure India Has Enough Testing Kits?

The ICMR has said India has 1.5 lakh testing kits and one million kits have been ordered.

But it must offer more information: How many testing reagents and probes does India have? How many stocks have been ordered, from where, and when will they arrive? What is the budget allocated for such purchases? Does the government have any budgetary constraints that stop the country from stocking up further? Can India manufacture the reagents and probes domestically?

7. How Is the Government Distributing the Kits Among States?

The ICMR is monitoring the testing process and supplying kits to state government-run labs spread across the country.

What is the criteria being used to determine the allocation of kits? At least one state government – Chhattisgarh – has criticised the Centre’s testing criteria and expressed an apprehension of shortage of kits, if it were to test more widely.

How is the Centre responding to the concerns of states?

8. How Many People Have Been Placed Under Quarantine and Does the Government Have Enough Facilities?

The government has been releasing data regularly on the number of people being screened at airports, sea ports and border check-posts. However, it must also release state- and city-wise data on the number of people being kept in isolation wards and quarantine facilities.

Many people who stayed in such wards while getting tested have complained of poor and unhygienic conditions.

However, the lack of hygiene is not the only concern. As the number of people getting tested for coronavirus expands, the government will have to ensure health workers testing them and attending to them have personal protection equipment. What is the government’s strategy to beef up such arrangements?

9. How Is the Government Tracking People Who Were Asymptomatic at the Time of Arrival in India?

The rules for how to deal with passengers disembarking at airports from coronavirus-affected countries are very specific and exacting. Yet cases have turned up of asymptomatic passengers – who later test positive – travelling on trains and other modes of transport to other parts of the country, exposing more people to the virus. Is there a process to follow-up with those who passed the thermal screening but have been asked to do home quarantine?

10. Is the Government Keeping a Track of Other Ailments That Might Indicate as yet Undetected Community Transmission?

Multiple officials have made it clear that India’s population is simply too large to carry out a huge amount of testing. The danger of low levels of testing, however, mean that community transmission may go undetected.

One way of addressing this is by carefully tracking cases and deaths attributed to severe acute respiratory illnesses, pneumonia and other ailments that might be coronavirus infections that went undetected.

Will the Centre keep track of these numbers and publish them? Is it taking any steps to better ensure hospitals are registering deaths appropriately?

(This article was originally published by Scroll and has been republished with permission.)