Coronavirus: Is India’s Testing and Tracing Strategy Working?


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Par shruti menon
BBC reality check

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legendFaster, less reliable method of testing has gained traction in many states

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Indian Prime Minister Narendra Modi has called on the worst-affected states in the country to prioritize testing and contact tracing to tackle the coronavirus.
Daily cases in India have been on the decline since mid-September, but there are concerns that various testing strategies may hamper the battle against the disease.

What kind of test is India doing?

India used what is called a PCR test very widely – considered the gold standard in testing.
But currently, only 60% of all tests use this method, and many Indian states – which are in charge of their own health policies – have switched to rapid antigen testing (RAT), a faster but less reliable method. .

  • How do mass tests work?

RAT tests are known to miss up to 50% of cases due to false negatives (where infected people go undetected), although some experts believe they are still useful in areas that have become hot spots. for viruses.

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“The ability to detect cases depends on a relative mix of the less sensitive RAT test and the benchmark PCR test,” says Professor Gautam Menon, an infectious disease expert at Ashoka University in Haryana.
India is not alone in using these tests, and some European countries struggling with new waves of infection have also resorted to rapid tests.

Are the tests uniform across the country?

Maharashtra is the worst affected state in India, with 17% of all cases.
In terms of total coronavirus cases, it is followed by states with significantly smaller populations like Karnataka, Andhra Pradesh, Tamil Nadu and Kerala.
But Uttar Pradesh and Bihar – two other large population states – appear to be doing much better.
They have lower proportions of confirmed cases at 2.9% and 1.6%.
What the test data reveals is that in Bihar and Uttar Pradesh (and some other states) less than 50% of total tests use the PCR method – so cases are missed.
In Maharashtra, nearly 60% of the tests were PCR tests (although they increasingly use rapid tests in the state capital, Mumbai).
And the state of Tamil Nadu has relied completely on PCR testing, which means it is likely to have a much more accurate picture of how the virus is spreading.

Uneven test levels across states

There is evidence that states may also not perform enough testing in heavily populated areas where infections tend to be higher.
As of November 30, 13% of Uttar Pradesh’s cases have been found in its capital, Lucknow, although less than 6% of total tests in the state have been done there.
Kolkata health worker with swab test kitimage copyrightGetty Images
Kanpur district has the second highest number of cases in the state, but just under 3% of the total tests were done there.
Data at the district level in Bihar reveal a similar trend. One of the most populous areas, Patna, accounts for 18% of all reported cases, but only performed 3% of total tests in the state.
Other parts of the state have done a relatively high number of tests, but have fewer cases.
“If you do less testing in areas with high cases and vice versa [more tests where cases are low], you end up reporting fewer cases while still achieving a specific high testing target, ”says Dr Rijo John, Public Health Policy Analyst in Kerala.
A policeman wearing a mask in Chennai, Tamil Nadu stateimage copyrightGetty Images
He adds that this can make the case number data a little meaningless.

Different monitoring systems

India’s national guidelines on Covid-19 say states should trace contacts of at least 80% of positive cases within 72 hours.
Delhi migrant workers return home to Bihar amid national lockdownimage copyrightGetty Images
legendMany migrant workers left Delhi to return home during national lockdown
But India’s parliamentary committee on family health and well-being said “poor contact tracing and less testing could have been a factor in the exponential growth of Covid.”
It is difficult to get reliable information from every state on contact tracing.
Uttar Pradesh was recently praised by WHO for its “early and systemic follow-up of high-risk contacts”.
In contrast, data from Karnataka show that its numbers for primary and secondary contact tracing have declined since September.
Telangana state has data on the proportion of tests performed on primary and secondary contacts of those who have contracted Covid-19.
This has declined slightly since September with the overall test numbers.

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In Kerala, data shows that 95% of all cases since May 4 have been attributed to primary and secondary contacts of infected people.

But none of these datasets reveal whether 80% of an HIV-positive person’s contacts were traced within the deadlines set in national guidelines.
And many states do not make this data public.

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