I have been working as a community doctor in Chhattisgarh for over two decades. As one of the founders of the Jan Swasthya Sahyog—People’s Health Movement—an NGO that provides healthcare in rural Chhattisgarh, I understand the infrastructural problems of the state. There are only around 150 ventilators in the state’s public health infrastructure, and even fewer doctors who know how to run them. Given this state of the healthcare system, as confirmed COVID-19 cases rise well over a hundred in India, I worry about the community transmission of the disease, and dread whether it will overwhelm our weak health systems—both public and private. If a sharp surge of cases as occurred in Italy takes place in India, I worry about our capacity to serve the thirty-two million residents of the state.
The union health ministry’s current testing criteria is limited to international travelers and their direct contacts, and only if they show symptoms such as fever, cough and breathlessness. The tests are not available for people who have severe respiratory illnesses, but have not travelled abroad in the last 14 days and have not been in contact with a person confirmed to have been infected with COVID-19. As a result, none of the patients in my hospital would be eligible for the test presently. The explanation offered by the Indian Council of Medical Research, the nodal agency framing India’s policy for COVID testing, is that there is no evidence of community transmission in the country. This rationale—or lack thereof—reminds me of an old aphorism: absence of evidence is not evidence of absence.
Technical decision makers have claimed that there is no evidence of community transmission. But the source of this evidence is thin and inconclusive. Between 15 and 29 February, the ICMR conducted random tests on 20 samples of patients with respiratory illnesses to determine whether India had community transmission of COVID-19. The samples were sent to the various Viral Research and Diagnostic Laboratories across the country to test whether they were infected with COVID-19 by the RT-PCR—a molecular biology technique that looks at the nucleic acid core of the virus.
The ICMR stated that it did not find any evidence of COVID-19 in those samples, and on that basis, concluded that there is no community transmission in India. If we assume the median date of these samples to be 22 February, over three weeks have lapsed since we concluded that there is no evidence of community transmission. But there is a fundamental flaw in this conclusion. For COVID-19, three weeks means a lifetime of evolution of the epidemic—for instance, Italy has shown the exponential increase that can take place in a short time span.
On 15 March, the Economic Times reported that the ICMR was beginning the next set of tests. According to the report, each ICMR laboratory would test twenty random samples every week for community transmission. Two days later, the ICMR stated that it had conducted tests on 1,020 random samples, and that preliminary tests on 500 of them did not yield any positive results for the COVID-19 virus. Balram Bhargava, the ICMR’s director general, had accordingly concluded, “There have been no signs of community transmission.”