Kerala is taking its eyes off COVID-19 testing because the administration believes that the State has crossed that critical point in the pandemic, wherein the immunity in the population, either due to natural infection and/or through vaccination, has made the number of new cases, samples tested daily, and the test positivity rate (TPR) irrelevant.
In a conscious decision, the logic behind which seems to be elusive to many in the scientific community, the State has now decided to do away with antigen testing in the private sector, even when scientific literature says that antigen tests are very efficient in picking up a person in infectious stage (apart from the convenience of use and quick results). The release issued by the Chief Minister’s Office also said the asymptomatics should not be tested.
Hospitalisations down
The official stance now is that as long as vaccination is proceeding at the current pace and the State is keeping an eye on the hospitalisation graph, the new cases reported daily do not really matter. It is pointed out that despite the 20,000-odd new cases daily, hospitalisations have been coming down steadily (only about 13% of the active cases), something which is attributed to the impact of vaccination.
The State, which used to do around 1.5 lakh tests daily, has now reduced it substantially. In the past few days, it has also done away with TPR as an indicator for assessing disease transmission.
As vaccination progresses, vaccine breakthrough infections and re-infections will make up a substantial proportion of the new cases. With community transmission on, there is no point in increasing testing as it will only contribute to more cases and a higher TPR, which the government feels is being used by media and vested interests to ‘belittle’ its achievements. The other argument is that since transmission is expected to continue even when the entire population is vaccinated, why should one test more.
“With a good proportion of the population still vulnerable to infection, it would be foolish to expect TPR to go down as it did in northern India, where a chunk of the population was infected when Delta swept through. The weekly infection population ratio (WIPR) is a better indicator because it determines infection in a population, which is a constant,” says T.S. Anish, epidemiologist and a member of the State’s experts’ committee on COVID-19.
Case of asymptomatics
That said, doing away with antigen testing and testing of asymptomatic individuals in order to keep the test and case numbers down is short-sightedness, which will eventually upset the apple cart, many public health experts say.
Testing has to be maintained at adequate levels so that new infections in the community are picked up, according to them. Current testing guidelines say that the primary contacts of a positive case should test for COVID-19 on the eighth day of quarantine, or earlier, if they develop symptoms. Or else they should remain in quarantine for 14 days.
The Health Department’s own data analysis says that 74.23% of those tested positive for COVID-19 in the State are asymptomatic at the point of testing.
The role of asymptomatic persons in the transmission of COVID-19 is huge. The disease can also be transmitted by a patient in the pre-symptomatic phase.
In such a situation, doing away with COVID-19 testing in asymptomatic individuals and antigen tests in the private sector might serve the government’s purpose of reducing case numbers but would not be in the interest of the community.
