It would be a bit crazy to argue against the combined wisdom of the premier biomedical research agency of the country and the strategic path of the central government during a national emergency. However, while adhering to the principles of lockdown as a dutiful citizen, I couldn’t help notice the glaring chasm in logic of what we see as the number of confirmed COVID 19 cases (694 on 26th March 20) and what could it really be; in light of our rather subdued approach to ramping up testing for the virus.
With a significant percentage of COVID-19 cases being asymptomatic and likely to remain undetected in community, it would be counter intuitive not to expect a significant number of hidden cases and a sudden emergence of submerged whale of community transmissions making a gigantic bump on our case numbers in the coming two weeks. From what is available in the media this seems to be an emerging consensus among the best minds in the field of public health and medicine; two of the most notable and articulated opinions were of K. Sujatha Rao IAS (retd) former Union Secretary for Health & Family Welfare and one of countries finest brains on public health, and Dr. T. Jacob John, Retired Professor of Virology, CMC Vellore, one of the legends in his field.
The key gaps in our testing approach and planning are:
Volume of Testing – As on 25th March we have tested 25,144 samples from 24, 254 individuals in over two months of outbreak. In comparison, the US is currently testing over 25000 cases per week. The sheer volume and approach to testing South Korea undertook and its effectiveness in controlling the disease is well documented. As per Dr. Balram Bhargava, DG ICMR we have a capacity of over 10,000 tests per day (news conference 22nd March 2020), then why are we testing only an average of 1500 cases a day. In her interview to Syed Firdaus Ashraf in Rediff, Sujatha Rao says, we should immediately start testing 5,000 per day.
Rapid Approval of Testing Labs – ICMR has approved 121 public sector medical labs (16th March 20) and 25 private medical labs (26th March 20) as of now. These 146 medical labs are far lower than the required numbers to face a possible avalanche of cases. The public and private sector bias is evident. In fact, FICCI on 19th March has submitted a list of 76 private sector labs capable of testing as per the ICMR approved criteria. There are many curious cases like that of Manipal Institute of Virology; a center which has tested 400 Nipah samples (a riskier virus) during the last outbreak in Kerala, who are not approved for testing as yet.
Accelerated Approval and Support for Test Kits Manufacturing & Innovations – We have two cases of private sector manufacturers being approved for manufacturing COVID 19 testing kits in India. There are several innovative ideas still stuck in red tape at ICMR as per news reports. In the moments of the greatest crisis that our nation faces in its 73 years, ICMR seems to prefer the bogey of US FDA approval and other bureaucratic roadblock than take a leap of faith to rely on the ability of Indian jugaad to mass produce kits at the lowest possible costs.
ICMR is definitely doing the best it can. As of yesterday it floated an RFQ for the supply of one million test kits to be procured from Indian companies. A case of too little too late? Shouldn’t we have done that much earlier? The DG ICMR is active in communicating to the nation and surely is one of the assuring technocratic faces of the government in the current crisis.
One of the most curious facts is that fighting our nation’s health and safety threats is not among the key objectives of ICMR, like it is for CDC in the US. We do have an equivalent body in India – NCDC but with no track record in providing leadership in such situations or health information to the public. The fact that most of us have not heard of them even during the greatest pandemic of our lifetime is one of the root causes of our current dilemma. It should make us realize that we missed the bus in creating institutions that are proactive and have long term vision. We cannot miss the bus on the impending issue of COVID-19 testing. If need be let us all come out once again to our balconies and doorways to send a message to every one that matters, ringing bells, clinking plates and blowing conches to create a rhythmic message – TEST, TEST, TEST.