Kerala Health Minister Veena George on Sunday announced a new testing strategy for Kerala. Essentially, as part of the revised strategy, random tests and sentinel surveillance will be stepped up in all 14 districts to identify hidden clusters. In other words, the new strategy would be a mix of targeted testing and random sampling.
Kerala government had constantly argued that the state's high test positivity rate (TPR) was the upshot of targeted testing, a strategy under which only the most likely candidates - those with high symptoms and close contacts of the infected - are tested. From now on, to flush out hidden cases, random tests will be carried out. This can bring down the TPR in the coming days.
The stepped up testing will be generally done using rapid antigen tests (RAT), considering convenience, cost and the tool's ability to give quick results (within 15 to 30 minutes as opposed to RT-PCR tests that take at least 24 hours to give a result).
However, there will be more RT-PCR tests in districts and local bodies where the total number of people who have taken at least one dose of vaccination is over 80 per cent. In such districts and local bodies, those with COVID-19 symptoms – like mild throat pain, cough, diarrhoea – will be mandatorily subjected to RT-PCR tests. In areas with below 80% coverage of the first dose, RATs will be continued to be employed.
Nonetheless, even in high coverage areas, RATs will be used for sentinel surveillance and random sampling. Sentinel surveillance will be done among groups that have high social contact like healthcare workers, police, local body representatives, those who work in public offices and institutions, employees of malls and shops and also those working in transit centres like bus stations.
In districts where there is over 80% first dose coverage, 1,000 samples each will be collected daily as part of sentinel surveillance. In areas with lower coverage, 1,500 samples will be taken. If without symptoms, those who had taken two doses of the vaccine will be kept out of the random tests and sentinel surveillance. So also those who had recovered from COVID within two months.
Even doctors who are part of the government's COVID-19 advisory panel are not sure why RT-PCR has been made mandatory to test symptomatics in areas where over 80 per cent had received at least a single dose of vaccine. "The medical advisory board had not recommended such a measure," a member told Onmanorama.
"It is good to have RT-PCR tests but the fact is we do not have the capacity (lab facilities) to ramp up RT-PCR tests from what it is now. Already we do 25,000 to 30,000 tests daily, which is near full utilisation. More tests would mean that our labs would be stretched and the turnaround time (time to get the results) will increase. We will have to wait for two or three days to get the results," the member said.
The wide gap between test and result will defeat the most important objective of identifying the infected and quickly isolating them. "Those who are actually positive would move around, mingling with people, till the results come, thereby increasing the risk of transmission," the member said.
Another member felt that by announcing more RT-PCR tests, the government was only trying to keep critics at bay. The Opposition had been demanding a complete shift to RT-PCR tests.
The new announcement, anyway, is not going to vastly increase RT-PCR test numbers. There are just three districts in Kerala that have more than 80 per cent of their target population (those above 18) given at least one dose of the vaccination: Ernakulam (85%), Pathanamthitta (87%) and Wayanad (89%).
If the entire population is taken into account, there is no district in Kerala that has inoculated more than 80% of its population with at least one jab.
"It looks like the government wants to merely show that it is doing something. The restoration of night curfew is another such measure," an advisory board member said. Ostensibly in the light of the increase in cases, the government has reintroduced the curfew from 10 pm to 6 am on all days.
"It was already demonstrated that such a measure would bring about no change except empower the police to harass the public," the member said.
