Get real and test more

These are testing times, quite literally. Amid the awful din of partisanship in Pakistan, the need to aggressively “test” for COVID-19 continues to be ignored and nobody is holding the government’s feet to fire on this count. Among the gloom of uncertainties, one of the few things that are known with reasonable certainty is that the virus’s spread can be halted by actively testing random people, isolating the suspected and confirmed cases, and then tracing their contacts.

In addition, “testing” holds the key to gradually reopening economies as the war on virus won’t end until about two-thirds of the global population has been vaccinated for the so-called ‘herd immunity’ to kick in. It’s a long fight and Pakistan is also in it for the long haul. But the way the lockdown has been eased amid the absence of widespread testing reeks of gambling.

As of April 14, official data from the government’s covid.gov.pk portal show that Pakistan had conducted a total of 73,439 tests, which equates to 350 tests per million people. As per global datasets, in neighboring India, testing density stood at 177 per million people as of April 14; in Bangladesh it was 80 tests per million people; and Sri Lanka had performed 223 tests per million people as of April 14.

While Pakistan leads South Asia on testing count, there is no reason to suggest that the country is testing enough people. It also matters what the testing approach is. The current “passive” testing approach needs a review. There are several harrowing reports how designated public hospitals are denying folks with mild symptoms the right to a free test; instead test is performed when symptoms become severe. But by that time, it is too late and virus has spread further. Private lab tests are out of reach for majority.

Analyzing fortnightly data since April 1 – the time when Pakistan was in the middle of its first lockdown and authorities had had ample time by then to grasp potential severity of the crisis – throws up an interesting insight. Between April 1 and 14, Pakistan conducted 37,144 tests and confirmed 3,949 positive cases. This corresponds to 11 percent of the tests conducted in the period that came out positive.

To account for reporting delays, the metric of seven-day rolling average of daily tests done and daily new cases, for the latest week (between April 8 and 14) also provides an 11 percent infection rate, on average. This infection rate is significant in understanding how things will likely unfold. Start testing more and more people and every tenth person will test positive, and then those people will need to be isolated and their contacts traced for further action. This is how this fight needs to be waged to reduce the spread.

Otherwise, without active testing and with lockdowns compromised by political mixed-messages, religious discord and administrative weaknesses, the virus will spread further and the infection rate of 11 percent will jump higher in the future.

Currently, there is false security being felt in numbers, as widespread testing has not been performed. But the lockdown has been eased by the federal government, based on deceleration in growth rate of new daily cases. The growth rate of daily new cases, which averaged 10 percent in the first week of April, declined to 6 percent in the second week of April. But even within this suspected dataset, there is cause for alarm: the first 3,000 confirmed positive cases took 40 days; the next 3,000 cases have taken 10 days. How much time will the next 3,000 cases take? Well, only large-scale testing can provide a true picture.

Be that as it may, it is not an easy task to ramp up testing capabilities. The NDMA Chairman claimed over the weekend that Pakistan had acquired a capability to perform 40,000 tests per day, for a period of 75 days. Hypothetically, if this capability went into full-utilization mode tomorrow on a random basis and continued for 75 days, Pakistan would have tested about 1.5 percent of its population (3 million people) by the end of June. That would provide a good picture of where the silent coronavirus hotspots are.

But securing testing kits is one thing, and having the right infrastructure to perform tests in large numbers in a failsafe way is quite another. A few dozen laboratories with limited number of qualified staff having scant number of protective gear cannot be expected to level up their game overnight to do testing on that scale. Not to mention that the test under question is way more complicated than normal lab tests.

No wonder, the coronavirus tests, which averaged 2,878 tests per day in the second week of April, have not been able to grow exponentially despite the availability of tens of thousands of more testing kits. The authorities need to do everything they can to ease the suffering of the people, but those efforts will be nullified if “active” testing is not embraced to deal with the situation head on. To significantly raise testing capability, the federal government, provincial governments and private sector need to come together now!