Blocking is not enough. Acceleration test – analysis
The national blockade is necessary, but it is not a cure.
Management of the coronavirus pandemic (Covid-19) still requires a comprehensive strategy of testing, identification, tracing, and isolation. India should initiate widespread testing, issue screening and confirmation protocols, develop a randomization process for surveillance testing, and identify high-risk locations. This alone can control the spread of the virus, or it will reappear once the block is lifted.
Testing is not expensive and can be done on a large scale. The blockage is the opportunity cost of not testing early: a loss of approximately Rs 10 billion rupees per day in taxes, plus expenses to mitigate the effect on unfortunate people. The opportunity cost of a seven-day lockout tax loss could pay for screen tests of our entire urban population, and we are locked out for 21 days. So far, we have tested just 25,000 people. We need to do much more.
56 districts across the country account for half of male interstate migration.
The test strategy would be determined by capacity, which is hopefully building rapidly; test kits and personnel to test and interpret results; a logistics chain, if necessary, to take the person’s sample to the laboratory; and an electronic system to transmit the results to the person, with clear instructions on what a person should do with positive results.
If there are capacity limitations in the infrastructure for the polymerase chain reaction (PCR) tests currently in use, the initial screening test can be performed using rapid test methods, such as the South Korean antibody test , which provides fast results. Their reported over-prediction of the presence of virus is not a disqualification as a screening test, which is confirmed by PCR tests. The fact that the Indian Council for Medical Research (ICMR) is interested in such tests is encouraging news.
The ICMR already has a protocol to evaluate symptomatic people. People infected prior to confinement will begin to show symptoms during confinement, and even with limited transmission, will spread to family and neighbors. We must communicate broadly and insistently, especially in the dense urban settlements to which people must be tested, if they are symptomatic. These people will form a group to be tested; This is allowed in the current protocol, but contact in such settlements must be broadly defined.
Such insistent communication is also necessary in villages, especially those with returning migrants. This is essential to identify groups of infections.
Going further, and this is key, ICMR urgently needs to revise its protocol to allow widespread asymptomatic surveillance testing.
First, start with random tests of people in dense urban settlements using voter lists. These may be in slums, unauthorized colonies, resettlement sites, ancient cities. If the virus takes root in such settlements, it will spread very quickly.
Second, run random tests on people who may move during shutdown. It is important that your identity be recorded, while passes are issued to move around during the block. These include police officers and sanitation workers, but also vegetable vendors, delivery men, grocery stores, pharmacists, mediators, among others. Maintenance personnel in apartment complexes are particularly vulnerable, especially in complexes with possible cases of infection.
And three have conducted random tests of migrants who have returned home to smaller towns or villages in larger cities: villagers know which homes have returning migrants. There are already reports that those people are labeled and isolated, which can be good and occasionally discriminated against, which is definitely not good, even from a transmission control standpoint.
Initially, surveillance testing can be prioritized in the intensive migrant districts identified in the government’s Migration Task Force report. Only 56 districts, 25 in Uttar Pradesh, 20 in Bihar, three in West Bengal, two in Karnataka and Uttarakhand, and one in Odisha, Rajasthan, Jharkhand and Maharashtra, account for half of male migration between states. This is best implemented through panchayats and will require significant information and communication support to allay people’s concerns about testing. These 56 districts have around 35,000 panchayats that can serve as initial sites of intervention.
The random assignment of returning migrants and people allowed to move during the closure can be done through a protocol involving their Aadhaar numbers.
Increased testing (especially using antibody tests, which will identify people who have had the infection but are not currently contagious) will naturally increase the number of reported infections. This should not cause alarm, if communicated correctly. Currently, there is no communication on the evidence beyond laconic ICMR press releases. This must change and the media and people must be educated about plans to expand surveillance testing and the protocols to follow for isolation after positive test results. After communication, the test itself can start after a week. This will also allow people infected before the block to develop symptoms of Covid-19.
But testing alone will not stop the virus unless we can isolate infected people, preferably at local facilities. Odisha has been ahead of the curve by allocating Rs 5 lakh to each panchayat to put this infrastructure and systems in place. This cost, for all panchayats in migrant-intensive districts, is only Rs 1,800 crore. Extending this to all panchayats in India would be Rs 10 billion rupees, a rational investment in public health if the virus becomes endemic. We also need to prepare healthcare facilities to receive patients in large numbers, including building hospitals / quarantine facilities on soccer fields, as Assam is doing. Blocking is the time to prepare so that the health system is not overwhelmed and mortality is mitigated.
The bottom line is that the ICMR should allow widespread testing and states should start doing so and report back to a common database. Without this, it may not be possible to avoid a second crash.
Partha Mukhopadhyay is a member of the Policy Research Center, Delhi.
The opinions expressed are personal.