COVID-19: A smart testing strategy is a smart economic investment

Health Tips


coronavirus testing strategiesMore than a year into the pandemic, as cases continue to swell and shrink in waves, people have begun to pin their hopes on a vaccine.By Dr Daya Krishan Mangal and Sharang Shah

The last twelve months have been tumultuous. From detection of the first case of COVID-19 in Wuhan city, China to its spread like wildfire; the disease has impacted almost every country in the world. The rapid spread of COVID-19 is a result of an increasingly globalized world and lack of knowledge of the epidemiology of this novel virus.

In just one year, there have been 93.53 million confirmed cases of COVID-19, and over 2 million people have succumbed to the virus (as of January 15, 2021). The human cost of the pandemic has been devastating; it, however, pales in comparison to the economic cost. The International Monetary Fund (IMF) has conservatively estimated that the global economic cost of the pandemic will be around $28 trillion – a per capita productivity loss of over $4,000 per person, higher than the median annual income for a majority of the countries in the world. According to a study by Dr David Cutler (Harvard University) and Dr Lawrence Summer (former Chief Economist, World Bank) released in October, the direct and indirect cost of the virus to the American economy alone could amount to $16 trillion, or approximately 90% of the annual gross domestic product of the US, if the spread of COVID-19 isn’t substantially contained until the fall of 2021. Closer home, India has reported 10.52 million confirmed cases and 0.15 million deaths due to COVID-19 since the detection of the first case in Kerala on January 30, 2020. As per official data released by the Ministry of Statistics and Programme Implementation, the Indian economy contracted by 23.9% in the April-June quarter of this fiscal year; the sharpest contraction for any quarter in the past for which the same economic data is available.

The economic policy response in India and across the globe has also been unprecedented. Notions of fiscal prudence and austerity have been shunned aside with governments ballooning their deficits, lowering their interest rates, and providing a mix of monetary and fiscal measures to restimulate the economy and consumer demand. In May, Prime Minister Narendra Modi announced a special economic package of Rs. 20 lakh crores ($266 billion economic stimulus or approximately 10% of India’s GDP) to fight COVID-19. This was followed up with another stimulus announcement of about Rs. 2.65 lakh crores (approximately $35.14 billion). In March, Rs. 15,000 crores was also allotted towards building up India’s COVID-19 emergency response and health system preparedness.

As part of our public health response, we adopted the standard public health practices as advised by the World Health Organization for control of the disease, including testing strategy for it. The ICMR issued advisories for testing in early March 2020 and revised them on a timely basis with increasing information on the virus. Unfortunately, this did not curb the spread of the virus.

With the added advantage of hindsight, it is easy to criticize the government and bemoan the lost opportunity at closing the borders in a timely manner. Had policymakers been fully aware and informed of the possible magnitude of the virus, a smarter screening strategy at our borders, contract tracing, isolation and strict quarantine would surely have been implemented. Unfortunately, with limited and suspect data from China to go on, India and the rest of the world were flying blind, and did the best they could, given the circumstances. The scenario, however, has now changed.

In the past nine months, the amount of accurate information available on COVID-19 and the best responses to it has increased manifolds. In line with the recommendations of the National Taskforce on COVID-19 cases, the ICMR issued the sixth version of testing advisory on September 4, 2020, which advised the use of different tests (RTPCR, TrueNat, CBNAAT and Rapid Antigen test) in different situations like surveillance at points of entry, routine surveillance in non-containment areas, in a hospital setting or testing on demand. Till January 15, 2021, a total of over 184.9 million tests have been performed in the country. The rate and cost of tests performed daily varies widely between states reflecting differentials in the strategy implemented. Based on our understanding now, we can deduce that it would be essential to adopt a standard protocol of testing in different situations for enhanced comparability of the data and improved access, affordability, and effectiveness.

From countries such as New Zealand and Taiwan, we know that having a smart testing strategy, which is designed in such a manner that not only suits the needs of the region but also ensures quick detection of cases, fewer hospitalizations, lower mortality and lesser burden on the healthcare system, can yield benefits to both public health and the economy. From an economic perspective, we are also cognizant of the fact that early and rigorous testing, behavior change communication, strict social distancing and contact tracing could have diminished the need for lockdowns, which are the main cause of both the consumption slowdown and supply-side shocks that sent economies into a spiral.

More than a year into the pandemic, as cases continue to swell and shrink in waves, people have begun to pin their hopes on a vaccine with several countries including the United States and the United Kingdom beginning to administer the first doses. However, on the flipside, the emergence of a new, more contagious mutation of the COVID-19 in the United Kingdom has sullied global sentiment. As the roll-out and administration of a safe vaccine could still take months, India still needs to look at alternative policy measures to break the chain of transmission. With the fiscal deficit hitting 119.7% of the year’s target within the April – October period, another round of lockdowns is something that we cannot afford. Smart testing and contact tracing strategies must be leveraged till the virus is contained so that the economy can be kept open while ensuring that the spread of the virus is curbed.

(The columnists are Dean Research, Professor, Advisor (SDG-SPH), IIHMR University and Public Policy Consultant, Chase India respectively. Views expressed are their own.)

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