Dr V Ramana Dhara is a professor at the Indian Institute of Public Health in Hyderabad. He trained for the most part in the United States of America, and worked at America’s Center for Disease Control in America for ten years. With a background in environmental and occupational health, at the CDC, Dhara gained exposure to organising responses for many of the outbreaks around the world, such as swine flu and Ebola. He has been following the COVID-19 outbreak closely, as it has spread around the world and begun affecting Indian life. As of 20 March, India had confirmed 563 cases of COVID-19, but Dhara, among others, fears that these optimistically low numbers are the result of an egregious lack of testing. He spoke to Lewis Page, a Luce scholar at The Caravan, about the hurdles India will soon face, and what can be done to surmount them.
Lewis Page: What is the current status of tests for COVID-19 in India? How are the tests being conducted, and who specifically is being tested?
V Ramana Dhara: The government has developed criteria for who needs to be tested. Currently, they are only testing people with foreign travel, people who were exposed to a known case of COVID, or people who have symptoms of acute respiratory illness which cannot be explained by any other diagnosis. [On 20 March, the Indian Council of Medical Research had also stated that “asymptomatic direct and high-risk contact” of a confirmed case will be tested between five and 14 days of the contact, and so will symptomatic health-care workers.]
This is a good start, but the WHO has recommended “test, test, test, test”—as widely as possible. Initially, the Indian Council of Medical Research said that a test-intensive strategy was not best for India, for reasons best known to themselves. There was some speculation in the media that if testing turned out to be positive, there would be anxiety and panic. But it’s also a fact that the testing facilities may not have been adequate for the scale of the testing required. But now, a whole range of public-health experts have critiqued that strategy, and said that you do need to test widely, because you want to know what the burden of disease is in the country. You may test the people from abroad—a certain fraction tests positive, and then you may quarantine them. But then some of their family members will also get infected. From what we are seeing around the world, this virus seems to be attacking people in clusters, and spreading rapidly from there.
Right now, the only armamentarium we have against this disease is prevention methods. We don’t have a vaccine yet, and will not have one likely for the next eighteen months. We don’t have a drug yet, though there have been some trials with [the antibiotic] azithromycin and [the malaria medicince] hydroxychloroquine. But at this point in time, the only strategies we have are prevention, and to test widely so that we know how and where to most effectively apply prevention methods. It is only with a comprehensive testing strategy that we will really know what the number of cases is, and what the spectrum and the pattern of cases in the country are.
LP: If someone were to have mild symptoms of COVID-19, what would you recommend they do? Are there ways for people to get tested?
VRD: At this point, it does not look like that, for most people. The local dean of a medical college here in Hyderabad, who is well-known in government circles, said he developed upper respiratory symptoms and he wanted to get himself tested for COVID. Eventually he did get tested, but he had to go through several hoops and obstacles before he got there. And he had to pull a lot of levers. But for the ordinary person with mild symptoms, this cannot happen. The testing labs will go through the criteria for these people.