India Coronavirus News: New COVID-19 Infections Rising Exponentially, Cheap Rapid Testing Kits That Give False Negatives Also A contributing Factor
India Coronavirus News
: In the last 24 hours, India health authorities have reported 69,239 new COVID-19 cases and 912 deaths; bringing the total number of infected cases in India to now 3,044,940.The total number of COVID-19 deaths in India now stands at 56,815. Once again Indian medical doctors and healthcare professionals are crying foul and saying that what is truly occurring at ground levels and official figures being released are vastly different. It is estimated that actual figures in India could be as high as seven fold with state governments deliberately underreporting figures.
The situation on the front lines are as usual ie shortages of hospital beds, ICU’s full, shortage of medical equipment, PPEs and more healthcare workers including doctors becoming casualty figures.
The COVID-19 disease is now spreading through impoverished rural areas in the north and the wealthier but older populations of the south.
Health authorities are claiming that cases have leveled off in India's two largest cities, with serological surveys showing widespread prevalence among the residents of the capital, New Delhi, and financial center Mumbai. However local scenes are showing a different picture, one in which hospitals and clinics are still overflowing.
Indian media has reported that new hot spots are in the rural areas of Uttar Pradesh and Bihar states in India's north, and in the southern states of Telangana, Karnataka, Tamil Nadu and Andhra Pradesh.
Country wise, India is testing more than 920,000 samples per day, exceeding the World Health Organization's benchmark of 140 tests per 1 million people. But about a third of these are antigen tests, which are faster but less accurate compared to RT-PCR, the gold standard for the coronavirus.
The Northern state of Uttar Pradesh, with 210 million people India's most populous state and also one of its poorest, is conducting the most tests, with an average of 112,000 daily.
The Southern state of Telangana, home to India's tech hub of Hyderabad, has come under fire for insufficiently testing its 40 million people.
In its city of Hyderabad, which is normally buzzing with activity, an ongoing fear of the coronavirus has kept parks, shopping areas and roads quiet.
The state of Telangana has reported about 79,500 total cases. But two prominent scientific bodies ie the Center for Cellular and Molecular Biology and Indian Institute of Chemical Technology have warned that an analysis of Hyderabad sewage suggests that the real rate of infection in the city alone could be six to seven times higher than the state's reported total.
India began using cheaper, faster but less accurate COVID-19 antigen tests to scale up testing for the coronavirus, a strategy that the United States is now exploring.
These cheap rapid tests boosted India's testing levels nearly five-fold within two months. But government numbers suggest some parts of the country might have become over reliant on the faster tests, which can miss infections. Experts warn that safely using them requires frequent retesting, something that isn't always happening.
Sadly, cases surged faster than labs could scale up testing once India's harsh lockdown was relaxed. So far authorities have rationed the use of the more precise molecular tests that detect the genetic code of the virus. But on June 14, India decided to bolster these with faster tests that screen for antigens, or viral proteins.
Although less accurate, these tests are cheap and yield results in minutes. Most do not even require a lab for processing or any specialized equipment or trained personnel. The plan was to rapidly increase testing to identify infected people and prevent them from spreading the virus. Samples tested using both tests increased from 5.5 million in mid-June to 27 million two months later, and nearly a third of all tests conducted daily are now antigen tests, health officials say.
However India's experience also highlights the inherent pitfalls of relying too heavily on antigen tests, at the expense of more accurate tests. The danger is that the tests may falsely clear many who are infected with COVID-19, contributing to new spread of the virus in hard-hit areas.
Rapid test results can be verified further with more accurate laboratory tests, but these are slower and expensive. Experts also warn that since the two types of tests vary in accuracy, they need to be interpreted separately to properly assess the spread of infection, something India is not doing.
America faces a similar need to strike a balance between speed and precision, with overburdened labs struggling to keep pace with the outbreak.
Medical experts at Harvard and elsewhere are proposing developing a US$1 saliva-based antigen test for all Americans to test themselves daily, something that has not yet been approved by the US FDA.
American experts say antigen tests don't catch as many patients early in the infection, when virus levels are low. But these people aren't considered the greatest threat to spreading the disease since it's only after virus levels surge that they become more infectious, and by then they will be picked up by antigen tests.
Things might change soon in America as the White house has removed certain powers from the US FDA with regards to COVID-19 diagnostics and these rapid and cheap but inaccurate testing must soon be the new thing in America. https://www.thailandmedical.news/news/must-read-u-s-medical-news-white-house-removes-us-fda-s-power-to-regulate-and-standardize-all-medical-laboratory-tests-including-for-covid-19
As a negative antigen test doesn't guarantee a person is virus free, people should be retested regularly, experts are saying. If their symptoms change, you want to think about retesting those people, they said.
However, India's strategy is different. Health officials have asked for those who test negative with antigen tests but have symptoms to be retested with the more accurate laboratory tests. In reality, India has largely been opaque about how many negatives were being retested, and what type of tests were being used.
Interestingly, Delhi which includes the Indian capital, New Delhi, and where the High Court is monitoring testing, was among the first to aggressively use antigen tests to screen patients for free. Centers were created in dispensaries, schools and government offices. But only 0.5%, or 1,365 of over 260,000 people who tested negative from June 18 to July 29, were retested, court documents show. Delhi conducted over 280,000 tests in this period.
Indian medical experts are saying that the figures are abysmally low. In Maharashtra for example, India's worst-hit state decline in use of more precise lab tests by nearly half, from a capacity of 11,000 tests daily to just 5,400 tests per day, was a worrying trend.
Medical experts fear that over-reliance on antigen tests without retesting could impede efforts to contain the virus as it spreads to states with fragile health care systems, like Bihar and Uttar Pradesh, with a combined population of over 300 million.
These two states now conduct over 100,000 tests daily, the most in India. But only a fraction ie 6,100 in Bihar and 30,000 in Uttar Pradesh use laboratory tests.
Experts say that it’s a circus there and it might be better to not do any testing at all rather that to deploy a testing platform that is messy and giving a false sense of the whole situation.
India is fortunate however compared to other countries in that it has a huge generic drug industry supplying substandard pharmaceuticals hence it has a never ending supply of chloroquine and hydroxychloroquine and generic remdesivir that most of its greedy entrepreneurs were trying to flog off to other countries at inflated rates. It can now rely on these meds!
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