Why Kerala should increase COVID-19 testing

Kerala, which attained global acclaim for its successful model of global pandemic management, is witnessing exponential growth in the number of positive cases in last couple of weeks. Community spread and formation of active disease spreading clusters have been reported from few areas in districts like Thiruvananthapuram and Ernakulam.

As the state is in the third phase of pandemic outbreak when the virus transmission is centered in active clusters, experts stress the need to increase the number of COVID-19 testing to prevent the outbreak from entering Phase 4 which is community transmission.

“Community transmission has started and this is the stage in which the testing has to be hiked to maximum. The more we test, the more we can identify and isolate people. More tests means higher chances to identify clusters which can be cordoned off effectively. Without increasing tests, asymptomatic patients cannot be identified. And if such patients are not identified and isolated it will definitely lead to community spread,” said a health expert on condition of anonymity.

However, Kerala has increased the number of testing recently from the earlier 3000 to 5000 tests per day to 20,000 to 25,000 since the second week of July.  

“It is because of extensive testing in the coastal village of Poonthura in Thiruvananthapuram, that it helped authorities to identify presence of super spreading of virus and formation of big cluster in the region. Like that, every cluster has to be identified through extensive testing and cordoned off, which is the only strategy that works in Phase III,” he added.

One-shot virus spread in Kerala

Since Kerala has no clear urban-rural divide with high population density and high mobility of people across the state it will be a one-shot virus spread in all places, observe a section of public health experts. In other states with big cities which are quite disconnected with rural areas, the cities are badly affected while rural regions are slowly waking up now. When cities start to wane off, the numbers might go up in villages. But this situation won’t happen in Kerala where virus spread will rise all together and subside all together in all districts, which has its advantages and disadvantages, point out public health experts.

Delay in test results a major challenge

“Kerala is passing through a critical phase of disease spread and it is crucial to increase testing facilities which will help assess the real situation of disease outbreak in the state. The government can finalise on what additional steps it should take after analysing the real extent of disease spread which is possible only through increasing tests. The number of testing centres in the state is grossly inadequate when compared to rapidly increasing positive cases,” said Dr. Abraham Varghese, president, IMA state president.

“Delay in getting test results is another issue which can be addressed by permitting more private hospitals and labs to set up testing facility. During a recent meeting, Kerala Chief Minister Pinarayi Vijayan cited slowdown in data entry operation as the major reason for delay in releasing test results which is unacceptable reason during such a crisis. Private hospitals and labs are reluctant to install testing facility due to various procedural hurdles. If the procedures are eased, testing facility can be installed which will be useful to many who can afford such labs and hospitals,” he added.

Though RT-PCR test is the most sensitive and acceptable testing method, it is expensive and time consuming. Hence, the low cost and quick antigen testing which has 50 to 80 per cent specificity will be more appropriate as it is more useful for surveillance, according to IMA state president.

Nearly 80 percent of patients are either asymptomatic or minimally symptomatic. When tests are less they are directed at the seriously ill and asymptomatic people are missed. Hence, the number of positives as per records will be less and the chances for community transmission higher.

Meanwhile, the Indian Council of Medical Research (ICMR), has given approval to Neuberg Diagnostics Private Limited for COVID-19 testing in Kerala.  

“Neuberg Diagnostics in Kochi has already started collecting COVID-19 samples. We intend to adhere to the regulated timeline of 24-48 hours for reports throughout Kerala. Reporting and sample acceptance will be strictly in accordance with the ICMR guidelines. We have also set up a special support fund for the weaker sections of society. Through this, we will offer free of cost testing to people with a BPL ration card and appropriate doctor prescriptions,” said Aishwarya Vasudevan, group chief operating, Neuberg Diagnostics Private Limited.