Covid-19 crisis: At 32 per million, India lags far behind on testing

Kerala, which accounts for 3% of the country’s population, has carried out nearly 7,000 tests for the coronavirus disease (Covid-19) while Uttar Pradesh, which has the highest number of people among any Indian state, has tested only 2,824 samples – numbers that indicate how some states are farther behind in getting a sense of the outbreak than others.

Data shows that populated states such as Bihar, West Bengal, Jharkhand, Madhya Pradesh and Odisha have, as compared to Kerala, conducted fewer Covid-19 tests in absolute numbers as well as tests per million population -- a strong argument for relaxing the testing criteria that is largely responsible for the low numbers across the country.

Health officials in Kerala said that much more tests was a reason for the state, with population of 34.8 million, reporting highest number of Covid cases in the country. Kerala has conducted 6,690 tests, highest for any state in the country, and has also decided to conduct rapid tests, which can identify the possible carriers of the coronavirus. Kerala has also put 151, 370, as on Sunday, under home and institutional quarantine.

According to Kerala health department officials, after the first Covid-19 cases were detected in January, the government insisted on getting the tests conducted as regional virology institute in Alapuzha. From mid-February, tests started there and three more labs were operational by end of March, when most of the states had just one Covid-19 testing lab.

Click here for the complete coverage of the Covid-19 pandemic

“It’s contract-tracing and surveillance mechanisms are good. But we wish Kerala could have done more tests by now as some areas of the state have turned pandemic zones. It has to raise the number of tests immediately,” said Dr Rajgopal Kamath, science writer and researcher.

In comparison, India’s most populated state, Uttar Pradesh, with the population of 200 million, only 2,284 samples have been tested, of which 2,171 have been negative. There are eight testing labs in the state including King George’s Medical University (KGMU), LLRM Medical College in Meerut, Aligarh Muslim University in Aligarh and Banaras Hindu University in Varanasi.

The calculations for cases per million has been done with data from the 2011 Census

Surya Kant, head of department of respiratory medicine, KGMU, said the number of tests done were less in UP as the numbers of travelers from foreign countries in the state were less as compared to Maharastra and Kerala. “Many traveler who came via Mumbai and New Delhi airports, were first screened there. In the coming days, we will see increase in testing,” he said.

Dr PK Gupta former president IMA, Lucknow, said the government should focus more on identify those with symptoms. “Selecting the correct person for test will ensure infection does not spread fast. I think number of tests will go up in the coming days as more people have entered UP,” he said.

West Bengal, with population of 91 million, and 20 Covid-19 cases and one death has conducted 389 tests.

Chief minister, Mamata Banerjee, blamed the Centre saying the kits were not available, governor, Jagdeep Dhankhar, on Sunday claimed the Centre has provided 10,000 coronavirus kits to the state.

State health officials, however, said there was shortage of RNA extraction kits, needed to identify the new strain of corona virus. There are six laboratories including a private one to conduct tests in Bengal and five more are waiting for approval from the ICMR.

Dr Sumon Poddar, associate professor, Institute of Child Health, Kolkata, however, said most of the tests were limited to urban areas even though flow of migrant labourers to rural Bengal has increased in the past few days. “Tests help to identify Covid-19 hotspots quickly and that is the reason the WHO has been asking governments to conduct as many tests as possible,” he said.

Bihar with population of 90.9 million and 15 Covid-19 cases has conducted 792 tests. Two labs in the state capital, Patna, are authorised to conduct the tests. Bihar Covid-19 nodal officer, Dr Ragini Mishra, defended the low number of tests saying they were following health ministry’s guidelines. “The guidelines do not suggest taking samples of those who are asymptomatic,” she said.

Dr Ajay Kumar said less than 800 samples tests were “far too inadequate” for a populated state like Bihar. “The state has not been able to thoroughly test the 1 lakh-plus migrant labourers who returned during the lockdown period. Our people work in Maharashtra, Kerala and UP, which are among some of the worst Covid-19 affected states in India. Moreover, Bihar also shares an open border with Nepal,” he said.

The number of samples for testing has increased since March 24, when the Indira Gandhi Institute of Medical Sciences (IGIMS) became the second centre to commence real-time polymerase chain reaction (RT-PCR), a confirmatory test for novel coronavirus (Covid-19).

Madhya Pradesh with 72.6 million people, have tested 525 samples till March 28 at the two labs --- AIIMS, Bhopal and NIRTH, Jabalpur. “If small state like Kerala can test 500 persons every day, why can’t MP test at least 1,000 persons every day. Kerala has as many as 16 labs whereas Madhya Pradesh had only two labs till a couple of days back,” said Amulya Nidhi, director of Jan Swashthya Arogya, a social organisation working in the field of health.

Additional director, department of health, Sapna Lovanshi, said, “We are having five laboratories now. Our department is taking all the measures to test all the samples collected and control spread of the virus as per guidelines of the central and the state governments.”

Jharkhand, which has so far not reported a single positive case of Covid-19, has tested only 196 persons, lowest in the country along with much smaller and sparsely populated Himachal Pradesh. Giving the reason, Dr Manoj Kumar, head of Ranchi based Rajender Institute of Medical Sciences microbiology department, said they have not noticed any spurt in Covid-19 cases in the past one week.”If we needed, we can scale up the testing,” he said.

Most state health departments are, however, increasing the capacity to conduct tests.

Punjab, which is conducting, 160 tests every day in two labs, plans to increase it to 400 every day by next week. Principal Secretary, Medical Education and Research, M Tiwari, said the machines will come by March end to increasing the testing capacity.

Karnataka chief minister B S Yediyurappa on Sunday said there was no shortage of kits to conduct tests and the state has the highest number of Covid-19 testing centers at 11, apart from sample collection centers spread across the state. Karnataka has conducted 3170 tests so far.

Telangana chief minister K C Rao said testing has been increased around 50% since March 24 and it will further go up in the next few days. Andhra Pradesh will also increase tests from present 251 to close to 1,000 by next week.

“Given the lack of adequate testing facilities and expensive kits, it is not possible to test every suspect. If the facilities are increased, the governments can do random testing to ensure that there is no spread of the disease,” Hyderabad based health expert, M Somasekhar, said.

However, the state health department officials assured that the number of tests would be increased in the coming days if there is spurt in Covid-19 cases and new hotspots emerge. Kasargod in Kerala, Indore in Madhya Pradesh, Bhilwara in Rajasthan and Shaheed Bhagat Singh (SBS) Nagar district of Punjab are some of the identified Covid-19 hotspots in India.