Not testing enough to check community transmission: Dr Gagandeep Kang

India’s response system is not watertight, leaving the possibility for community transmission cases, according to Dr Gagandeep Kang, executive director of Translational Health Science and Technology Institute, an autonomous body under the Science and Technology Ministry’s Department of Biotechnology.




Despite the Indian Council of Medical Research’s (ICMR) claim that it is adequately testing as many patients for coronavirus, another senior official in the government set-up has argued that the testing done so far is not enough.

India’s response system is not watertight, leaving the possibility for community transmission cases, according to Dr Gagandeep Kang, executive director of Translational Health Science and Technology Institute, an autonomous body under the Science and Technology Ministry’s Department of Biotechnology.

Asked whether India is testing enough patients to check for community transmission, Kang said, “No, we are not testing enough.”

While stating that testing travellers entering the country was a good step in the early stages of the outbreak, she told The Sunday Express, “But when you begin to hear the kinds of stories that are circulating about people walking out of quarantine, people saying (they weren’t screened at the airports), that sort of sets up the thinking that this is not a 100-percent perfect system. Therefore, we need a backup plan to try and evaluate whether there is community transmission and how much.”

Community transmission occurs when the illness is widespread and it is difficult to find out how the patients got the infection.

The government has now decided to test all hospitalised patients with severe acute respiratory infections (SARI), including pneumonia. This comes amid a spike in fresh cases in the country and criticism of the way India was limiting testing for the contagious and virus to only those with travel histories showing symptoms of COVID-19.

Experts such as Kang have shared the view of the World Health Organization, which feels the best way to curb the spread of the novel virus is to “test, test, test.”

According to the Department of Health Research, community transmission of the disease has not been documented so far.

Kang is worried that the strategy followed so far may have already allowed for potential community transmission cases to go undetected. ICMR had been testing random samples of patients with SARI and influenza-like illnesses since February at its centres to make sure that it was not missing cases of community transmission.

Earlier this week, ICMR had said that none of the 826 such samples drawn in March had tested positive for COVID-19.

“I believe it was reiterated that there are no positive patients coming up from the random surveillance, but 820 or so tests cannot represent an entire country,” she said. “It is important to understand when disease comes in, it’s spotty. There will be little pockets here or there. So, whether your surveillance network is properly representative or not requires a fair amount of mathematical modeling to say that if I test 20 samples versus 30 versus five, that this is the right approach to be taking.”

“Now, I don’t know if ICMR did that, but that would have been, as they did, step two in surveillance. When do you actually move out of the severe respiratory disease and think about what else we should be testing?”

According to Kang, looking at testing at a population level is another option that can be explored.

“The other option to not do a complete lockdown is to figure out where the disease is prevalent, because it will enter the country only in certain areas and then spread. If you look at China, for example, it did not shut down the whole country. It only shut down Hubei,” she said.

“So, if you know where the disease will be concentrated, you can then advise measures in an area where you are expecting a significant burden. You can test and also concentrate your resources in terms of building up hospitals in that location.”

At the individual level, promoting isolation and curbing any community transmission is also crucial, according to her. This can be done by looping in the private sector, even if it means that some patients might have to pay for the tests.

She said, “Openness to private labs is a way to do it. You could open it to anybody who wants to test, and it doesn’t need to be free for everybody. Those who can pay for it, pay for it. Those who require to be tested because they are severely symptomatic, can you think about making those tests free?”

Kang said donations or the Corporate Social Responsibility (CSR) route would also be good options. “There are lots of ways we can think about expanding testing. Would this have the ability to cover a country of 1.3 billion people? No, it won’t. But, will it do better than we are doing currently? Absolutely,” she said.

At the same time, she said that it is crucial to have mathematical modellers involved in the process. “I have great faith in asking people to generate multiple mathematical models of what they think the disease is going to look like, and what interventions should we be thinking of…I’m sure the government is working with modellers…these are the people that we need on the job, advising us about what they think is going to happen.”

ICMR officials had earlier said they did not wish to perform “indiscriminate” testing and needed to rationalise their tests. They had argued that it was not necessary at this stage to test every person for the virus, and that the country is testing the cohort it needed to test “for now”.

Here’s a quick coronavirus guide for you to stay updated: Who all should be tested for Covid-19 and when? | How should you quarantine yourself? | How often (and how) should you clean your home? | What is the Janata Curfew announced by PM Modi? | Who are restricted from coming to India, and from when? | How long can the virus live on surfaces or in air around you? | Still more Coronavirus Q&A Explained news here

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