Indian authorities on Tuesday said that they would not widely expand testing for COVID-19, as most affected nations are doing, despite mounting criticism from some experts that the limited tests could mask the true toll of the disease in the second-most populous country in the world.
The WHO has urged countries to test as many people as possible to curb the pandemic, but India has taken a different approach, limiting testing to those who have traveled from affected countries, or come in contact with a confirmed case and shown symptoms after two weeks of quarantine.
Authorities on Tuesday expanded the population eligible for testing to healthcare workers with symptoms who are treating patients with severe respiratory illnesses.
Photo: AP
However, officials said the WHO guidance did not apply in India because the spread of the disease has been less severe than elsewhere.
Balaram Bharghava, who heads the Indian Council of Medical Research, the nation’s top medical research body, said that the guidance was “premature” for India, where community transmission had not yet been detected.
“Therefore it creates more fear, more paranoia and more hype,” he said.
A British patient sent home from hospital last week in New Delhi did not fulfill India’s testing criteria.
The woman, who requested anonymity fearing business consequences for her employer, said she told hospital officials that she might have had contact with a coronavirus patient in her hospitality-sector job, but could not be sure.
After trying and failing to be tested a second time, she left India this week for France, where her family lives.
Indian authorities have justified their strict testing limits as a way to keep a deluge of people from demanding tests that would cost the government money it needs to combat other diseases, such as tuberculosis, malnutrition and HIV/AIDs.
The council said there was no need to offer such testing more widely, while authorities said they are preparing for community spread by bolstering their lab testing infrastructure.
As a result of the stringent criteria, sick people with potential exposure to the new virus are being sent home, and some experts fear that India’s caseload could be much higher than government statistics indicate.
Bharghava said virus infections in India can still be traced back to people who traveled into the country from affected locales.
He said that if community transmission is detected, then testing protocols would be revised.
Authorities have confirmed 126 cases, most of which have been “imported” — linked to foreign travel or direct contact with someone who caught the disease abroad.
India is conducting only about 90 tests per day, despite having the capacity for as many as 8,000. So far, 11,500 people have been tested.
However, concerns of so-far undetected communal spread are growing.
“Given the pattern of disease in other places, and given our low level of testing, then I do think that community transmission is happening,” said Gagandeep Kang, director of the Translational Health Science and Technology Institute.
In India, where more than 400 million people live in crowded cities, including many without regular access to clean water, the disease could spread rapidly, experts say.
“Community spread is very likely, but the only way to know for sure is through more expansive testing,” said Anant Bhan, a global health researcher in Bhopal, India.
The virus causes only mild or moderate symptoms, such as fever and cough, for most people, but severe illness is more likely in the elderly and people with existing health problems.
India has a lower proportion of elderly than in other countries, but its healthcare facilities are limited and already cannot accommodate the large number of patients with other diseases.
“This along with our high population density can be our great challenge,” public health researcher Oommen Kurian said.
India has been reluctant to expand testing, partly due to the cost: While the tests are free, each one costs the government about 5,000 rupees (US$67).
In an already stretched and underfunded public healthcare system, money spent on COVID-19 leaves less for other public health problems.
The coronavirus might also be spreading in India because health officials have struggled to maintain quarantines, with people fleeing from isolation wards, complaining of filthy conditions.
In Maharashtra, five people, one of whom had tested negative and the rest who were awaiting test results, walked out of an isolation ward on Saturday last week.
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