Indian Journal of Health Sciences and Biomedical Research KLEU

REVIEW ARTICLE
Year
: 2022  |  Volume : 15  |  Issue : 2  |  Page : 110--113

COVID-19: Are we in testing fatigue or testing fatiguely?


Priya Sharma, Saurabh Rattan, Vikram Katoch, Gurdarshan Gupta 
 Department of Health and Family Welfare, National Health Mission, Kangra, Himachal Pradesh, India

Correspondence Address:
Dr. Priya Sharma
District Consultant, Dakshta Mentor, O/o Chief Medical Officer, Kangra at Dharamshala, Himachal Pradesh
India

Abstract

The rapid spread of COVID 19 across the globe gave no country any chance to stay guard of what consequences it would follow. India, with 462 million of its 1.3 billion people living in densely populated urban settlements with high contact rates, was at risk of catastrophic spread of the virus. Extensive testing for SARS CoV 2 set the precedent for managing the vicious cycle of COVID 19. The study focuses on the COVID-19 testing and positivity rates across the country to attain information on whether we are testing enough or we need to be more rigorous in approach. What's the pattern so far and what follows in future. COVID 19 health portals, original articles, reviews, and case studies were studied to identify articles which correspond to the COVID 19 database comprising statistics of various Indian states published during the ongoing pandemic. The study reveals that nine states had tested more than 100% of their population with the highest 399.3 from Lakshadweep, followed by Ladakh (209.7), Delhi (175.5), Chandigarh (151.4), Jammu and Kashmir (134.3), Puducherry (126.9), Kerala (121.5), Goa (112.7), and Mizoram (107.6). It becomes pertinent to note only one of the above states (Goa 1.7) among the above list falls into the category of high death rate which can be attributed to the fact that early testing and tracing formula have suited most of these states well.



How to cite this article:
Sharma P, Rattan S, Katoch V, Gupta G. COVID-19: Are we in testing fatigue or testing fatiguely?.Indian J Health Sci Biomed Res 2022;15:110-113


How to cite this URL:
Sharma P, Rattan S, Katoch V, Gupta G. COVID-19: Are we in testing fatigue or testing fatiguely?. Indian J Health Sci Biomed Res [serial online] 2022 [cited 2022 Aug 13 ];15:110-113
Available from: https://www.ijournalhs.org/text.asp?2022/15/2/110/345839


Full Text



 Introduction



The rapid spread of COVID-19 across the globe gave no country any chance to stay guard of what consequences it would follow. India, with 462 million of its 1.3 billion people living in densely populated urban settlements with high contact rates, was at risk of catastrophic spread of the virus. Extensive testing for SARS-CoV-2 set the precedent for managing the vicious cycle of COVID-19. Even now, after having COVID-19 around for more than a year and soon to be entering into year 2 testing remains the only and most accomplished base strategy for fighting against corona. With coming across various hypotheses and information, the WHO chief expresses that health system might have fatigued but virus has not fatigued and labels it as no negotiation deal.[1] Timely and accurate reporting can lead to proper contact tracing and effective containment measures. Real-time reverse transcription-polymerase chain reaction (RT-PCR)-based molecular assays for various SARS-CoV-2 gene targets have been the mainstay of diagnosis for COVID-19 since the beginning and continue to be the same. Given the evolving strategies for testing worldwide which now also include testing asymptomatic individuals with pertinent contact history, the load of sample testing has grown manifold in laboratories testing for SARS-CoV-2. Among the different strategies adopted for dealing with testing crisis in the laboratory, pooling of respiratory samples, specifically nasopharyngeal samples, has received attention, given the simplicity of the approach and the fact that there are no additional requirements in terms of equipment or reagents for this approach. Similarly, rapid antigen tests which initially garnered negative reviews have helped in the early identification of those affected and thus filtering and sorting the leads for samples reaching laboratories. Although sensitivity still continues to be an issue, it has helped to unburden the laboratories.[2] Increased cases have always been directly proportional to increase in testing. As on January 20, 2022, 221 countries and territories around the world have reported a total of 339,541,932 confirmed cases of COVID-19 that originated from Wuhan, China, and a death toll of 5,583,965 deaths. While US with 69,808,350 has been on top for the number of cases followed by India 38,218,773 and Brazil 23,420,861. The sequence is the same for the testing also as a higher number of tests have been done in the US followed by India which corresponds to the fact that more the testing more will be clarity on the status of disease among the population although India has a population four times more than the US.[3] Decades of underinvestment in public health, with inadequate diagnostic capacity and programmatic agility, made the implementation of test, trace, and treatment strategies at scale challenging during the initial phase of the disease. The country's leadership had little choice but to enforce a harsh nationwide lockdown to give themselves time to strengthen capacity. Although the lockdown did result in delaying an exponential increase in infections, when the restrictions on activity and movement were reduced, cases of COVID-19 increased.[4]

 Materials and Methodology



COVID-19 health portals, original articles, reviews, and case studies were studied to identify articles which correspond to the COVID-19 database comprising statistics of various Indian states published during the ongoing pandemic. As the study focuses on the COVID-19 testing and positivity rates, data were searched to assess whether we are testing enough or we need to be more rigorous in approach. What's the pattern so far and what follows in future.

 Results



The study reveals that nine states had tested more than 100% of their population with the highest 399.3 from Lakshadweep, followed by Ladakh (209.7), Delhi(175.5), Chandigarh (151.4), Jammu and Kashmir(134.3), Puducherry (126.9), Kerala (121.5), Goa (112.7), and Mizoram (107.6). It becomes pertinent to note only one of the above states (Goa 1.7) among the above list falls into the category of high death rate which can be attributed to the fact that early testing and tracing formula have suited most of these states well [Table 1].{Table 1}

 Discussion and Conclusion



Laboratory diagnosis of SARS-CoV-2 is extremely important in disease and outbreak management. The development of rapid point-of-care tests with better sensitivity and specificity is the critical need of the hour as this will help accurate diagnosis and aid in containing the spread of SARS-CoV-2 infection.[5],[6] The study reveals that nine states had tested more than 100% of their population with the highest 399.3 from Lakshadweep, followed by Ladakh (209.7), Delhi (175.5), Chandigarh (151.4), Jammu and Kashmir (134.3), Puducherry (126.9), Kerala (121.5), Goa (112.7), and Mizoram (107.6). It becomes pertinent to note only one of the above states (Goa-1.7) among the above list falls into the category of high death rate which can be attributed to the fact that early testing and tracing formula have suited most of these states well. Of all states, 13 states showed testing rate <50%. The states that have projected the least testing are Andaman and Nicobar Islands (3.9), Dadra and Nagar Haveli and Daman and Diu (10.5), Nagaland (20.7), Rajasthan (21.3), and West Bengal (21.9). The highlighting feature of this finding is that the positivity rate has been very high in these states, with Nagaland being the state with a high death rate also [Figure 1], [Figure 2], [Figure 3].{Figure 1}{Figure 2}{Figure 3}

Appropriate sample collection is the most important step in the laboratory diagnosis of any infectious disease. RT-PCR tests involve fairly complex steps and take nearly 24–48 h for generating the results. The advent of rapid nucleic acid detection-based tests appears to accelerate the COVID-19 diagnosis in India. One such test is TruNat, an indigenous testing developed originally for tuberculosis, has been explored and is now being used for COVID-19 testing in India. TruNat test is promising, especially in areas/districts where modern laboratories are not available.[7] Antigen-based rapid tests detect the presence of SARS-CoV-2 antigens such as the nucleocapsid (N) protein and the S1 or S2 domains of the spike(S) protein. Antigen tests are best used to identify acute or early infection, especially in settings where a rapid test turnaround time is required. The sensitivity of antigen tests reportedly varies from 34% to 80%, which means that there could be nearly 50% of false-negative results, depending on the group of patients tested. Hence, it is important for clinicians and laboratory personnel to understand the analytical performance characteristics of antigen test assays, including sensitivity, specificity, and positive and negative predictive values.[8] Going by the initial dearth of infrastructure and resources, we as a country have paced faster than the fast world. The resources have amped up in the past 1 year. The Indian Council of Medical Research, the apex body in India for biomedical research, is at the forefront of the battle against COVID-19. With as many as 637 government laboratories and 240 private laboratories in the country, there seems to be no dearth of resources but definitely a dearth of willpower. It is time to reiterate ourselves that the only way to tackle the virus is to stand in solidarity against the fight. The festival season in India may have been considered happier times in the past but calls for an insight for future.[9]

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

References

1World May Be Tired, But Virus “Not Tired Of Us”: WHO Chief. Available from: https://www.ndtv.com/world-news/world-may-be-tired-but-virus-not-tired-of-us-who-chief-tedros-adhanom-ghebreyesus-2322900. [Last accessed on 2022 Apr 27].
2Praharaj I, Jain A, Singh M, Balakrishnan A, Dhodapkar R, Borkakoty B, et al. Pooled testing for COVID-19 diagnosis by real-time RT-PCR: A multi-site comparative evaluation of 5- & 10-sample pooling. Indian J Med Res 2020;152:88-94.
3Worldometer. Available from: https://www.worldometers.info/coronavirus/. [Last accessed on 2022 Apr 27].
4Agrawal M, Kanitkar M, Vidyasagar M. Modelling the spread of SARS-CoV-2 pandemic – Impact of lockdowns & interventions. Indian J Med Res 2021;153:175-81.
5COVID19 India Portal. Available from: https://covid19tracker.in/. [Last accessed on 2022 Apr 27].
6Giri B, Pandey S, Shrestha R, Pokharel K, Ligler FS, Neupane BB. Review of analytical performance of COVID-19 detection methods. Anal Bioanal Chem 2021;413:35-48.
7Kumar KS, Mufti SS, Sarathy V, Hazarika D, Naik R. An update on advances in COVID-19 laboratory diagnosis and testing guidelines in India. Front Public Health 2021;9:568603.
8Interim Guidance for Antigen Testing for SARS-CoV-2 Centres for Disease Control and Prevention. Available from: https://www.cdc.gov/coronavirus/2019-ncov/lab/resources/antigen-tests-guidelines.html. [Last accessed on 2022 Apr 27].
9Indian Council of Medical Research. Available from: https://www.icmr.gov.in/pdf/covid/labs/archive/COVID_Testing_Labs_11062020.pdf. [Last accessed on 2022 Apr 27].