WHO’s representative Dr Henk Bekedam: ‘India does need to step up testing, it is on that path’

India’s response has been comprehensive and robust. Right from the onset, the government has taken things very seriously, as reflected in the high-level of political commitment, including by the Prime Minister himself.

Massive efforts are being made towards containing the spread, including strengthening surveillance, laboratory capacity, contact tracing and isolation.

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The (Health) Minister and (Union Health) Secretary have been calling the states regularly… They have mobilised the states very effectively. Also, various departments and ministries were involved — what we call a whole-of-government approach. They are well mobilised in case of a larger outbreak at this stage.

There are concerns that India’s testing base is too low and we may be missing cases. The WHO SEARO (South-East Asia Regional Office) regional director has said as much. What’s your opinion?

India does need to step up testing, and it is on that path. What is important is that since mid-February, India has included testing for patients having severe acute respiratory illness from the surveillance system — these are people who have no travel or contact history. Some results have already come out negative, other results will be out by end of the week.

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There are two things: one is increasing capacity, the other is increasing scope. I understand that India is already considering increasing the scope to include testing of atypical pneumonia patients. This was one of the lessons from SARS (2003).

On the issue of capacity, the government is already expanding capacity substantially. There are also several tests on the commercial side, which I understand ICMR is now evaluating. Once they are validated, there will be an increased role for the private sector in testing.

Dr Henk Bekedam.

Between lockdown and testing, which is the more effective way of controlling spread of infection?

The most effective way to deal with an outbreak is to act as soon as possible. We still hope that India is in the early part of responding to an infectious disease, and has the advantage of learning from the world. We also welcome the government’s call for social distancing as a preventive strategy. Effective implementation of this strategy will go a long way in controlling the spread of the virus, along with hand-hygiene, coughing and sneezing etiquette. We hope these steps will result in flattening the curve. In China, in all provinces outside Hubei, they flattened the curve mainly by community intervention strategies like these.

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Even though 17 states/ UTs have confirmed cases, containment strategy is the main approach. All states are implementing this strategy. Also, what India has done very well is contact tracing and isolation. Thousands have been tracked, isolated and tested when required.

Is there any move internationally to bring down testing costs or to make the test faster?

The test in India, from what I understand, is available without cost. It is a new virus, so we need to develop tools, diagnostics, medicines and vaccines to fight it. South Korea has now reduced the testing time to 4-5 hours. The development of vaccines takes time.

There are vaccines in the works in Australia, the US, and some other countries which will take at least another year before the public can use them.

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Now ICMR has isolated the virus. I am excited about India engaging in research on vaccines and better diagnostics. This includes serological testing which will be important to get a better idea about the outbreak.

It is important to understand that the throat swab procedure is risky if the PPE (personal protective equipment) is not done right. I lost a colleague in Vietnam during the SARS outbreak. Doctors need to be very careful while collecting swabs.

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Globally, is there an end in sight?

I am quoting my Director General: This pandemic is one of the first pandemics that can be controlled. Singapore, China and South Korea are good examples. I would end by saying let’s all work together and do our bit to fight this new disease and flatten the curve.