Public-health experts raise concerns about India’s restricted testing for COVID-19

13 March 2020
At the Gandhi Medical College and Hospital in Hyderabad, a dedicated lift for people suspected to be infected with COVID-19. Public-health experts have expressed concerns with the Indian government’s restricted testing for the novel coronavirus. Mahesh Kumar A/AP Photo

On 12 March, India reported its first death arising from the novel coronavirus, or COVID-19—a 76-year-old man from Karnataka. The previous day, the World Health Organisation had declared COVID-19 a pandemic, confirming what was already clear by then—that the virus will likely spread to all countries around the globe. That same day, the union health ministry announced drastic travel restrictions, preventing foreigners from entering the country and suspending all visas, barring a few categories, till 15 April. But these travel restrictions may not be effective, given that the virus has reached most corners of the world. “This will stop new cases coming in, but now it is about tracking down local transmission,” Giridhara Babu, a professor of epidemiology at the Indian Institute of Public Health, said.

Even as the state government of Karnataka started tracing and isolating those in contact with the deceased man, union health ministry officials maintained  that the government had no evidence of local transmission in India. Addressing a media briefing on 12 March, Lav Agarwal, a joint secretary in the health ministry, noted, “There is no need to panic as we have limited local transmission.” But public-health experts have highlighted two primary concerns with the Indian government’s response to the ongoing crisis. First, the health ministry has restricted testing for COVID-19 to the few government-accredited laboratories in the country. Second, the government is limiting the tests only to those with a travel history, and those who came in contact with international travellers.

Since it was first identified, in China’s Wuhan city last December, COVID-19 has swept across 114 countries and killed more than four thousand people. As of 6 pm on 12 March, according to the health ministry, India had reported 74 positive cases of COVID-19. With the travel restrictions, India joined a growing list of countries that have taken similar decisions, including Israel and the United States. “Since the virus is already in India, it is important to trace the contacts of all infected people to ensure that we are not missing any human to human transmission,” Babu said. “It is better to be over cautious now than repent later. The logical way to ensure there is no local transmission is to monitor contacts of all travellers, and positive cases, through the incubation period of 14 days.”

In the press conference, Agarwal stated that twelve states across the country had reported positive cases of COVID-19. Given the extent to which it had spread already, public-health experts had hoped that the testing parameters would be expanded to include people without a travel history, which would reveal the full scale of crisis. But Agarwal made it clear that the Indian government had “no plans to revise testing parameters, as testing everyone would create panic.”

Experts also hoped that the health ministry would allow private laboratories to test for COVID-19, so as to not overwhelm the government sector. “There is a real concern that the government is not expanding testing parameters to include everyone because they want to keep the numbers low,” an epidemiologist working with a global-health organisation said, on the condition of anonymity. “If you are not looking for cases, you are not going to find any cases. How can the government know that there is no community transmission, when they are not testing enough people?”

At least two leading epidemiologist and a health policy expert I spoke to also expressed concerns—each requesting not to be identified, fearing retribution from the government—about the restriction on testing for the virus. As of 12 March, the testing was limited to 52 government centres, and there were 56 collection centres where samples could be given.  But Agarwal maintained that the country had adequate testing centres and “there was no need to involve the private sector for testing.”

The central government has also invoked the Epidemics Diseases Act of 1897, which allows a state to prosecute any person or institution violating quarantine norms. The decision was taken after a patient in Bangalore and another in Punjab, who had been quarantined in local hospitals with symptoms of COVID-19, went missing. 

Coronaviruses are a large family of zoonotic viruses, which means that they can be transmitted between animals and humans. The family of viruses has been infecting humans for long, causing illness ranging from the common cold to the more severe diseases such as Middle East Respiratory Syndrome and Severe Acute Respiratory Syndrome, more commonly known as MERS and SARS, respectively. The strain of coronavirus that began spreading in Wuhan, however, is a new strain that has not been previously identified in humans. There is no drug or vaccine for it yet.

Common signs of the infection include fever, cough, shortness of breath and breathing difficulties. In more severe cases, infection can cause pneumonia, severe acute respiratory syndrome, kidney failure and even death. While scientists are still trying to understand the full ramifications of the novel coronavirus, what is clear is that the disease is deadlier than the flu. According to WHO, both diseases may have a similar presentation, but COVID-19 is more infectious, with a higher mortality rate than flu.

The spread of the pandemic is an extraordinary global event, and WHO has recommended a radical change in behaviour to stop new chains of transmission. In a public advisory on WHO’s website, it noted that the most effective steps to combat the infection are regularly washing hands, covering the mouth while sneezing and social distancing. Social distancing essentially seeks to increase the physical space between people in order to slow the spread of the virus. At this point, social distancing has emerged as one of the most effective ways to stop newer chains of transmission from occurring.

While it is a radical change, WHO’s director-general, Tedros Adhanom Ghebreyesus, has said during a media briefing, on 11 March, that “this is not just a public health crisis, it is a crisis that will touch every sector—so every sector and every individual must be involved in the fight.” He also noted that the situation is expected to worsen. Ghebreyesus added, “In the days and weeks ahead, we expect to see the number of cases, the number of deaths and the number of affected countries climb even higher.”

Follow the hyperlinks for WHO literature on COVID-19 precautionsmyths and FAQs.

 Central government helpline for COVID-19: (+91)11-23978046

Vidya Krishnan is a global health reporter who works and lives in India. Her first book, Phantom Plague: How Tuberculosis Shaped History, was published in February 2022 by PublicAffairs.