COVID-19 testing: Which Country is testing how many?

In terms of the COVID-19 testing, there are wide variations among countries. While some countries have been aggressive with their testing strategy, some others have been conservative. Here is a look at the status of testing in various countries including India.

The number of confirmed cases of COVID-19 across the world are increasing at a rapid rate. As per WHO’s dashboard on 29 March 2020, there are over 6.34 lakh confirmed cases in 202 countries. This exponential increase over the past few days can be attributed to USA and Western European countries like Italy, Spain, Germany, France etc.

Meanwhile, countries in Latin America, Africa and South Asia have been reporting comparatively lower numbers. While there are multiple reasons cited for the wide variance in confirmed cases, the difference in the number of tests being conducted by each country to identify positive COVID-19 cases is also considered one of them.  

How is each country testing? Are there wide variations between the countries? Are the positive cases identified proportional to the numbers being tested? Here is detailed analysis.

No comprehensive data available for testing numbers

Testing is critical to identify if a person is infected with COVID-19. Studies indicate that it could take anywhere between 2-14 days after the exposure for the symptoms to be visible. Hence, testing helps to:

• Identify the infected individuals and restrict their social movement, else they could unknowingly move around and spread the infection.
• Providing required care for the infected and take necessary measures
• Understand the spread of infection so that authorities can plan more effectively in tackling the pandemic.

However, the rationale & the testing strategy followed by countries varies widely.  While few countries have been aggressive on this front by facilitating the conduct of tests for anyone who suspects to be infected, few other countries like India have laid down certain criteria for testing. Further, testing is offered for free in some countries while in a few others, there is an associated charge. Availability of testing kits and other resources also seem to influence the policy being followed by the county for optimum use of the limited means available or testing.

So, what is the number of tests being carried out by each country?

Currently, there is no centralized database which tracks the number of tests being conducted by each country. Unlike the database for the number of positive COVID-19 cases and the deaths, WHO does not maintain any database for the number of tests being conducted in each country. However, few countries have from time to time published the details of the tests being conducted which remains the only reliable source. In absence of any official aggregator of such data, few private organizations are making an effort to collate the information.

The information which is available is not up to date and is quite dynamic. The latest information available for each of the countries is for different dates and hence cannot be compared. There are chances that a country might have stepped up testing after the publication of such data.

However, a brief look at the tests data may indicate a general trend in the testing strategy followed by various countries.

Germany & Italy are among the countries with high number of tests in Europe

Italy is the worst-hit country due to COVID-19 with more than 10 thousand deaths being recorded. Italy along with USA are the new epicentres of spread of the virus beyond China.

Apart from Italy, many of the European countries especially the West European countries have recorded high number of positive cases of COVID-19.

Germany which has the 5^th highest number of COVID-19 positive cases has conducted the highest number of tests of around 4.83 lakhs. It is followed by Italy with 4.29 lakh tests. Spain which has the next highest number of COVID-19 cases in Europe after Italy has conducted 3.5 lakhs tests. Switzerland, United Kingdom and France are the other European countries which have conducted more than 1 Lakh tests, as per the latest available reports. Russia which has around 1,500 positive cases have conducted around 2.43 lakhs tests.  

South Korea and USA among countries which did extensive testing

Over the last one week, U.S.A has overtaken China as the country with the highest number of COVID-19 positive cases. The exponential increase in the number of positive cases can be attributed to the increase in the number of tests being done. As per the official reports, as on 29 March 2020, more than 7.62 lakh tests were conducted in USA, which is the highest across the globe.

Although the situation now appears to be under control, South Korea happens to be one of the earliest countries hit by COVID-19. Its geographical proximity with China being one of the reasons for the early outbreak. However, they have conducted aggressive testing to identify and control the pandemic, which is reflected in the 3.94 lakh tests conducted here. Meanwhile, China, where the outbreak first happened has conducted 3.2 lakh tests in the Guangdong province alone. Data for other provinces is not available.

Among the other countries, Canada and Australia have been proactive in conducting the tests with 1.84 and 1.38 lakh tests. Iran, which is among the countries with highest COVID-19 positive cases, as per a report on 14 March 2020, conducted 80 thousand tests. Latest data is not available.

Meanwhile, the testing is quite low among the other Asian countries. India and Pakistan, which are among the highly populated countries in the world have conducted only 27.6 thousand and 13 thousand tests respectively and in each country, the number of positive cases has crossed one thousand.

Brazil has conducted the highest number of tests among Latin American countries with more than 45 thousand tests. The testing is yet to pick up in African countries. South Africa conducted more than 7 thousand tests so far.  In a tweet on 16 March 2020, United Arab Emirates stated that they have conducted 1.25 lakh tests.

Norway, UAE & Switzerland conducted the highest tests per million population

The total number of tests conducted by a country is a measure of volume and does not completely reflect the extant of tests in proportion to the population of that country. For example, USA may have conducted the highest number of tests. However, countries like Belgium & Croatia despite conducting a fewer number of tests may fare better in terms of covering a greater chunk of their population.

Hence the number of tests conducted per a million (10 lakhs) of the population is a more appropriate measure.  By taking into consideration the respective population of the countries and the total COVID-19 tests conducted by the country, the number of tests conducted per million is calculated.

Among the countries which have been considered for this analysis, Norway records the highest with 15,386 tests per million followed by UAE and Switzerland. Australia & South Korea have also fared well in terms of tests conducted per million population.

The highly affected European countries of Italy, Spain have conducted around 7 thousand tests per million followed by Germany and Austria.  Meanwhile, India with its huge population and fewer number of tests being conducted so far averages around 20 tests per million. Pakistan, Brazil and Mexico the other largely populated countries follow suit.

Meanwhile, China (Guangdong province) and USA the main epicentres of the pandemic were able to conduct around 2,800 and 2, 400 tests per million.

Kerala has conducted the highest number of tests in India

In its notification on 27 March 2020, Indian Council of Medical Research (ICMR) has stated that 27,688 samples have been tested for COVID-19 so far. As in the case of countries, the states within India have been inconsistent with publishing the information related to samples tested. Only a few states have furnished this information.

Among the states whose information is available, Kerala has conducted the highest number of tests with 5,432 samples.  This is followed by Karnataka and Rajasthan with 3,076 and 2,325 tests respectively. Maharashtra which along with Kerala is among the states with a high number of positive cases has not furnished details of the number of tests carried out.

From the available data, a proportional correlation is observed between the number of tests conducted and the number of COVID-19 positive cases.

Need for conducting more tests within the country as well as globally

The case of USA, wherein the number of COVID-19 cases has increased exponentially with the increase in the number of tests underscores the need for increased testing. Increased testing might help understand the prevalence of the virus more accurately. South Korea acts as a positive example where proactive testing has helped to identify and restrict the spread.

Meanwhile, Italy and Spain have also witnessed an increase in the number of positive cases proportional to the tests being conducted. These examples offer learnings for countries like India, Pakistan, Brazil, Argentina, Bangladesh, etc. with higher populations to increase testing for COVID-19.

Many of the countries in South & South East Asia, Latin America and Africa have reported a low number of COVID-19 cases which could be due to a fewer number of tests. One can only ascertain the actual spread once testing improves.

Even within India, the states which have conducted a greater number of tests have reported a higher number of cases. The data on the number of tests conducted in states like U.P & Bihar with huge populations is unavailable. The lower number of positive cases recorded in these states could be due to lower testing.

The availability of test kits is a major challenge affecting many countries, forcing governments around the world to prioritize testing. The need of the hour is to identify means to increase the number of test kits or develop effective testing strategies that allow for a greater number of people to be tested. Until this is resolved, and the testing numbers increased, we may never know the actual spread of COVID-19.

Featured Image: COVID-19 testing