Testing critical to control Covid-19

Is it the resources we lack for testing, or is it conviction?

I

magine going on a long drive with your family while your car’s fuel gauge is broken. Wouldn’t you be worried? What if your car ran out of fuel at the wrong time? That’s exactly what it is like to drive a nation through a pandemic without adequate testing. We may run out of luck as summer peaks.

Adequate testing for Covid-19 is the most urgent and important step in controlling this outbreak. People keep debating the date when our society will reopen. Folks, it's not about the date; it’s about the data. Let’s look at the numbers.

Pakistan has tested a total of 145,000 people. This means we have not tested 99.94 percent of our population. South Korea, the poster child of Covid-19 containment, has also not tested over 98 percent of its population. Mass testing, for now, means diagnosing just 1-2 percent of your high-risk population immediately.

What will it take Pakistan to get to that level? Extrapolating data from a recent Harvard study (and rounding the numbers to our realities), Pakistan should perform at least 30,000 tests daily for the next couple of months. Our daily average since February 26, when Pakistan diagnosed its first Covid-19 case, is 2,300 tests.

We are not alone; it’s a regional problem. All eight SAARC countries combined (Pakistan, India, Bangladesh, Sri Lanka, Bhutan, Maldives, Nepal, and Afghanistan) have done less than a million tests for a staggering combined population of 1.75 billion.

But why is testing critical? Remember the broken fuel gauge? Everything we say without testing data is a conjecture. It’s hard to make good decisions based on conjecture. Should we loosen or tighten the shutdown? Should we send our children to school or not? Is it safe to fly? Are we winning or losing?

While no one knows, nations should prepare for this pandemic to last 1 to 2 years at the minimum. This is another reason why building an infrastructure of adequate testing is critical.

We should test everyone with a cough, fever, shortness of breath, chest pain, body aches, or symptoms of heart attack or stroke. Covid-19 has touched almost all organ systems. We should then (at an average) test 10 close contacts for every positive patient. Follow this cycle repeatedly, and a time comes when sick contacts of diagnosed patients can be placed in quarantine, without testing. We are following the same principle in the US.

Don’t test and we end up driving without a gauge. Since March, Twitter warriors have tried to convince me that Covid-19 will not hit Indo-Pakistan. Arguments have ranged from we have a stronger immunity and BCG vaccine will protect us to warm weather will kill it. Even celebrities and politicians have been playing armchair epidemiologists. But since Pakistan ramped up testing in April, the mood has shifted.

The number of positive Covid-19 patients has doubled every ten days. On April 2 Pakistan had approximately 2,500 Covid-19 cases. That number doubled to approximately 5,000 on April 12 and doubled again to 10,000+ on April 22. More testing, more cases. It’s that simple.

The naysayers may dispute the value of testing when a sizeable number of Covid-19 patients are asymptomatic and false-negative results (meaning you had the disease, but the test failed to detect it) have been reported. I get that. But most asymptomatic Covid-19 patients go on to develop symptoms, so testing will ultimately catch them. And I’d rather detect thousands of Covid-19 patients and accept a few hundred false-negative results as compared to hoping that 99.9 percent of the untested population must be negative.

The consequences of not increasing our testing capacity, urgently, could be twofold. First, we lose lives. The Azad Kashmir earthquake in 2005 killed 75,000 people. Undetected Covid-19 is a slow-moving, invisible earthquake in all provinces which may infect almost 50 percent of the population over the next 1 to 2-year period. For Pakistan, that could mean 100 million infections, 20 million hospitalisations and (even if the mortality is 0.5 per cent), 500,000 deaths.

Second, we lose trust. As cases mount, citizens will become afraid of one another. Every allergic sneeze, every smoker's cough, every viral fever, and physical exhaustion will be stigmatised as Covid-19 until proven otherwise. Governments will be closing and reopening the economy on guesswork. Foreign investments will dry-up. International travel? A dream.

The fight against Covid-19 is complex. Everything has its place: PPE, a ground force for contact tracing, hospital capacity, medications, ventilators, and so much more. But testing is the foundation.

How do we get the resources to build the infrastructure for adequate testing? It takes money and leadership.

Some may argue: “But we don’t have the resources for testing”. I disagree; we don’t have the conviction. We are all over the place with our priorities, and are not learning from countries like Taiwan, South Korea, and New Zealand who have successfully contained this outbreak.

How do we get the resources to build the infrastructure for adequate testing? It takes money and leadership. Even if each test costs Rs 4,000, we will spend $22.5 million a month to maintain 30,000 tests daily. We could keep doing tests at this rate for well over a year and still spend significantly less than the cost of a single 777 that sits idly at our airports because we do not know if it is safe to fly. For issues beyond money, we need leadership. We can do it. It is a question of priorities.

We desperately need adequate Covid-19 testing. We are not just driving a car with a few family members; we are flying a plane with 220 million people. We need a functioning gauge. We cannot afford to run out of fuel.


The writer is the chief quality officer and chief of infectious diseases at the University of Maryland-Upper Chesapeake Health. He tweets at @FaheemYounus and can be reached at [email protected]

Testing critical to control Covid-19