With the nationwide lockdown to curb the spread of coronavirus to be lifted in four days, India is staring at new challenges in preventing a spike in cases. With the number of confirmed infections crossing 31,000 countrywide, public health experts say India needs to review its strategy while aggressively continuing contact tracing, testing and social distancing.
More than 770,000 samples have been tested until 29 April in 288 government labs and 97 private labs across the country. Testing has indeed been a challenge considering the shortage of facilities, and more recently with the doubts about the accuracy of Chinese rapid testing kits.
“India cannot afford an extension of total lockdown as the cost to the economy and people is huge. The thing to do is to impose lockdown only in areas reporting positive cases while continue testing aggressively," said Dr Prasanta Mahapatra, Dean, The Institute of Health Systems in Hyderabad.
The fear that cases will surge once lockdown is lifted is genuine going by the experience of Singapore and a few other countries. “While we must focus on testing, it is important that we follow coughing etiquette, social distancing and wear masks. If we do this diligently, there will be fewer new cases, which, in turn, will reduce the number of tests we need to do. Staggered opening is the way out keeping in mind the health infrastructure of our country," said Dr H Sudarshan Ballal, Chairman, Manipal Health Enterprises Private Ltd.
Prof Giridhar R Babu, Professor & Head, Lifecourse Epidemiology, Public Health Foundation of India, said India needs a district action plan. “As movement of people from bigger cities to districts and rural areas is expected to restart, there should be Covid-19 designated hospitals in districts. Existing testing facilities in many more institutions must be identified. We should also start identifying quarantine facilities in rural areas," he said.
Another long-term solution would be indigenous production of testing kits. “We are facing a shortage of testing kits. The best solution for India now is to start manufacturing own kits so that we don’t go slow on testing for want of kits when the numbers surge. The government has already ramped up procuring PCR machines as they are more accurate. Private labs are capable of testing nearly 800 per day," said Dr Kunal Sharma, oncopathologist & section head, pathology, SRL Reference Lab, Bengaluru.
Mere ramping up testing will put overwhelming load on the hospitals, and so selective, small-scale lockdowns and decentralized preparedness at the level of villages and towns is required now. Stressing on the strategy of maximizing detection and minimizing transmission, Dr Prashanth NS, Assistant Director Research & head, Cluster on Health Equity, Institute of Public Health, said, “We have been doing this but the sooner we improve, particularly after the lockdown ends, the better we will be in flattening the curve."