Tanvi Choudhari, a 32-year-old architect living in Goa, has fears about how COVID-19 may affect her in the future. If not soon, at some point in the coming months, she believed that she or someone she knows would contract the infection. Her 56-year-old mother lives in Gujarat, where the outbreak has shown a high fatality rate. With respect to both states, Choudhari feared about where she or her mother would go if they were symptomatic. But her biggest concern was the financial strain of getting tested and treated at a private clinic. “I am a freelancer and I am worried that testing costs are too high,” she said. “Then comes the treatment costs. I hear other countries are doing this for free, and am wondering why India is not.”
The question was not unfounded. In India, the test, if done from outside a government facility, is prohibitively expensive, with the Indian government allowing the private sector to charge up to Rs 4,500 per test. According to guidelines issued by the Indian Council of Medical Research, this amount “may include Rs 1,500 as a screening test for suspect cases, and an additional Rs 3,000/- for confirmation test.” The guidelines do not disclose the actual cost of these tests that private clinics have to pay. While India imposes costs that restricts the capacity of citizens to get tested for COVID-19, its neighbours in the subcontinent have ensured that tests are available for free, or minimal costs, as ought to be a priority during a public-health crisis.
Choudhari also recognised that individuals who need to get tested might invariably need to undergo it thrice before they can be discharged. Dr Naman Shah, who works at a rural hospital in Chhattisgarh run by a public-health initiative called Jan Swasthya Sahyog, explained why this was the case. “The majority of tests around the world use a technology called reverse transcriptase polymerase chain reaction, or RT-PCR, which detects traces of the coronavirus in mucus samples,” Shah said. “The patient might need a second test because the initial test may not be accurate as the amount of viral material available in the mucus sample may be too little for the tests to detect the virus. Every subsequent test adds a little bit more information but there are significant costs attached to this. Many hospitals test a third time to check if the patient is negative, before discharge. This is, however, not needed.”
As a result, a patient might be compelled by a private hospital to undergo three tests . “The treatment cost will be over and above the testing cost,” Choudhari told me. “The testing rates of three rounds, at Rs 13,500 per person, is a big concern for me.”
This is in sharp contrast with India’s poorer neighbour, Bangladesh, where testing as well as treatment is free. “We do testing and treatment for free,” Meerjady Sabrina Flora, the director of Bangladesh’s Institute of Epidemiology, Disease Control and Research, in Dhaka, said. “It is very important to make sure that the poor citizens are able to get themselves tested. The only way that can be done is by making both testing and treatment available for free.”