The first case of novel-coronavirus was reported in the state of Kerala on January 30, 2020 and as of June 31, 2020 the total number of positive cases stands at 5,86,056 including 2,20,728 active cases, 3,47,851 discharged/recovered and 17,411 deaths have been confirmed across India (Source). To effectively prevent the spread of COVID-19, well-organized testing programs, and extensive efforts to isolate infected people, contact tracing and quarantining people they have come in contact with is the need of the hour. Indian Council of Medical Research (ICMR) on June 31 informed that till then 88,26,585 samples have been tested of which 2,17,931 samples were tested in the last 24 hours.

Right from the outbreak of the COVID-19 several preventive strategies are adopted by the central government in consultation with states. After the lockdown is lifted there lies a huge burden on the states to work on containment of the virus. Recently through social media, COVID-19 comparison ratios are becoming widely popular where certain states and their administration are being widely criticized for their testing rates and inefficiency.

Flatten the Curve – State’s Difficulties.

It is relatively easy to design for the perfect cases, when everything goes right, or when all the information required is available in a proper format

 Donald Norman

Adequate testing and proper information are the only means through which public health intervention by the state can be done both diagnostically and therapeutically to flatten the curve. But the figures released cannot be perceived in isolation, they should be tallied with the population (test per million) of the state or test positivity rate in the state which captures the size of epidemic and scale of testing in number. 

Delhi has one of the highest testing rates per million but in terms of test positivity rate, it is relatively performing low. Also, the test positivity rates show wide variations in Delhi at 23 per cent positivity rate and Telangana at 18 per cent whereas West Bengal is at 3.5 per cent. Test positivity rates show the prevalence of infection and approach adopted where the epidemic is growing and tests are lagging. 

This presents a huge problem with respect to expanding the amount of testing base in the country because even though the testing rates are increasing in the country as a whole, positivity rates are constant at 7.4 to 8.1 per cent. So this presents a picture that there is no proper circulation of data which can show the exact incidence of the disease through which we can estimate whether we are testing enough. Overburdening of Government hospitals and reduced testing needs to be encountered as part of expanding the testing base in the country.

Testing Deregulation as a Way: Private players

With the rise in the risks of community spread of the virus, the Telangana government is often being criticized for its approach of not engaging private labs in testing even after demands pertaining to that was made by ICMR and Telangana High Court. 

Engaging private players in the fight can always be treated as a viable option because of efficiency. Also, these players are controlled by an incentive-based environment where performance is always rated. Germany’s success in testing for the virus proves the mechanism engaging the present approach. Germany has been testing more than one hundred thousand people per week since late February. By April 20, it had tested more than twenty-five persons per thousand. Compare this to India, where the testing rate is less than one person per thousand. One reason for Germany’s success is a relatively freer market for medical testing compared to India. Private companies in Germany were able to mass-produce the test kits early on, as they were less burdened by a central regulatory body like the Indian Council of Medical Research. 

In the name of quality maintenance, there is a heavy licensing mechanism for private labs inserted by Indian Council of Medical Research but it has forgone the key idea that then government organizations private players predict the probabilities of demand in the community concerning testing as they need to make living out of it. It is just the way they predict stock prices.

Conclusion

The primary question that arises most often in the community is “How many tests are enough tests?” and “When will we reach normalcy?”. The only answer for that would be that all states should ideally keep a watch at the indicators such as positivity rate and condition of spread in an epidemic that needs immediate attention. Thus till vaccine comes into the picture we can flatten the curve only by considering the epidemiological indicators and rampant testing through the inclusion of private players.

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