By Kiran Mazumdar Shaw
India needs to promptly start epidemiological data collection and analysis to fine-tune its response to the COVID-19 outbreak, flatten the curve and avoid interventions that may turn out to be unnecessarily costly for the nation.
Epidemiological data is very important as it can answer critical questions about how the virus is being transmitted, how many people have been infected with the virus, what is its severity in the Indian populace, and which control measures are working.
Everyone, from governments to local health authorities and disease modellers to global agencies, need data to monitor the impact of COVID-19 and extract actionable intelligence for effective decision-making.
The current dataset on the COVID-19 situation in India is inadequate. This is because like most countries, including the U.S., India currently lacks the ability to test a large number of people.
Will short-term extreme social distancing help? How long should lockdown measures be kept in place? Can the Indian summer play saviour? Do Indians have inherently better immunity? Is the viral strain less virulent? Does India have an advantage because it has among the youngest populations in an ageing world?
We will need to collect a large patient data set and analyse the data thoroughly to generate critical insights that can answer these important questions. The 21-day lockdown announced by the government provides us with a great opportunity to generate this data.
Situation is Encouraging Thus Far
Data collected thus far suggests that though the number of people infected by COVID-19 is on the rise in India, the severity of the disease seems quite manageable and deaths are low.
Data available as of March 27, 2020, showed just over 750* confirmed cases in India, with Total Deaths per 1 Million Population at 0.01. Also, ~70 patients in India have recovered, which currently puts the recovery rate at 9%.
If this trend continues as the number of infections grow, we are safe to assume that we can manage the disease and that our hospitals will not be overwhelmed.
The graph (below) clearly shows India as an outlier when we compare COVID-19 related mortality rate.
Convert Hotels into Quarantine Zones
In the next 21 days, we will need to convert big government hospitals into dedicated COVID-19 facilities, as well as, create isolation zones for patients who are found to be COVID-19 positive.
Totally, there are ~714,000 government hospital beds available in India, amounting to 0.55 beds per 1,000 population, according to a recent blog by Brookings India. Given the shortage of hospital beds, the government should convert hotels into quarantine–nursing homes.
These temporary quarantine zones should be used to house those COVID-19-positive cases who are asymptomatic or have mild symptoms. Patients housed in these hotel-turned-quarantine zones need to be monitored 24×7, provided nursing care and teleconsultation for 2-3 weeks. They need to be tested every week and released if they test negative three consecutive times.
If any of these cases take a turn for the worse they should be immediately moved to a dedicated COVID-19 hospital with ICU care and ventilator facilities.
This model of treatment will help ease the pressure on existing healthcare infrastructure. It will also enable us to generate a lot of data on the severity of the disease. If we can use the data to establish the low severity of COVID19 in the Indian population it will give us the confidence to manage the outbreak with existing resources.
We Need Large Scale Testing Over 21 Days
India has done a reasonably good job on most counts: airport screening, quarantining, public awareness, and even contact tracing in most places. However, we have to do a lot more when it comes to testing. India has one of the lowest testing rates compared with Asian countries that have had greater success at managing coronavirus outbreaks. A total of about 26,800 individuals had been tested for COVID-19 till March 27, 2020, according to ICMR data.
We need to scale up testing rapidly. Since diagnostic kits are still in short supply, we should prioritise who can take the test according to the following criteria:
All quarantined persons
- All health workers treating COVID-19 patients
- All persons carrying out essential services and working in essential sector industries
- Random sampling of slums and rural communities to see if there is community spread
- Employees returning to work after the lockdown must be tested before they resume their duties
Need to Determine Onset of Herd Immunity through Serological Testing
Over the coming days and months, the Indian government will need to start serological testing to make accurate public health decisions about when and how to lift the lockdown and ease strict social distancing regulations currently in place. Data from these tests will also help determine the potential threat from any subsequent waves of the COVID-19 outbreak.
Serological testing is used to detect antibodies in the blood to identify the real number of people in a population who have come in contact with the COVID-19 virus.
If serologic testing on enough representative people across the country reveals for example that 60% or more of the population have got antibodies to the COVID-19 virus then it’d mean they’ve already had the infection and India as a country has developed ‘herd immunity’ against the disease, lowering the danger of the disease spreading uncontrollably through the population.
This will give the government a key data matrix to gradually lift curfews \ lockdown. This approach will hopefully give us a “coast is clear” by mid May.
Boosting Manufacturing of Low-Cost Diagnostic Kits in India
Biotech companies in India are already making probes and primers needed for diagnostic kits. India can exponentially step up the production of low-cost antibody and PCR kits if the ICMR can supply the following:
- Extracted RNA from COVID19 virus
- Serum sample of convalesced patients
- Human positive controls
As we prepare for the long haul, data will play a key role in fighting this pandemic.
4 thoughts on “COVID-19 Testing & Analysis to Flatten the Curve”
Great. Jai hind. We will succeed and we have the will courage and govt support. Some public active cooperation needed and no need for religiousc activies. Law should punish the guilty very quickly even it means capital punishment. We are time bound asd we have to be covid free by 15th april 2029 to a large extent.
i represent a cap accredited path lab.i read everything on covid .yours is most erudite article combining biostatistics epidemiology and pathology.i fully endorse your view about antibody testing. icmr is on the same page about. will await more of your incisive articles.
Everything you say stands correct. But executing this plan in India is a massive administrative challenge. I do believe you should communicate these ideas to General Secretary of Health ministry who can chalk out some solid execution plan.
Thanks for sharing your thoughts with a holistic approach. Testing all definitely counts, needs to be executed on war footing. Otherwise, we are dealing with too many blind spots and don’t exactly know where we stand today in terms of the pandemic, scale of it, behavior of the virus in India, steps towards containment-prvention-cure etc.