Is there still a case for testing contacts?

Experts say targeted testing and limiting the number of deaths is the way forward

The question of testing has been coming up, repeatedly, at health press conferences in Tamil Nadu. Health Minister C. Vijayabaskar has been assuring the audience, via televised speeches, that there has been no fall in the testing rate in the State. Tamil Nadu continues to be at the top of the testing table in the country, he has said, dismissing any contention that there has been a slackening in the number of tests.

But look at the numbers shared by the Health Department over a period of time — while testing peaked at over 13,000 samples a day in mid-May, it has subsequently fallen, and is in the realm of just over 11,000 tests now.

It is important to do at least 15,000 tests a day in the State, said K. Kolandaswamy, former director of public health. “More is good, but we must at least do that many tests, and they should be distributed geographically,” he said. Testing is a must for front line workers, people who travel into the State, and pregnant women (because they present a true sample of the general population), he recommended.

Do close contacts of persons who test positive also have to be offered tests? While Dr. Vijayabaskar has said that contact tracing is vigorous in the State and all contacts are being tested, on the field, only people who have symptoms are encouraged to test. Healthcare workers inform contacts to seek medical help if they develop fever, dry cough, breathing difficulties or loss of smell and/or taste.

Senior Vellore-based virologist Jacob John explained that contact testing and clinical diagnosis were two different aspects of testing, and globally, countries had moved from the former to the latter. “In the beginning, contact testing was done to find positive cases, and quarantine them, around the world. But once they realised that they cannot do it well, they quickly moved on to clinical diagnosis for COVID-19, followed by testing. India currently has a hybrid model,” he said.

Pointing out that ICMR has changed the testing policy multiple times, Dr. John insisted that it was still up to States/regions to tweak the guidelines as per their needs. Given the numbers in the country, he suggested that the government now forget about flattening the cases curve, and focus instead on flattening the mortality curve.

P. Kuganantham, former Corporation health officer, agrees on focusing on limiting the number of deaths and advances the principle of focused testing. “We need focused testing of people who are symptomatic, those who are vulnerable because of age, or because they have non-communicable diseases, or front line workers, and finally, contacts of people testing positive, in that order,”

Sanjay Sarin, head, Foundation for Innovative New Diagnostics- India, a non-profit organisation that aims to improve the availability of diagnosis for a range of conditions, votes for targeted testing.

Limited supply

“While the demand for tests is high, supply is an issue and there is limited supply globally. Yes, testing capacity has been ramped up over the months, but more than 80% of the population is asymptomatic. In this context, smart testing of vulnerable populations and high density areas will be the way to go,” he said.

He suggested that India doubled its testing, and improved the turn around time for test results too.