At a time when India is being criticised for its poor testing rate for COVID-19, the Brihanmumbai Municipal Corporation (BMC) has been forced to prioritise who will be tested.
The BMC will first test only symptomatic people to reduce the load on testing laboratories, which have a huge backlog. Senior citizens or those with co-morbidities also will not make the cut unless they are symptomatic. Asymptomatic people will be second priority.
Mumbai has reported more than 1,500 COVID-19 cases so far and more than 100 deaths. Around 65-70% patients in the State are asymptomatic. In Mumbai, samples are being tested at the pathology labs at Kasturba and KEM hospitals and branches of the 16 private labs approved by the Indian Council of Medical Research (ICMR). Between February 3 and April 12, the city tested more than 24,000 people, of which 5.8% were positive.
Private labs have been collecting swab samples from people’s homes and a few drive-through testing facilities. Besides, fever clinics and health camps are being held in containment zones.
Till now high-risk contacts of a COVID-19 patient would also be tested. However, the BMC will now test only those with symptoms.
ICMR strategy
A senior civic official, on the condition of anonymity, said, “There is a school of thought that unless a person does not exhibit symptoms, he does not transmit the virus. The BMC is following that as it is in accordance with the ICMR testing strategy.”
Another official, who did not wish to be named, said, “This is also to bring down numbers. Mumbai has the most cases in India and that is gaining international attention, even though 70% cases are asymptomatic.”
The latest testing strategy released by the ICMR on April 9 also says that symptomatic individuals — those with international travel history, contacts of positive patients, healthcare workers — and patients with severe acute respiratory illness (fever and cough and/or shortness of breath) should be tested. Asymptomatic direct and high-risk contacts of a confirmed case should be tested once between days five and 14 of coming in contact. In hotspots, clusters and in large migration gatherings and evacuee centres, all symptomatic patients should be tested.
Ramesh Pawar, deputy municipal commissioner (health), said, “Including government and private labs, we can do a maximum of 2,200 tests per day. If we go on testing everyone, the ones who really need the test may be left out.”
Mr. Pawar further said, “Let’s say a patient is admitted to a hospital and is symptomatic. He will be first priority. An immediate contact who is symptomatic will be tested. Other than this, if possible, we will go for asymptomatic ones from among high-risk contacts. I am not saying they won’t be tested, I am saying we need to determine priority as we have limited testing capacity. Fever clinics, dispensaries, all patients in hospitals, phone calls we get, quarantined high risks are where we collect swabs. When we are getting 3,000-4,000 swabs a day, we have to prioritise.”
When asked if the BMC is in fact limiting testing, he said, “Many patients, while awaiting reports, turn critical and die. That is why we had to come up with a strategy. We are not limiting testing, but prioritising until testing capacity is increased.”
The BMC said the patient being a senior citizen or having co-morbidities are not factors for priority testing.
Municipal Commissioner Praveen Pardeshi said, “Mumbai is testing not only the most in India, but on a par with South Korea, which is the gold standard. The question of changing criteria does not arise, we are testing all. There are strict protocols for testing. We have proactively started fever clinics to look for anyone with symptoms. These are people who didn’t come to us, we went to them and of those, 20 were found positive. We have initiated calls to people and based on those, recommended tests to 300 people.”
He said even positive patients have to be tested on the seventh day, otherwise the test result might be a false negative.
‘Quarantine crucial’
Commenting on asymptomatic people being carriers, Mr. Pardeshi said, “Yes, that is why they have to be quarantined. We have put 2,541 people in institutional quarantine since they were living in narrow residences. Quarantine has been made more stringent in high-risk cases.”
Microbiologist Dr. Sujata Baweja said prioritising those with symptoms is a step in the right direction. “Asymptomatic people who are exposed to the virus can be transmitters, but their tests may be a false negative. The negative report gives a false sense of security to the people and they may not be as careful as they have to be,” said Dr. Baweja, adding that stringent quarantine is thus crucial.
A paper published in the International Journal of Infectious Diseases earlier this month showed that COVID-19 can be transmitted by asymptomatic carriers, but also said further studies on this aspect are needed.
