Thread on testing and COVID-19 in India:

India started with very low levels of testing, drives by a narrow testing strategy that began with a focus on symptomatic incoming travellers and their close contacts. This placed at the lowest end of tests: people globally.
What they were worried of in the early days was of testing centres being inundated and of hospitals filling up with people with mild symptoms. There were also availability issues. I summarised this in an early episode of my mini-cast https://medium.com/@rukminiwrites/the-moving-curve-episode-4-4deae49f62bc
The testing strategy has now been gradually expanded to include asymptomatic close and direct contacts of positive persons. It's still not a case of 'anyone who wants a test gets it' - but it isn't like that anywhere comparable globally.
A few developments have happened in the last few days. One is that many states are now reporting that they cannot locate travel history or known contacts for a significant number of their new cases.
The other is the new ICMR study which found that 40% of the people hospitalised for acute respiratory distress who tested positive for COVID-19 had no travel history or know contacts either.
These twin issues can only mean community transmission (forget the endless arguing over the term) and to understand and/ or arrest this, you need to expand testing.
(Note though that given the share of tested people who are testing positive is low relative to other countries,band hasn't grown in India over time, there wasn't a trigger to expand testing until this.)
So how do you expand testing? It's not a simple call because it needs to move in a clear direction. One way is to institute a big NFHS-style national random test. Many favour this (me too) but note no comparable country has done this and it would take a lot of time + manpower.
The other is to further branch out from the current testing strategy, by doing pooled tests in certain areas. The minute you pool though it's not diagnostic at the individual level any more, only indicative.
Also the podcast is now on Pocket Cast and Spotify. Thanks for listening. (Thread ends.)
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