In Mumbai, Delhi and Ahmedabad, Expanded testing is the only way

In Mumbai, Delhi and Ahmedabad, Expanded testing is the only way
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The Testing Trends that we saw today showed a scary trend for Maharashtra and Ahmedbad during the last two weeks. As testing increased, the % of people who had infection was going up. In every other State it was the reverse, as testing went up, % of people who had infection came down.

In the last two days in Maharashtra, 10% of the people who were tested were found to be positive. In Gujarat it was 7%. At the same time, in Andhra Pradesh it was 0.9%. Andhra carried out as many tests as Maharashtra. It took AP 7 days to move from 1000 to 1500, Maharashtra took 3 days. 

What does this mean?

Currently, States by and large follow a standard protocol for testing. So, you get tested only if there is some chance of you getting infected. So, if you are a healthcare worker, or a Journalist or a Government worker interacting with a lot of people OR if you are someone who has come in touch with a person who is already infected. The second part is called contact tracing. 

Here is the definition on wiki 

Contact tracing is the process of identification of persons who may have come into contact with an infected person (“contacts”) and subsequent collection of further information about these contacts. By tracing the contacts of infected individuals, testing them for infection, treating the infected and tracing their contacts in turn, public health aims to reduce infections in the population

Invariably, there is going to be some leakage with the second group. The infected person may not recall all names OR they may deliberately hide some names. So if the infected person transfers the infection to even 1 person whose name was not shared with the authorities, that would be a leak. This is in short the problem with contact tracing.

The Government has tried to overcome this problem through 3 ways

– Restricting Movement of People by Creating Red, Orange and Green Zones. Less interaction, less leakage

– Insisting that people wear masks all the time and wash their hands regularly

– Install the Aarogya setu app

In reality, commerce pushes people to take all kinds of risks and law enforcement can only monitor that many people. Masks work well when everyone wears it and when even 1 infected person does not wear it, it causes problems. Not everyone has installed the Aarogya Setu App (The Govt is now making it mandatory in many instances).

Relying on discipline, carefulness and compliance is not going to cut down the cases in the 3 most infected Metros. There are two ways

1. Bring in Central Forces in large numbers and keep people off the roads OR

2. Expand testing randomly and increase it 2-3 fold

Bringing in central forces etc is quite a complex decision given the politics around it. For example, if the Central Govt were to send troops to Mumbai and not Ahmedabad, that would be explosive. On the other hand, sending troops to Ahmedabad would be an admission that the State Government has failed.

So the solution is expanded and random testing. Apart from testing those identified in the Contact tracing process, the 3 cities must target a sample of 4000 to 5000 per city picked up on a random basis. The Universe could be elctoral rolls or it could even be random door to door knocks. Multiple benefits of this process

 – If 25 tests are available at each municipal seat, more people in that vicinity are likely to test themselves if they came into contact with a person who was infected. Currently many just keep quiet praying they don’t fall ill

– Individuals with even mild symptoms are more likely to go and test themselves instead of waiting for Government to find them.

– We will get a true estimate of the infection rate. For example, Mumbai currently has 6382 Active cases. Random sampling is likely to yield less than 3 cases. But when combined with the above, we are likely to have many more and reduce the leakage substantially.

It is time for the Central Government to work with these 3 States and may be a couple of others to significantly expand testing in the top 10 most infected Cities. 

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