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Public Health

Covid19 Test. Trace. Treat… Are We Doing Enough?

While India seems to holding on well both on recovery rates and fatalities, the lack of testing could be its undoing…

We have been hearing this advice from many sources for the management of Covid19 effectively. For understanding more about Covid19, I went on to check for a simple metric i.e. percentage of confirmed Covid19 cases vis-a-vis a total number of tests conducted by various countries affected with Covid19. My data sources are shared at the end of the article. I have used a different data source for the month of May; the reason being comparable dataset was not available with the earlier source.

March Numbers

CountryDateTotal TestsTotal Confirmed Cases%Confirmed
SpainMar 18, 2020300001117837.26
ItalyMar 20, 20202068864103519.83
IranMar 14, 2020800001136414.21
United StatesMar 19, 202010394594159.06
IndiaMar 20, 2020145411911.32

May Numbers

CountryDateTotal TestsTotal Confirmed Cases%Confirmed
SpainMay 24, 202035565672823707.93
ItalyMay 24, 202033911882293276.76
IranMay 24, 202078128613352117.08
United StatesMay 24, 202014357969166682911.60
IndiaMay 24, 202029434211326744.50

Just to mention, the source which I used earlier did not have the data for China so I could not include the same. Apart from China, I have shown the data for the countries which have got the maximum number of confirmed cases to date (in March) for illustration purpose and I also included our own country to put this in perspective. Now, if we compare the data for two instances; it shows different positivity rate (i.e. percentage of total confirmed cases / total test)

As we all know that lockdown was imposed in our country for preparing ourselves for fighting this long battle against Covid19 and a very important aspect in this battle is to increase our daily testing capacity as it’s the only way available to us to understand the spread of the virus in any particular community.

We have come close to daily testing capacity of 1 lakh+ tests a day which is almost 100 times increase from the initial days but still we are way behind when we see tests per million vis-à-vis other developed countries. Just to put this in perspective; India is doing 2135 tests / million population whereas Iran which has almost similar number of confirmed cases has been doing 9544 tests/ million population. And if we compare this with developed countries this number is in the range of 20000 – 75000 tests/ million population.

At the same time; we should not forget that various studies world over suggest that actual number of infected individuals are always higher than number of confirmed cases the reason being each country depending upon their testing strategies are able to identify the confirmed cases. Also, we should not forget that number of confirmed cases is a lagging indicator to understand the spread as the symptoms start to emerge only after 2 to 14 days from the day an individual got infected with the virus.

I am writing this article at a time when we are in lockdown 4.0 and have got relaxation in many parts of the country. This would be the real test of our healthcare infrastructure which we have managed to build during the national lockdown.

Key Points:

  1. Positivity rate for India is less vis-à-vis other nations which also got impacted with Covid19 (which is a good sign)
  2. We need to improve our testing capabilities to understand the level of community spread (as it is done in other countries); the reason being based on the historical evidence and current developments globally pandemic strikes in waves so we should not discard the possibility in our case as well.
  3. We should also increase the use of rapid antibody test to ascertain the level of community spread.
  4. We should be more concerned about deaths happening due to Covid19 as it is believed that 80% of the cases would be mild in nature; 15% would need hospital support and 5% would need ventilator support.

In our country, one can also debate the number of deaths happening because many of deaths happening in our country are not certified medically. But that is something we should discuss separately.

Again as always, questions and clarifications are welcome.

About the author

Yatindra Jha is a healthcare consultant with a focus on public health policy.

Sources

Data Source: https://ourworldindata.org/covid-testing – March Data

Data Source: https://www.worldometers.info/coronavirus/ – May Data

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