On September 4, India crossed four million novel coronavirus cases, 13 days after crossing three million on August 22. On Saturday, the fresh cases reported surpassed China’s total recorded cases (90,070) so far. On Sunday, India surpassed Brazil to record the second highest number of cases in the world. Since August, India has been reporting the highest number of cases each day, which has been steadily increasing — from over 50,000 in the last week of July to over 60,000 in the first week of August, over 70,000 in the fourth week, before jumping to over 80,000 cases in September. Though the number of tests done each day has been over one million for the past week, the test positivity rate nationally is still high at 7.7%, indicating that testing has to be ramped up. Though the testing done each day by many States has been growing, nearly 50% of them are rapid antigen, of only about 50-60% sensitivity. Unfortunately, with no repeat testing of negative cases and only a small percentage of people with symptoms but negative results being validated with a RT-PCR, many of the infected are not being diagnosed.
The ICMR’s latest advisory provides for testing on demand to “ensure higher levels of testing”. While ramping up testing is needed, testing on demand by anyone might not be the correct approach to adopt. The ICMR is theoretically making India’s 1.3 billion people eligible for a test, even when there is no capacity to undertake this. While it is a welcome measure, especially in the private sector, the general fear about infection might result in diverting some of the government’s stretched health resources if it has to test those who do not, on the face of it, require a test. With States not validating the negative results from rapid antigen tests with RT-PCR, non-directed tests on demand might help more in increasing the number of tests done each day and hence in reducing the test positivity rate than in early detection and containment. The focus must remain on diagnosing the most probable cases listed out by the ICMR — those with symptoms or at high risk. Since many of those infected have mild or no symptoms, tests on demand might be particularly helpful in detecting cases that might otherwise have been missed. But such a strategy should be restricted to clusters, hotspots, and containment zones, besides dense urban areas with anticipated high transmission in the unlock phase. Else, States might be forced to use their discretionary power to deny tests for people not exhibiting symptoms or in low-risk categories, or selectively charge for testing to pay for procurement of testing kits and to avoid more pressure on the testing infrastructure. There is also the possibility of an over-reliance on antigen testing to cope with the growing demand for testing. A more nuanced approach to testing guidelines is therefore necessary.