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Can India test a million people a day?

11.08.20, 18:11
Can India test a million people a day?
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India's Prime Minister, Narendra Modi, has pledged to ramp up testing to one million per day over the next few weeks to tackle one of the world's worst outbreaks of the coronavirus.

But can he achieve this, and are the tests being used reliable?

How much testing is India doing now?

At the start of August, around half a million tests were being carried out each day across India on a week's average,

But the available data shows that less than 1% of those who tested negative in an antigen test went on to have a PCR test, and 18% of those who did tested positive. 

The recorded infection rate in the capital has fallen in recent weeks, but experts suggest that could be because many cases have been missed.

The authorities have now asked testing centres to conduct more PCR tests. 

But data shows that more than 50% of the tests conducted are still antigen tests, despite the Delhi High Court's order that it should be used only in hotspots and healthcare settings.

The southern state of Karnataka started using antigen tests in July, aiming for 35,000 a day across 30 districts.  Although they haven't been able to achieve the target, the number of antigen tests has been going up, and the number of PCR tests coming down.

Karnataka ramps up antigen tests

Source: Karnataka state government

Available data suggests that in the last week of July, 38% of those who initially tested negative but had symptoms and then took a PCR test, came out positive. 

In Telangana state, the government also ramped up antigen testing in July.

Although the state does not provide daily data on how many PCR and antigen tests are conducted, there are currently only 31 government and private labs equipped to do PCR tests, as against 320 government facilities for antigen tests.

India's worst affected state, Maharashtra, first began antigen tests in Mumbai. The city's municipal corporation reported that 65% of those who had symptoms of Covid-19 tested negative in the antigen test, but went on to be positive in a PCR test. 

Dr Anupam Singh, a public health expert, says there are some advantages to the rapid tests: "It allows a faster detection process and means you can quickly detect highly infectious individuals with a high viral load who might be so-called super-spreaders."

But he also has concerns about this strategy, which can potentially miss many infections.

"As PCR testing requires higher investment and resources, the authorities have switched to a focus on reducing deaths, and catching highly infectious people - the low-hanging fruits," says Dr Singh.

So the switch to rapid antigen testing may satisfy performance targets and meet public demand for more testing.

But it runs a real risk of not revealing the true extent of the outbreak - unless it's backed up by continued PCR testing.

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