Health |

Covid-19: Test, Test and Test

The curious case of Korea
Italy’s healthcare system is reeling under the enormous strain presented by Covid-19. The disproportionate growth in the number of cases and fatalities has completely overwhelmed the healthcare infrastructure. 

So, how did this happen? South Korea and Italy had roughly the same number of cases about two weeks back. South Korea has largely managed to limit the number of fatalities whereas casualties in Italy have proliferated uncontrollably, standing reportedly at 3405 deaths on March 20, 2019, overtaking China’s official tally of 3245.

Demographics
There are major differences in the demographics of Italy and South Korea. Italy has one of the oldest populations in the world, 28.6 per cent of the population is 60 years or older according to a UN report (World Population Ageing 2015) compared to 18.5 per cent of South Korea. Over 90 per cent of the fatalities in Italy have occurred in people 70 years or older as of March 20. On the other hand, the affected population in South Korea is much younger, only 20 per cent of the cases are of people 60 or older whereas over 30 per cent of the cases are in their twenties(https://www.epicentro.iss.it/).

Gender is also another major factor in the number of fatalities. The global split among the cases is roughly 50-50 but according to data from the source of the outbreak in China’s Wuhan, the overall death rate is 4.7 per cent in men versus 2.8 per cent in women — a wide difference. Again, luckily for South Korea, 62 per cent of the cases have been in women.

Smoking is another important factor associated with higher fatalities. Italy and South Korea roughly have the same number of smokers but in Italy 28 per cent of men and 20 per cent of women smoke, while in South Korea about 50 per cent of men and less than 5 per cent of women smoke.  

Out-testing the epidemic
 “We have a simple message to all countries – test, test, test,” WHO Director General Tedros Adhanom Ghebreyesus told a press conference in Geneva.

Testing of suspected cases can help identify the infected and isolate the confirmed cases immediately. Then quarantining their close contacts can help stop the spread. The reason testing is so critical is because over 80 per cent of Covid-19 cases show very mild symptoms and might spread it unknowingly.

South Korea has conducted 3,692 tests per million, the highest in the world. In comparison Italy has tested only 826 people per million. The number of tests conducted has a direct bearing on the cases identified and therefore helps the authorities adopt containment and preventative measures in time. South Korea’s expansive aggressive testing of all suspected cases both in the Daegu-Gyeongbuk region and nationwide coupled with contact tracing and aggressive quarantine helped them avert huge casualties. The epicentre of Korea’s outbreak, Daegu and nationwide, shows a slowing down of the epidemic now. Rapid scaling up testing is needed to stop this dangerous pandemic in its tracks.

India: A ticking time bomb?
The number of confirmed cases and deaths in India stand at 206 and 4 (ICMR Report, March 20) respectively but the numbers can be grossly misleading. India is conducting only about 90 tests a day, which is around 4 per million, despite having reportedly the capacity for as many as 8,000 per day. So far, 13,486 people have been tested, according to the ICMR report on March 20. The figures are indeed low for a densely packed population of over 1.3 billion. India needs to ramp up its testing campaign on a war footing to stop Covid 19 in its tracks. 

The basic reproduction number of the novel coronavirus is between 2 to 2.5, which means that every infected person will spread it to at least 2 to 2.5 people before being detected. Then there is the disease’s  incubation period, which is about 14 days for Covid-19, meaning a person can be infected but not show symptoms for 14 days, infecting many others in the process. These are scary statistics for India. 

According to the Indian Council of Medical Research (ICMR), India has not yet reached Stage-3, community transmission, where the source of the infected cases cannot be ascertained. Experts say that community transmission is inevitable in India and we have a 30 day window to gear up for it. Currently, all the test kits are being imported. ICMR and the National institute of Virology, Pune have partnered with private players like Biocon and the Manipal Institute of Virology to step up its testing efforts. The test costs between INR 6000 and 6500, but is free for patients at government hospitals. 

We can win
The novel coronavirus disease is probably the most defining moment of the 21st century and according to the experts it has just begun. The National Health Service (NHS), UK has projected that the novel coronavirus could very likely last up to spring, 2021 and infect more than 80 per cent of the UK’s population. In another modelling study conducted by researchers at the Imperial College London predicted 22 lakh deaths in the US and over 5 lakh deaths in the UK. For India, no such modelling studies are available. However, if only, testing, testing and testing can give us a fighting chance, the people of India would be ready to come together, in partnership with the Indian government, to test themselves. New Covid-19 specific pathological labs pan India, door to door collection of samples, paramedic deployment for monitoring home quarantined families and individuals, increasing ICU beds in hospitals and opening guest houses, hotels and other such facilities for isolation can work wonders in the control of the disease.

References

  1. Kent Sepkowitz, Why South Korea has so few coronavirus deaths while Italy has so many. Available at :
    https://edition.cnn.com/2020/03/16/opinions/south-korea-italy-coronavirus-survivability-sepkowitz/index.html
    2. AYLIN WOODWARD,SKYE GOULD, One chart shows how many coronavirus tests per capita have been completed in 8 countries. The US is woefully behind. Available at:
    https://www.businessinsider.in/science/news/one-chart-shows-how-many-coronavirus-tests-per-capita-have-been-completed-in-8-countries-the-us-is-woefully-behind-/articleshow/74559290.cms?utm_source=contentofinterest&utm_medium=text&utm_campaign=cppst
    3. Report of the WHO-China Joint Mission on Coronavirus Disease 2019 (COVID-19), Available at:
    https://www.who.int/docs/default-source/coronaviruse/who-china-joint-mission-on-covid-19-final-report.pdf
    4. India’s poor testing rate may have masked coronavirus cases, Available at :https://www.aljazeera.com/news/2020/03/india-poor-testing-rate-masked-coronavirus-cases-200318040314568.html
    5. Neil M Ferguson, et al, Impact of non-pharmaceutical interventions (NPIs) to reduce COVID19 mortality and healthcare demand, Available at:
    https://www.imperial.ac.uk/media/imperial-college/medicine/sph/ide/gida-fellowships/Imperial-College-COVID19-NPI-modelling-16-03-2020.pdf
    6. UK coronavirus crisis ‘to last until spring 2021 and could see 7.9m hospitalised, Available at :
    https://www.theguardian.com/world/2020/mar/15/uk-coronavirus-crisis-to-last-until-spring-2021-and-could-see-79m-hospitalised
    7. SARS-CoV-2 (COVID-19)Testing: Status Update, March 20, ICMR. Available at: https://www.icmr.nic.in/sites/default/files/whats_new/ICMR_website_update_20March_10AM_IST.pdf

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