Explainer: What is COVID-19 testing strategy for countries around world?
Sai Krishna Muthyanolla
April 28, 2020
Testing the right set of people seems to be one of the effective ways of identifying COVID-19 spread. However, different countries follow different testing strategies. Here is a look at the testing strategy of various countries.
As COVID-19 is spreads rapidly across the globe, scientists, healthcareworkers, and governments are working together to delay, contain, and stop thespread of the virus. Despite all these efforts, number of cases reportedglobally is getting closer to 29 lakhs. The number of lives claimed by the virus has also crossed the 2 lakhmark and this continues to rise. One of the key efforts of the global efforthas been effective testing. But what is the testing strategy being followedaround the world? Here is an explainer.
WHO has stressed on widespread testing in all
countries
The Director- General of the World Health Organization (WHO) has repeatedly emphasised on the need for rigorous testing of persons. Everycountry must detect, test, isolate, and care for every case, and trace contacts.Increased testing will give insights into the extent of infection in thepopulation and how it is evolving. This will also help the governments  make decisions based on real evidence.
It is now known that the virus is highly contagious. Research is still ongoing to know more about the virus- its origin, nature, andstructure, which will aid in development of vaccine. (Factly has already written an article on the important research studiespertaining to COVID-19, undertaken in India.) Thus, the best way to confrontthe infection now identifying all active cases, their diagnosis, isolation, andtreatment.
Even though the WHO has chalked out recommendations on testing strategyto be followed by countries based on the level of transmission, the strategy adopted by different countries is varieddue to multiple factors such as trend within regions, availability ofresources, existent healthcare system, and availability of tests and kits. Thisstory explores the different strategies for testing adopted by some majorcountries.
WHO has categorized countries into four groups of
transmission level
Laboratory testing strategy recommendations for COVID
-19 released by WHOon 21 March 2020 has listed out recommendations depending on the level oftransmission in the region. The four categories of transmission described by WHO are:
On the basis of transmission level, WHO has recommended
appropriate testing strategy
In the following table, WHO’s recommendations regarding testing strategyhave been summarized.
In all the categories, testing of all suspect cases is mandatory. Suspect cases are defined by WHO as a patient with acuterespiratory illness such as fever and cough/difficulty in breathing/ any othersymptom of respiratory disease, who
The WHO has also mentioned that not having laboratory confirmed casesneed not suggest that the country is free from COVID-19. It can also be becauseof insufficient testing.
Latest situation report shows India is at the ‘Clusters
of Cases’ stage
As per the latest Situation Report on COVID-19 released by WHO on 26 April 2020, Indiais in the stage of ‘Clusters of Cases’. As of 8AM on 27 April 2020, India hadtested 6,65,819 samples and 27,891 individuals were found to be positive, asper data released by the Ministry of Health & Family Welfare (MoHFW). TheWHO report of 26 April 2020 shows 26496 cases for India.
In the following section, the strategies adopted by different countrieshave been discussed.
India
ICMR’s testing strategy for India released on 09 April 2020 requires testing offollowing symptomatic individuals:
In addition, all patients with SARI should be tested ( with fever ANDcough and/or shortness of breath). Between 5 to 14 days of contact with aconfirmed case, all asymptomatic direct contacts and high-risk contacts must betested. Symptomatic ILI patients identified in clusters/hotspots should also betested.
China
China notified WHO about the epidemic on 03 January 2020. Since theinitial cases were reported in Wuhan and parts of Hubei provinces, efforts weremade to prevent the transmission of virus to other places. According to WHO’s study, in this first stage, China worked on controlling thesource of infection, block transmission and prevent it from spreading further. Duringthe second stage, China’s aim was to reduce the intensity of the epidemic andslow down the increase in cases. The infection was classified as Class Binfectious disease. In the third stage, China worked towards reducing clustersthrough epidemic prevention and control.
China’s testing strategy involved collection of samples from suspectedCOVID-19 cases and from those who require diagnosis/ differential diagnosis forthe virus. Specimens were collected from those admitted in hospitals and, fromtheir close contacts. As per WHO’s classification, China is still in the‘Clusters of Cases’ category.
United States of America
According to CDC, in USA, priority for testing has been given in three levels. Those with mild illnesses and can recover at homeneed not get themselves tested. WHO’s classification shows USA is in thecommunity transmission level.
Priority 1: Hospitalized patients and health care facilityworkers with symptoms
Priority 2: Symptomatic patients
Priority 3: Those individuals possessing symptoms but do notfall in the above categories including critical infrastructural workers withsymptoms, health care facility workers and first responders, and individualswith mild symptoms in hotspots.
Europe
In EU’s recommendations on testing strategies, the member states were instructed to prioritizetesting like in India and USA. The five levels of priority in the decreasingorder are:
Priority 1: Patients hospitalized with SARI
Priority 2: Any case of Acute Respiratory Infection in health carefacilities and symptomatic health care staff
Priority 3: Patients with Acute Respiratory Infection or ILI in sentineloutpatient clinics and patients admitted to sentinel hospitals with SARI.
Priority 4: Elderly people with underlying chronic healthconditions and vulnerable populations
Priority 5: All patients with respiratory infections, tracedcontacts, and asymptomatic patients
In UK, the government claimed that it had undertaken one of the highestnumber of tests in Europe. Germany has a higher testing rate than UK and hasbeen lauded for its efforts. UK had doubled testing from 5000 to 10,000 perday. Italy, which is an epicentre of the pandemic, between 24 February and 10April 2020, more than 9 lakh tests (around 25,000 to 35, 000 per day) wereconducted. Italy had around 1.5 lakh confirmed cases. Italy, Germany, and UK arein the community transmission level.
Australia
Like India, Australia mandatorily tests symptomatic individuals who have a travel history inlast 14 days, health care workers, or have lived in area of high risk. Thosehospitalized for respiratory symptoms or fever without any specific cause forsymptoms are also tested. Australia is also in the category of ‘Clusters ofCases’.
South Korea and New Zealand have managed to ‘flatten
the curve’
New Zealand, South Korea, Iceland, and Germany have been praised by media for their effective measures to contain the disease. New Zealand has announced that community transmission has stopped and is all set to ease the lockdown. Even South Korea has now started reporting only single digit number of new cases. Reports suggest that Germany has conducted more than 1 lakh tests per day. What is evident from these reports is that some countries have conducted widespread testing as an effort towards flattening the curve.
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