The Telangana government on Tuesday declared that cases of COVID-19 in the state had been drastically falling over the last few days and expressed hope that normalcy would soon be restored.
"Cases have fallen to single digits per day...We have implemented lockdown successfully from the village-level to the city. We hope to put coronavirus behind us by May 8 and hope to restore normalcy gradually," Health Minister Eatala Rajender told reporters in Hyderabad. Telangana had earlier extended its lockdown until May 7, even as the nationwide lockdown is until May 3.
The state has seen a declining trend, reporting 56 new cases on Thursday, 15 on Friday, seven on Saturday, 11 on Sunday, two on Monday and six on Tuesday.
But behind the falling numbers, another question was also raised. Is the state testing enough?
The numbers
As per data released by the state government, Telangana had cumulatively tested 18,687 samples by Monday morning. A day later, on Tuesday morning, the figure was 18,894, an increase of 207 in 24 hours.
Between Tuesday and Wednesday morning, Telangana managed to test only 187 samples, with the total number of samples tested rising to 19,081. At the time of writing on Wednesday afternoon, the number of samples tested are 19,166. That’s 547.54 tests per million population, which is less than the national average of 636.89 tests per million.
Compare Telangana’s testing numbers to neighbouring Andhra Pradesh, which has carried out 1772 tests per million population - one of the highest in India -as of Wednesday morning. According to data released by the state's Health Department it had conducted a total of 74,551 tests as of 9 am on Monday. In 24 hours, the Telugu state managed to carry out 5783 tests. Daily testing has since ramped up to over 7000 tests between Tuesday and Wednesday. As of Wednesday morning, Andhra has conducted 88,061 tests.
Tamil Nadu is testing around 7,000-odd samples each day, with the tally rising from 87,605 on Monday to 94,781 on Tuesday to 1,01,874 on Wednesday. Tamil Nadu has carried out 1,412 tests per million population.
Should Telangana be testing more?
"Testing is among our foremost strategies right now for confirming the spread of COVID-19. The number of tests in Telangana are pretty low, given the size of the population and given that Hyderabad has seen so many cases," says Dr Anant Bhan a researcher of global health, bioethics and health policy. Hyderabad has a total of 556 confirmed cases of COVID-19 as of Tuesday evening.
Many also feel that random testing should be done on the population to get a sense of how widespread the infection is.
"States can be strategic in their testing, no doubt. No one wants to waste tests and use them indiscriminately, but to be conservative with testing is a bad idea, especially at this time when the end of the COVID-19 extended lockdown is near. We want to be more cognisant about the situation on the ground, and some element of random testing would be useful, so a future course of action post-May 7 can be planned. Also, that the total number of individuals eligible for testing as per current testing strategy is only around 200 for a whole state on a particular day in the current context is a bit surprising," Dr Anant adds.
Other experts, however, feel that testing is one aspect of the fight against COVID-19, with the other being the implementation of the lockdown.
"It depends upon how rigourous the lockdown is. If the lockdown is very rigorous and there are hardly any slippages, then the testing numbers do not matter that much. The idea of testing is not to guide the treatment. It is essential to take a decision regarding isolation, either at home or hospital. During the lockdown, all infected persons and their contacts are isolated in any case,“ Dr Srinath Reddy, President, Public Health Foundation of India (PHFI), tells TNM.
Telangana was one of the first states in India to implement the lockdown on March 22, and has ensured that a strict night curfew has been in place from 7 pm to 6 am. The state has also set up a lot of containment zones, especially in Hyderabad, even where only a single case of COVID-19 has been reported.
"It is only when we're coming out of the lockdown that the testing numbers become more important. That's when we want to see how fast the virus is spreading in a mobile population. That's when testing should be done much more liberally," Dr Srinath Reddy adds.
Srinath argues that random sample antibody testing in population samples can be stepped up in all districts as the lockdown is being lifted.
"If the lockdown is rigorous, then the purpose of testing is achieved in this way. Testing numbers at this stage will not predict how effective the response is but the testing numbers after the lifting of the lockdown will. Testing is only one instrument for assessing the severity of the epidemic. Hospital admissions for serious acute respiratory disease and household surveillance for influenza like illness provide additional information," he says.
Telangana govt defends move
Dismissing the allegations that the state was not testing enough, Eatala Rajender on Tuesday said that testing was done as per guidelines of the Indian Council of Medical Research (ICMR).
The state said that as per the guidelines, all symptomatic individuals with contact history, frontline workers with symptoms and all patients with Severe Acute Respiratory Illness (SARI) were being tested. He also said that direct and high-risk contacts who were asymptomatic were also being tested.
Stating that the tests being conducted by the Telangana government were 'more accurate', Rajender said, "Telangana is testing effectively and is not doing it unnecessarily....We are not against testing."
He added that it was not the number of tests conducted but the number of cases that tested positive, while pointing out that the national average of the percentage of positive cases was 4.1, compared to 5.3% in Telangana.
Eatala stated that the new guidelines of the Centre suggested home quarantining of those who tested positive but whose condition was not serious, he said there would only be a handful of people left in the state-run Gandhi hospital.
"We understand that home quarantine is difficult for many, especially for those from marginalised sections. We are taking a humane approach and treating them at the hospital itself (for free)," he said.
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