Continued Emphasis On Testing Can Limit Infection: Dr Jayesh Lele
In conversation with Dr Jayesh Lele, Hony. Secretary General, Indian Medical Association (IMA).
Are you satisfied with the number of COVID testing being performed every single day in India?
As of today, 59.70 crore cumulative total samples have been tested (up to October 21st). Although this number is promising, daily testing has been declining steadily. Despite the drop in cases and a low daily positivity rate (currently 1.19 per centa), this dip in testing is a concern. The ongoing vaccination rollout too does not rule out the challenges of potential new waves and variants. Further, community transmission may continue, attributed to asymptomatic, infected individuals. Continued emphasis on testing can limit infection without recourse to a costly lockdown.
With the return to economic activity and work, schools, travel and other daily life activities, testing will continue to play an important role in keeping people safe, ensuring preparedness. We must stay vigilant and test for infections/mutations to understand more about the virus, which will continue to exist and mutate. To do this, we must not only scale up the quantity of tests, but also ensure that tests administered are accurate in terms of sensitivity and specificity and that the most vulnerable and susceptible people are screened appropriately.
Multiple tests for different settings and stages of a person’s infection is key, particularly including tests detecting the viral transmission. Such strategies are also useful to identify clusters or outbreaks and support the investigation and implementation of needed public health interventions.
What steps should government take to stop the incorrect ways of getting a COVID negative report?
To counter practices of acquiring fake or incorrect COVID-19 negative reports, we must first understand and target the causes for these behaviours. One is misinformation, which is also termed as an ‘infodemic’ (information epidemic), referring to the high amount of false or misleading information about the disease outbreak, both in digital and physical environments.
Other reasons include inconvenience, cost or a lack of awareness about available testing solutions. Raising awareness of the continued need for testing, even amongst vaccinated individuals, is key to foster an understanding of the sustained vigilance and preparedness required to curtail further spread of infection and promptly detect worrying trends, variants and more.
With convenient, easy-to-use and affordable testing solutions, access to diagnostics can be scaled, reducing barriers of access to testing. Rapid tests, for instance, have emerged as a critical part of the nation’s comprehensive testing arsenal. They enable fast diagnosis at the point-of-care, providing accurate results during the critical period of infectiousness. This helps break the chain of transmission. For individuals who may be less willing to consider PCR or other lab-based tests due to increased time to receive a result, such options can be adopted, reducing people’s reliance on false reports.
Another solution is introducing screening programs at the workplace itself, which limits any scope for falsely reported results, while scaling testing solutions to ensure employee safety.
Moreover, with the progression of the pandemic, people have become more aware of the importance of testing and its benefits. By reiterating and raising further awareness of testing programs that quickly identify infectious individuals so they can be isolated quickly, proper testing behaviours can be more widely adopted.
What significant role did testing play after the implementation of mass vaccination drive? Will testing be required for all even after the population gets immunised as vaccination certificate have become the priority?
The first generation of COVID-19 vaccines aim to reduce the severity of the infection and thus hospitalization and sequelae. They are not intended to prevent infection or transmission of the virus. Although, this might be seen as a secondary effect after large proportion of people have been vaccinated.
Having said that, testing will remain vital when COVID-19 is no longer considered a ‘pandemic,’ as community transmission may continue, such as in the form of seasonal or endemic outbreaks. Thus, while COVID-19 incidence will presumably decline with increased vaccinations, the virus remains unlikely to be completely eradicated. This especially holds true until vaccines are approved for people of all ages and available everywhere, and the majority of the people are vaccinated.
Increased air travel between countries also poses additional risk of spreading the virus and variants, subject to disparities in virus control and vaccination rates amongst different regions. Thus, when used for regular testing, rapid tests, for instance, can help people in workplaces, schools and other public gatherings feel confident that infected individuals will be identified.
Since there have been cases where no detectable antibodies are present in the human body, the test results have gone wrong. How in such a situation, the virus can be prevented from spreading in a close working environment?
It is not just important to test – the quality of the test used is also crucial to give an accurate result. This is where the sensitivity and specificity of the test play a critical role to minimize false positives or negatives. High-quality, reliable testing solutions, backed by research, are necessary to support the nation as it gears towards a resilient recovery.
Additionally, in workplaces as well as in schools and universities, screening programs are most effective when testing is done on a regular basis, rather than sporadically. Mass screening or population-wide testing, of both symptomatic and asymptomatic individuals, can ensure infection is detected early.
With tests including rapid antigen tests, infected individuals can be identified sooner, prompting immediate isolation. Such tests perform best in individuals with high viral load, early in the course of infection. Thus, they help identify people when they are most contagious and need to self-quarantine.
Do people who have been fully vaccinated and are returning back to work, should also be required to get a COVID test done?
Vaccines certainly help reduce the severity of the infection. However, while the number of COVID-19 cases requiring hospitalization will presumably decline as more people are vaccinated, the virus remains unlikely to be completely eradicated, even if the pandemic is largely controlled. Vaccine efficacy can also vary as per individual and prevalent variant.
Testing remains the first line of defence. Alongside vaccination, it remains a cornerstone of COVID-19 management. Even as per the World Health Organization’s recent guidelines, diagnostic testing is a critical component for the overall COVID-19 prevention and control strategy.
Moreover, the below graph presented by the Centre for Economic Policy and Research illustrates the benefits of testing:
As reflected in the graph, testing offers health benefits (e.g., lower infections and/or mortality) and economic benefits (e.g., addresses lowering economic output) associated with a more stringent government lockdown measure. Testing is shown to have positive indirect effects on growth in addition to positive direct effects.
Moreover, testing could have indirectly contributed to about a 0.6 percentage point boost in growth by allowing countries to relax shutdowns without compromising on containment, and by infusing greater confidence in people to step out and engage in economic activity.
As the world attempts to scale up vaccination in the face of new waves and variants, continued emphasis on testing could limit the spread of infection. Testing, including for those fully vaccinated, can help people and businesses feel confident that infected individuals will be promptly identified. This enables organizations to prioritize the safety of their employees as they return to work, while reducing risk as critical, everyday business operations resume.
What according to you is the best and safest way for a person to return back to their work?
A robust, well thought-out testing framework is essential – enabling timely test results, ensuring individuals can promptly undertake COVID-19-appropriate behaviours to effectively trace, isolate and treat, following testing. Workplaces should establish carefully planned occupational health guidelines and safety strategies to support employee safety.
Rapid testing programs are enabling companies across the world to bring employees back to work without compromising safety, offering cost-effective testing programs with no instrumentation requirements. Referring to Europe as an example, the European Agency for Safety and Health at work (EU-OSHA) joined forces with the European Centre for Disease Prevention and Control (ECDC) to explore the use of rapid antigen tests for SARS-CoV-2 in the workplace. This May 2021 report (link) suggested that rapid antigen testing can help reduce the spread of the virus in high-risk indoor workplaces, whilst also emphasizing the need for complementary safety measures such as distancing. Such organizational measures could serve as a useful example for firms in India as they open for in-person work.
What testing strategies and plans, public and private organizations should adopt to ensure safe working environment for the employees?
A SMART testing framework could curtail the spread of infection.
According to the WHO as well, countries should invest in a national testing strategy with clear objectives that can be adapted according to changes in the epidemiological situation, availability of resources and tools and country-specific context. A broad-level strategy can then influence workplace testing frameworks.
WHO also recommends testing especially to be done in workplaces where there is high risk of exposure.