As India enters the third week of a nationwide lockdown, states are ramping up testing capacities. Asymptomatic patients, who were confined to their homes, are likely to start showing symptoms and massive testing is the only way to identify and isolate them. Further, with hotspots emerging across major cities, the country’s apex health research organisation — the Indian Council of Medical Research (ICMR) — has already advised resorting to rapid screening tests (using blood samples) at these containment zones to arrest the spread of the virus.
A quick review shows that most states are testing between 600 and 1,500 people per day, and have already requisitioned 50,000 to 100,000 testing kits. At the central level, around 700,000 rapid test kits are expected to arrive around April 10 and the major testing ramp up would have to wait till then.
Rapid tests use blood samples to look for antibodies that react to coronavirus protein and give results within minutes. These have to be followed up with conventional the polymerase chain reaction (PCR) tests that take a few hours to deliver results.
But the availability of diagnostic kits is a growing concern. Protective personal equipment (PPE) worn by the health care workers is in short supply, too. India is roughly testing 20,000 samples per day and the plan is to scale this up to 100,000 samples per day within the next few weeks. A public health expert said India needs to test at least 130 million people, which is only 10 per cent of its population, to control community spread of the disease.
These look like very steep targets at the moment.
Maharashtra said on Wednesday it was running out of PPE kits and the Brihanmumbai Municipal Corporation (BMC) is now aiming to procure 35,000 PPE kits every week. So far, around 12,000 PPEs have been air-lifted and 30,000 or so are on their way. BMC has also ordered 50,000 rapid testing kits.
The BMC has said the outbreak here has reached the community transmission stage, as fresh cases are neither contacts of patients nor do they have any travel history. Worli, Prabhadevi, and Lower Parel are among the worst affected, apart from Dharavi.
More than 50 health care workers have been detected Covid-19 positive in the city. On an average, Mumbai is now testing 890 people per million. This, according to the BMC, is better than the national capital, which is testing 96 people per million.
Private labs here have been asked to conduct 25 tests for free per day.
Delhi has requisitioned 100,000 rapid testing kits and has received many kits from ICMR recently. Uttar Pradesh (UP), which is sealing off 15 of its worst-affected districts, is gearing up to double the daily testing of suspected cases to 1,500 from Thursday. Apart from the districts where Covid-19 patients have been identified, the state will now conduct tests in the remaining districts as well to minimise possibility of spread of the pandemic, UP medical, health and family welfare principal secretary Amit Mohan Prasad said on Wednesday. The state will also collect samples of people with symptoms of respiratory illness or influenza. A tender to procure rapid test kits will be opened on April 11.
“These antibody testing would be used on health workers and at the quarantine facilities, since the UP coronavirus curve has started to flatten. It is time to go for aggressive testing to further rule out the possibility of positive cases,” added Prasad.
Meanwhile, the state government will expand the current testing facilities from 10 to 24 district hospitals and medical colleges in the coming weeks. Besides, all the 75 districts in UP will be equipped with coronavirus sample collection centres.
Down South, many states have adopted a kiosk approach to collect samples, like Tamil Nadu, Kerala, and Karnataka. So far, Tamil Nadu has ordered 100,000 rapid testing kits from China, which will reach the state on April 9. Testing would begin around April 10. As on April 7, Tamil Nadu had around 14,000 test kits from the National Institute of Virology, Pune. Tamil Nadu has tested a little over 6,000 samples till Wednesday. It is doubling the number of testing facilities from the current 19.
A walk-in sample kiosk has been set up at a government hospital in Tiruppur, in line with those installed in South Korea. In these sterile cabins, throat swabs can be taken from patients standing outside the cabin. This helps in collecting more samples in less time. It also reduces the requirement for PPE kits. Similar arrangements have been made at Kerala’s Ernakulam.
Kerala received its first set of 1,000 PCR test kits from Pune-based MyLab. It was ordered by Thiruvananthapuram MP Shashi Tharoor. The state is waiting for the rapid test kits now. Kerala is buying 100,000 rapid test kits from China. Of this, 25,000 kits have been delayed due to clearance of ships in China. Kerala CM Pinarayi Vijayan has said there is no scarcity of test kits. The state will get 20,000 kits from ICMR by Thursday.
Karnataka, too, is in the process to procure 100,000 antibody test kits from a Singapore firm and aims to ramp up testing from 600-800 per day.
K Sudhakar, the state’s medical education minister, who is the official in-charge for all Covid-19-related matters in the state, has said these test kits would be used in red zones and also for some random testing to check community transmission. Karnataka is also in the process of procuring one million PPE kits for the safety of health care professionals.
Andhra, too, has ordered 100,000 rapid antibody test kits to pro-actively screen high-risk groups. It has expanded the testing capacity to 5,000-6,000 samples per day. Symptomatic survey is being conducted on people above 60 years, health workers and high-risk patients. The department is planning to conduct tests on 1,800-2,000 from these groups. Besides this, about 1,000 blood samples were collected from clusters where infective cases had been reported recently. The health department has stocked up 2 million tablets of hydroxychloroquine and 1.4 million tablets of azithromycin for a possible treatment of the coronvavirus infection. The government has already placed orders for 2 million PPEs and 1.4 million N-95 masks for medical staff dealing with coronavirus cases in the state.
The Andhra Pradesh MedTech Zone has started manufacturing 2,000 testing kits per day. The capacity will be increased to 25,000 per day. Telangana, however, has taken a different route. Unlike in other states, the Telangana government decided against using rapid testing. It thinks conventional testing is a must to confirm the cases. About 200,000 conventional testing kits, 500,000 PPEs, 500,000 N-95 masks, 2.5 million regular masks and 2.5 million surgical gloves have been ordered here. The government is distributing 5,000-10,000 PPEs a day to hospitals dealing with coronavirus cases.
Gujarat has requisitioned an additional 50,000 kits from ICMR even as plans are afoot to ramp up daily testing to over 1,000 in newer containment zones being identified. According to the Gujarat government’s health officials, the ICMR has so far supplied 17,000 RT-PCR kits to six public hospitals.
“At our six locations, we have a daily testing capacity of 1,500. Private labs in the state can do another 600-700 tests daily. Currently, 600-700 tests per day are being done,” said an official.
West Bengal has been relatively tight-lipped. It has identified seven clusters where rapid testing would be conducted. There are 30 NABL-accredited labs in the state to conduct such tests.
Inputs from Virendra Singh Rawat, Dasarath Reddy, Gireesh Babu, Samreen Ahmad, Vinay Umarji, Avishek Rakshit & Sohini Das