On 30 March, Dr Harsh Vardhan, India’s health minister, chaired a meeting to review the nation’s COVID-19 testing strategy. While the Modi administration has been reluctant to expand testing, the novel coronavirus has marched away from India’s megacities, and emerging evidence suggests that testing gaps will hamstring efforts to contain hotspots in smaller cities and rural areas. In late March, the Chhattisgarh government, which is among the states that adopted a liberal testing policy that goes beyond the guidelines issued by the Indian Council of Medical Research, was faced with indisputable evidence of community transmission.
The state government had tested random samples and found that a senior citizen, who uses a wheelchair and lives in a basti—an unauthorised colony—near one confirmed case of COVID-19, had tested positive for the virus. According to the state health department, the patient had no travel history, no contact with any international travellers and could not provide any information that could trace the source of his infection. By all indications, the senior citizen’s infection was a case of community transmission. Multiple officials in the state’s health department have expressed concern that this case is emblematic of undetected infections within the community.
The Chhattisgarh government determined that the senior citizen had been infected during a house-to-house survey within a three-kilometre radius of a different confirmed case. The state has been one of the few to proactively test people and demonstrate this level of hyper-vigilance, which is an urgent necessity that the central government has failed to act on. The identification of such a case, with no history of travel and no record of contacts with other positive cases, is a clarion call to scale up testing, aggressively isolating those who test positive and preparing hospitals for the coming surge in cases.
According to TS Singh Deo, Chhattisgarh’s health minister, “the story” of the state’s fight against COVID-19 started in early March, with his government trying to convince the central government to expand their testing criteria. “At that point, the testing was entirely controlled by ICMR,” he said. “The testing facilities were controlled by them, and testing kits were also only with them.” On 16 March, Deo wrote to the health ministry calling upon them to “expand the criteria for testing,” noting that it was “too restrictive.” On March 31, he tweeted that although guidelines had been relaxed to some extent after his letter, “it has not been followed up with supply of large number of testing kits.” He continued, “Please do help Chhattisgarh @PMOIndia and @ICMRDELHI.”
On 1 April, Deo wrote to Vardhan again, this time urging the ICMR to formulate guidelines for the use of rapid antibody testing kits for COVID-19. He then tweeted, “Requesting the Central Govt & @drharshvardhan to ensure that @ICMRDELHI formulates comprehensive guidelines for use and purchase of Rapid Tests for #COVID19 as these tests have been used effectively across the world and are needed for expanding testing capacities.”