Criteria for testing still limited; govt using scientific terms wrongly, experts say

The measures initiated by India in the aftermath of a sudden spike in cases of novel coronavirus infection (COVID-19) on March 3, 2020, have raised eyebrows. The measures, initiated after 21 new COVID-19 positive cases on March 3, have either been inadequate or not completely scientific.

One of the biggest challenges after the cases went up was to ramp up the testing. With a total of 31 positive cases, health officials have maintained the risk to be low. But is India testing enough people?

A total 3,584 samples had been sent to 28 government labs for testing till March 5, according to the update provided by the Union Ministry of Health and Family Welfare (MoHFW). This is very less, according to experts, considering how dense India’s population is.

“That is low. India is a country of a billion. We can’t establish a truer picture of positive cases if we don’t test extensively in different parts of India. The number of cases might be more,” Bharat Pankhania from the UK’s University of Exeter Medical School, told Down To Earth (DTE).

If a breakdown of these numbers was available, it could have shown whether the samples had covered various parts of India or not, he added.

But the number depends on the criteria for testing. All suspect cases conforming to the ‘case definition’ are to be tested, according to the ‘containment plan’ prepared by the ministry.

According to the New Delhi-based National Centre for Disease Control (NCDC)’s case definition of a suspected COVID-19 patient:

A suspected case is a person who has acute respiratory illness with fever, cough and breathing difficulty, with no other etiology (cause of disease) and has either has a travel history to China or is a contact of a confirmed case or is a health care worker in a where a confirmed COVID-19 case has been admitted.

The geographical boundary had now been expanded from China to all COVID-19 affected countries, an epidemiologist said.

The US Centers for Disease Control and Prevention had a testing criteria similar to the NCDC till last week and faced flak for the same. It has since amended the criteria and expanded it saying clinicians should be allowed to recommend a test in addition to the set criteria for testing.

The European CDC too has an expanded criteria now. Even the World Health Organization (WHO) has said all suspected cases must be tested if permitted by laboratory capacity. “The more aggressive India is in early case detection, the better it would be because it will help containing the virus there before cases spike sharply,” Maria Van Kerkhove, the technical lead at WHO said in a reply to a DTE query at the virtual presser on March 6.

But those who would be sampled under this criteria would depend on surveillance by field health workers. They, in turn, are guided by people who have expertise in the field of epidemiology.

“India has less than 5,000 trained epidemiologists. This is way too less and the impact of this adequacy is felt all the more during big outbreaks,” Giridhar Babu, head of epidemiology at Indian Institute of Public Health, Bengaluru, told DTE.

“What is being done in India is selective sampling and it may not help knowing whether the virus is spreading and there are cases of community transmission,” Pankhania added.

Is the government misinforming?

The MoHFW put out a press release on March 5 that said the following:

Since, in addition to COVID-19 cases related to travel, some cases of community transmission have been observed.

However, the definition of community transmission is ‘infection in a person who neither has a travel history nor has s/he come in contact with a person who was infected’.

Incidentally, in India, all those who have tested positive have either had a travel history of one of the COVID-19-affected nations or they have come in contact with an infected person.

DTE’s attempts to get a clarification from the ministry over the usage of the term did not yield any result.

Experts warn that usage of scientific terms in press releases without giving ample evidence should be avoided as it may add to the chaos and confusion.

But the not-so-scientific usage was not restricted to this term. The Don’ts issued by the ministry include contact with ‘live animals’, travel to farms or ‘live animal markets or where animals are slaughtered.’

Does that mean that all live animals at risk?

“The idea that live animal markets are high risk is based on what we know about how Severe Acute Respiratory Syndrome (SARS) emerged in 2002. It should be noted that it emerged out of a wildlife market. But there is no data to support the guidance that exposure to any live animal is a risk for exposure to SARS CoV-2 (virus of COVID-19),” Jonathan H. Epstein, vice president with ‘EcoHealth Alliance’, a non-profit based out of New York City studying epidemics, told DTE.

But the misinformation campaign seems to have done its job. The poultry association of India is already saying that their sales have dropped 80 per cent.

Meanwhile, the number of global COVID-19 cases reached 100,704 on March 6, with 3,412 deaths being reported. Ninety-six countries are now affected.