Mass tests vital to map coronavirus spread after first death in India

India must rapidly scale up testing of the novel coronavirus as it seeks to contain damage from the deadly outbreak, with one expert concerned that cases could double every two to three days in the densely populated country.

With a population of 1.3 billion, India has so far reported 81 cases though that number has more than doubled in a week. The country also confirmed its first virus-related casualty on Thursday -- a 76-year-old man. The true extent of the outbreak is likely a lot worse, according to Ramanan Laxminarayan, director of the Center for Disease Dynamics, Economics & Policy, a research group in Washington, D.C.

“India has far more infected cases out there than we know. Community transmission is already happening and we’ll know about those cases only if we test more,” he said. “Cases could be doubling every two to three days right now.”

The government on Friday said it has adequate testing facilities and kits. It has expanded its network of laboratories equipped to test Covid-19 to 65 from 52 and the secondary test for reconfirmation of the virus have also been expanded to 32 labs to enhance capacity, said Raman R. Gangakhedkar, a senior scientist at the Indian Council of Medical Research.

About 100,000 testing kits are available now and additional 200,000 kits have been ordered, said Gangakhedkar. India can conduct up to 10,000 tests a day at present. “Testing capacity is not an issue,” he said. “We are in a position to contain this outbreak for a sustained period.”

The pandemic, which has infected 135,118 people globally and killed more than 5,000 has a pattern of surging after an initial slower phase. This was seen in nations such as South Korea and Italy -- the worst-affected countries outside of mainland China, where the highly contagious pathogen first emerged in December.

South Korea, which had a 2,000% jump in cases in a week last month, slowed the outbreak and deaths by testing hundreds of thousands of people in clinics and drive-through stations.

India, which has a population density of 420 people per square kilometer -- higher than in China -- had tested 6,700 samples and has placed more than 35,000 under community surveillance.

Unlike China, which locked down an entire province, India would find it hard to implement shutdowns of communities. It also likely will be hampered by overcrowded public hospitals, expensive private health care and a large migrant workforce.

Yet the keys to epidemic control remain the same for all countries, said Jessica Justman, a professor of medicine in epidemiology at the Columbia University Medical Center. She pinned it down to four elements -- test, trace, isolate and inform.

Identify Patients

Testing, in such a scenario, helps identify patients early, isolate them, and curb mortality as well as slow down the pathogen’s rate of transmission.

India should now aggressively move beyond containment into disease mitigation, CDDEP’s Laxminarayan said, and push for social distancing.

“We know it’s a highly infectious pathogen. We know it’s in India. We know that people can be asymptomatic for a while,” he said. “We should probably start planning to convert a few stadiums in the cities to prepare them to serve as temporary hospitals.”

About 4,000 potential cases have been identified through contact-tracing and put under surveillance, said Lav Agarwal, a senior official at the health ministry, adding the outbreak is not a health emergency and there is no need to panic. He said Thursday that no community spread has been observed.

India on Wednesday suspended most visas in a bid to halt the spread of the coronavirus. It decided on Friday to limit international traffic through the land route to 19 of 37 border check posts.