Mumbai: Maharashtra has been a bellwether of sorts in the country’s battle against the Covid-19 pandemic. During both the first and the second waves, Maharashtra led the surge, and was also among first to show signs of flattening the curve.
But the one parameter in which it has lagged behind other states throughout the rise and fall in cases in the two waves of the pandemic is its testing.
So far, the state has conducted 3,35,41,565 Covid tests, which translates to 2.7 lakh tests per million people in the state. While it is slightly higher than the national average, a significant number of states are performing better on this count.
For instance, Delhi has so far conducted 9.5 lakh tests per million; Kerala 5.4 lakh tests per million; Karnataka 4.4 lakh tests per million; Telangana 3.9 lakh tests per million; Tamil Nadu 3.5 lakh per million; and Gujarat has tested 3.1 for every million.
While Maharashtra has quadrupled its daily tests in the last two months, officials say there are major disparities within different districts in terms of testing infrastructure. With the virus now gripping a large number of rural districts, this makes it difficult to push the testing numbers, especially RT-PCR tests, beyond a limit.
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Testing ramped up, but large disparities within districts remain
As the second wave of the pandemic hit, Maharashtra rapidly scaled up its testing from 84,000-87,000 tests in February last week to breaching 2.9 lakh a day on 23 May. The test per million count too has vastly improved since February when it was 1.33 lakh.
Much of this growth in testing has come from Rapid Antigen Tests (RAT). These give quick results (within 30 minutes), but are less reliable than RT-PCR, the results of which can take up to a day.
According to an official from the state health department, about 45 per cent of the state’s daily tests, which have ranged from 2.63 lakh to 2.9 lakh in the last week, are through the RT-PCR, while the rest are RATs. Within the RT-PCR tests, about 55-60 per cent are using the state government machinery, while the rest are through private laboratories.
Maharashtra has a cumulative test positivity of 16.77 per cent. With increased testing, Maharashtra’s test positivity has dropped to an average of 10.2 per cent over the past week from 19 May to 25 May from a peak of 29 per cent on 4 April, according to data from the state government.
However, there are still 18 districts out of the 36 in Maharashtra where the positivity is higher than the state’s average for the past seven days. The state health department has directed these to increase testing.
The health department official mentioned above said there are large disparities within Maharashtra’s districts with regards to testing infrastructure.
“This makes it difficult for certain districts with limited infrastructure to scale up their testing beyond a point even if the health department gives them targets,” he said.
Bigger districts such as Mumbai, Thane, Pune and Aurangabad are better off in terms of testing infrastructure, especially testing by private laboratories, than several districts in the hinterland, he added.
Since the pandemic hit in March last year, the state government has set up at least one testing laboratory in every district of Maharashtra.
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Testing hurdles at the grassroots
In Ahmednagar district, as cases swelled towards the end of April and the beginning of May, the district became the state’s most worrying in terms of test positivity.
For the week ending 11 May, Ahmednagar recorded an average test positivity of 39.5 per cent, while the state’s average for the week was 16 per cent.
Speaking to ThePrint Tuesday, District Collector Rajendra Bhosale said the administration scrambled to increase testing by pushing private laboratories to do more; expanding the capacity of its RTPCR laboratory; sending samples to the neighbouring Aurangabad district for RT-PCR tests;, and buying expensive RAT kits from the open market in bulk.
“We tried to increase RT-PCR tests, but had limitations. Towards the end of April, we were also short of RAT kits so while cases were rising, we weren’t able to catch up with more tests. We didn’t get much response to our tender for RAT kits. There was a high demand and a pressure on supply so the cost of the kits rose to nearly Rs 140 per kit from Rs 57,” Bhosale said.
“We overlooked the cost and bought kits from the open market. We also borrowed RAT kits from districts such as Nashik and Nandurbar, which had them in surplus, and were somehow able to bring down the positivity rate,” he added.
Bhosale said the district is now testing between 15,000 and 18,000 samples a day from the earlier 4,000-5,000, and while a majority of these tests are RATs, they help in quick isolation of positive patients.
By the week ending 18 May, Ahmednagar’s test positivity rate had dropped to an average of 16.69 per cent.
Similarly, the Akola district built up its RT-PCR capacity to conduct about 2,200 tests a day from 500 during the peak of the first wave last year, but is now increasingly relying on more RATs.
A district official who did not wish to be named said, “Private labs barely collect 300-400 samples a day. We are currently conducting about 4,500 tests a day of which 50 per cent are RT-PCR. But, now beyond this, we will have to rely more on RATs. Test kits, though costly, are easily available.”
Akola is one of the 18 districts that the state government has asked to increase testing.
‘Not worried about testing, RATs help in quick isolation’
Subhash Salunkhe, technical advisor to Maharashtra for Covid control, said while testing in the state has peaked, it is not a major reason to worry.
“Earlier, the Union government was insisting on a 70-30 ratio of RT-PCR versus RATs, but now the understanding is that the disparity between the two tests is narrower if used as per proper protocol,” Salunkhe said.
“True positivity with antigen tests is quite good and it helps in quick isolation of patients. And symptomatic patients are anyway made to undergo an RT-PCR if the antigen test result is negative,” he added.
Salunkhe said from here on, testing patterns will be more decentralised with the district administrations deciding their most suitable testing strategy to arrest the increase in cases and the state government there for technical support.
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