More on Covid-19

NEW DELHI: In a bid to widen testing and ensure that no significant number of Covid-19 cases are being left out, the government plans to expand testing in clusters chosen in ‘cold spots’ or areas where there are no cases reported as of now. This will be a significant decision that takes the focus beyond hotspot areas in around 133 districts where there is a high incidence of the disease.The districts that will be taken up for sampling are being identified and a combination of pool and rapid testing will be adopted to check for the presence of Covid-19. The move, besides providing additional clinical data of the disease, is also intended to respond to criticism that India is not testing enough and positive cases might be under-reported.The sampling will be on the basis of surveillance and tests will be conducted on ILI (influenza like illness) patients to track the presence of coronavirus.As of now, at least half of India’s 720 districts are yet to report Covid-19 and the cases so far are concentrated in certain districts and cities in a pattern that can vary from state to state and even within states.While pool testing is a RT-PCR process, seen as a reliable means of detecting the disease, the rapid test option is intended to test for antibodies.The arrival of rapid test kits from China has been delayed but the first lot of kits is expected to reach soon. These will be used in hotspot areas and, in keeping with the decision under consideration, also in areas where there are no reports of the disease yet.Sources said India’s testing strategy has evolved and while it did initially have to tailor testing to availability of labs, this was based on scientific advice and did not miss out on the spread of the disease. People, mostly Indians, who returned from abroad and their contacts were at highest risk as established by their case histories. Testing of respiratory patients was expanded to cover all ILI patients and trends in ICU admissions and OPD visits were tracked closely so that neither serious or mild patients were missed.The government did not have a dogmatic position on testing which has been reviewed as the profile of the disease changed with the Centre adopting a proactive approach, seeking to anticipate the challenge by formulating aggressive containment methods and also increasing testing from a few hundreds a day to more than 16,000 a day now. The utility of private labs, an official said, was affected by the Supreme Court order that the tests must be free and the Centre was seeking an amendment in the order.The expanded testing regime reflects the added capabilities but does not depart from the view — backed by the Indian Council of Medical Research (ICMR) — that the process is not merely a “confidence-building” exercise. Tests must be performed on those who need it most while strategies adopt to the graph of the disease which so far reveals a positive rate of 4-5% of tests conducted on an average.So far, India has largely done targeted testing through RT-PCR — the conventional confirmatory test approved by ICMR — capturing mainly those who are symptomatic with travel or contact history. To check on community transmission, it later also included all hospitalised patients of severe acute respiratory illness (SARI) and asymptomatic direct and high-risk contacts of a confirmed case.Following a significant increase in cases after the exodus of workers from cities to their native villages and the Tablighi Jamaat outbreak, the government revised its testing strategy a number of times. On April 4, ICMR issued an advisory to test symptomatic people in cluster (containment) zones in hotspots and in large pockets of returnees from cities but through the first generation rapid antibody tests.Further, the government also evolved its testing strategy to include other tests for Covid-19 like TrueNat and CB-NAAT used for tuberculosis testing. It is also adding machines available with NACO.However, as cases continued to rise and in the absence of rapid antibody testing kits, ICMR on April 9 approved RT-PCR tests for all symptomatic people in hotspots and in large migration gathering or evacuees centres.In the last 10 days, the sample size tested through RT-PCT increased from 5,000 a day to an average of 15,000 in a single day, according to ICMR. Till 2 pm on Sunday, a total of 1,86,906 samples were tested for Covid-19, of this 4.3% were positive, ICMR said.