Last week, the global number of confirmed cases of novel coronavirus or COVID-19 crossed 110,000 in over 100 countries, with a significant number of new cases emerging in South Korea, Iran and Europe. Concern over the extent of the pandemic has already affected both the world’s financial markets as well as the economy. Although India has been relatively less affected so far — with only 43 confirmed cases as of 9 March— it is too early in the international disease cycle to relax. China managed to contain the spread by enacting a cordon sanitaire around lakhs of people, using authoritarian measures that might be hard to implement elsewhere in the world. So, the global outbreak could get a lot worse, and if it does, we will certainly be affected.
That is why India and the Narendra Modi government must take a national approach to manage the risks of a COVID-19 epidemic in India. Such an approach would not only pull together all government departments and institutions, but also involve the private sector and civil society. (Disclosure: A member of my immediate family works for a private genetic testing firm.)
It is important to say this because thus far, the task of addressing the COVID-19 has been delegated exclusively to the government. Almost all activities, from airlifting Indian nationals, screening arrivals at airports, testing samples, quarantining and treatment are carried out by the government. While this will be effective if the number of cases remains in the current order of magnitude, the government’s facilities alone will not be sufficient if the number of cases rises 100 times or more.
The good news is that India has a private healthcare sector and R&D capability that can be used in the fight. The bad news is that we’re not letting them.
If we even have a few lakh suspected cases, the government’s resources will fall short of what is required. The right time to think about the capacity required to handle such a massive crisis is now. The single most important thing for India to have a national response — as opposed to a government response — is to enable the private healthcare ecosystem to play an appropriate role to complement the government’s efforts wherever possible.
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Let private labs test for COVID-19
One of the most critical areas where private capability should be harnessed is in screening and testing. The greater our success in detecting COVID-19 cases early, the greater our ability to contain the outbreak. Faster testing means fewer people in unnecessary quarantine, lower load on hospitals and faster contact tracing.
Currently, there are 52 government laboratories in ICMR’s Virus Research & Diagnostic Laboratories (VRDLs) that are equipped to carry out COVID-19 tests. Another 57 VRDL network labs are authorised to collect samples through state government health authorities. All of these operate under the aegis of the National Institute of Virology (NIV), Pune. As of 6 March, “a total of 4058 samples from 3404 individuals have been tested by the network”. The ICMR-NIV-VRDL network has the capacity to handle perhaps a 10X increase in the number of samples and is bound to have procured test kits to handle such a load.
Currently, private laboratories are not permitted to test for COVID-19. In anticipation of a greater surge, the Modi government must enable the most reliable private players to conduct such tests as well. There are 53 private laboratories in India accredited by the College of American Pathologists (CAP) and hundreds more by the National Accreditation Board for Testing and Calibration Laboratories (NABL). Some of India’s best private laboratories can be carefully selected by the respective state governments based on their technical capabilities, biosafety levels, quality standards and track records.
We can double the number of test facilities in a few precious weeks, and increase it even more over a longer period. Many private laboratories already offer commercial testing for other viral diseases, so with incremental effort, they can test for COVID-19 too. This will also create incentives for private Indian companies with R&D capabilities to consider developing test kits for COVID-19, which currently have to be imported from China and Europe. It is in India’s strategic interest to be able to develop probes, reagents and test kits for the current and future viral epidemics.
Also read: With centre-state political standoff, can coronavirus outbreak be effectively fought?
Open up
In addition to mandating standards and safety levels, ICMR must insist on compulsory and real-time reporting of samples and test results so that the government authorities have a single database to work with. There should be no expectation of government funding or subsidy, just as there is no case for the government to intervene in the pricing of these tests.
As the number of cases crossed 400 last week, the United States not only permitted private laboratories to perform COVID-19 tests, but also changed policy to enable “laboratories to use tests they develop faster in order to achieve more rapid testing capacity in the United States”. Canada has distinguished itself by an open approach – decentralising and opening up testing from the very outset. These are prudent and responsible responses to a feared escalation of a public health emergency. India — with greater vulnerabilities and weaker public health systems — should take a similar approach.
The author is the director of the Takshashila Institution, an independent centre for research and education in public policy. Views are personal
Fantastic the more we cooperate the better. Govt, medical fraternity, society and private businesses all have a role to play. I am surprised big business houses like Ambani Tata Hindujas Adnanis and Birlas are not offeringg to contribute financially atleast.
Yes let’s not have the Govt have a say in the pricing of the tests and let the private sector make enormous profits based on people’s fears and misery! You filthy money-hungry prick!
Absolutely!
Sad that statistics show screening to mean pointing a thermal device to forehead. Real testing requires a 3 tier bureaucracy, whereas the key way is to aggressively test in clusters, in vulnerable geographies based on the technology tracking that will help. Our population is too high to wait for outbreak. All statistics from where covid has exploded show the multiple not detected for every one detected. Testing cannot be an issue of licensing. Teams in vans need to be going out to test few 1000 everyday in pockets. That data will help target the spread.
I had my cousin visit my home last week from Singapore. My wife is showing 99.3 f temperature from last 3 days. Iam showing signs of shivering and throat infection. We dont know what to do. If there was testing facility in private hospitals we could have paid any amount to get tested. In doubt we have isolated ourselves sending children to relatives. Though we are having mild symptoms, we dont want to spread it unknowingly. If there was a facility to test in private hospitals, we could have cleared our doubt, and our kids need not go to our relatives to stay.
Why haven’t you already visited a government testing facility?
No problem in media keeping a watch. However, we should trust agencies entrusted with fighting this; this is a war and losing this is not an option. There is nothing so far indicate that anyone is slacking.
Today (13th March 2020, I was watching reports that said USA has just about managed to deploy its test kits in limited quantity in the last week. It is a little too late considering there is a lot of spreading that has happened, and its people are enraged with sluggish action from its government. I was surprised that they had so much delay. If so, where did India get its test kits from? How were we prepared better than the mightiest nation in the world. Perhaps we are still vulnerable, but rate of import of the virus was relatively low due to lesser global interaction from India.
Rightfully in such cases where safety is paramount and is of national / global interests. Profiteering should be removed and rights to manufacturing should be given to specific parties keeping long term benefits in mind.
The biggest problem in getting the private sector in is that in India we have no insurance back up and so the charges for testing will go sky high . So far the pvt sector track record in affordable health care has been dismal.