Covid-19 cases in India have risen to 6,217 with 184 deaths so far. Cases in India are doubling in every 4 days as per the data released by the Health Ministry. This is bringing India closer to stage III of community transmission.  It is a stage where the source of infection is untraceable. It is fatal in nature and casualties can witness an exponential rise.

While ICMR in its guidelines has expanded the testing criteria to asymptomatic direct and high risk contacts, the efforts are still required to be ramped up. The current rate of 18 thousand tests a day, ICMR is viewing to increase it to 1 Lakh tests a day. Private labs are also being roped in. Supreme Court in its order dated 8 April has ordered all the government and private labs to conduct COVID-19 tests free of cost.

In the fight against the coronavirus pandemic, our policymakers are fighting blind, because of the uncertainty in defining the extent of infection in the population. Currently, the system is able to keep a track of only those positive cases which are getting traced & reported in the health care units. Those who are in need of hospitalization, suffering from extreme symptoms and are not getting traced are completely missing from the daily data reporting across the country.

Our response to the crisis critically depends on figuring out how fast the infection is spreading in the communities, both urban and rural.  For this, initializing a rapid testing program is the need of the hour.

India is already running low on testing kits hence it is prioritizing on people with severe symptoms and those who have been in direct or indirect contact with the positive cases. It is missing out on people who are not turning up, those who are asymptomatic but are the carriers of the virus, having the potential to infect others around them.

There are strong reasons to think that many individuals are asymptomatic, which means that true caseload is under-measured. For example, the city of Vò in Italy tested all its inhabitants and found as many as 50% of individuals were asymptomatic. On the Diamond Princess Cruise ship, 18% of the infected population showed no symptoms, while in Iceland, 50% of those who tested positive were asymptomatic.

A recently released report from Maharashtra suggests that 85% of cases in the state were asymptomatic, similar to the recent findings from China, published in The British Medical Journal. These studies suggest that we will never be able to measure the true prevalence of COVID-19 by testing only the high-risk populations.

Measuring infection accurately is an urgent need in order to combat the spread of the disease on point. Estimating the data accurately will help India to determine how much resources in terms of hospitals, ICU beds, critical care systems, ambulances, isolation wards and other health infrastructure is needed to meet the demand of estimated cases in the future.

Cities from all across the country have shown the way forward in such tough times. The most famous example has been from the district of Bhilwara in Rajasthan. Bhilwara was the epicenter of the new coronavirus in Rajasthan with 27 cases, second largest in the state.  It was the aggressive containment measures taken by the district administration which limited the spread of the virus. Since March 30 no new case has been reported from the district. 2000 teams conducted door to door testing drive along with strict enforcement of social distancing protocols by district administration for a population of more than 26 lakh people. The recent containment guidelines released by the Health Ministry are said to be based on the Bhilwara model only.

Similar examples have been shared from Ladakh, Pune, Jabalpur, Pathanamthitta where district administration implemented strict rules of tracing, testing and isolation. Earlier, all these places were reported to be the COVID hotspot but have now contained the outbreak to a large extent. Cities have shown that only ramped up testing efforts can help India fight this global pandemic.