Pakistan has increased its Covid testing capacity by multiple times since the first case. There is no award for that. What matters is if you have tested enough, or even close to enough. What is enough? Blue line in the chart that says “daily new confirmed cases of Covid-19” is an indication that you are doing near enough. The darker you go in blue, the nearer you are to have known the confirmed cases to the fullest. The darker you go red, it spells trouble. It means you have not done enough tests to know the extent of outbreak.
It is well established that the number of confirmed positive cases will remain a fraction of tests conducted. Also, confirmed cases will only be a fraction of the number of total cases, which will remain an unknown. How big a fraction of total cases are confirmed cases is the next big question. That is where the epidemic curve comes handy, which helps understand the spread of diseases through tests in relation to the outbreak.
Tests per million is one indicator to tell how a particular country is responding – but the limitation is that it usually reflects the testing capacity of the country, and not the response to the speed and extent of the outbreak.
The USA for instance, has conducted 65000 tests per million population, which is easily amongst the best in the world. Compare this to South Asian average of 3200 tests per million – to get the context. The USA already leads in the total number of tests 21 million, yet it finds itself in the red zone when it comes to the epidemic curve.
Pakistan finds itself in an unwanted group of countries with the lowest tests conducted per positive case, conducting less than 5 tests per confirmed case. This in more in line with Latin America than South Asia. The outbreak has been much faster than Pakistan’s ability to ramp up testing. It should also be noted that 12 of the 14 countries with a population of over 100 million fall in the red zone. Only Japan and Indonesia did enough tests to understand the size and pace of the outbreak to some extent – despite having one of the lowest ‘tests per million’ among similar size countries.
The WHO has suggested that around 25-30 tests per confirmed case is a general benchmark of what could be termed “adequate” testing. A very few countries fit that bill currently. Some that do now, either have smaller populations or have already faced the battering of long high peaks earlier.
There is a mirror way to look at the test per case number as well – and that could potentially tell if the outbreak is more prevalent in one country than the other. Pakistan has of late been reporting positive cases per tests at over 20 percent – which again sends it in the unwanted company of Latin America – which is right now the epicenter of the pandemic.
Note that there are more opinions out there on testing than the more prevalent one. Could it be that some countries have missed the bus in terms of using testing as an effective tool to reduce the spread? Could it be that countries with large population would invariably struggle to get out of the red zone? For some countries, testing remains a capacity issue, as the early response was supposedly not swift enough to curtail the spread. Big countries who managed to control the spread did it early despite not having to boast of sitting in the top bracket in terms of ‘tests per million’.
Be that as it may, Pakistan, its South Asian counterparts, and much of Latin America, seem to have a long hard battle in front of them. Adequate testing seems almost out of question, or at least highly unlikely. Resting the case on lower mortality compared to the rest of the world seems to be the only option – by design, not by choice.
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