COVID-19 testing in India in comparison to the rest of the world. If Indian testing strategy was replicated in the other top 15 COVID-19 affected countries in the world, the status would be startlingly different

COVID-19 is an unprecedented global pandemic that has infected more than 8 million cases worldwide (as on June 15, 2020) and unfortunately led to the loss of 435,666 lives.^[1] The caseload in India has been steadily increasing over the past 3 months, and presently, India is counted among the top four countries in the world (behind USA, Brazil, and Russia) in terms of absolute numbers.^[2] There is an ongoing debate about how governments and health authorities are responding to the COVID-19 pandemic.^[3] Specifically, there is a lot of criticism regarding the adequacy of testing and whether all the cases are being detected.^[4]

To evaluate these claims, we decided to analyze the publicly available data obtained at a single point in time (June 15, 2020) from an international, online, and publicly available non- government resource that have provided real-time facts from across the globe – covering 215 nations.^[1]

Table 1 compares the number of cases in the top four countries – USA, Brazil, Russia, and India. Not to compare apples with oranges, we have added columns to show the number of cases per million of each country’s population as well as the number of deaths per million of population (along with the world rank for these parameters). While India may be ranked #4 in terms of absolute number of cases, its rank is 132^nd in terms of cases per million population (out of a total of 215 countries). These are very encouraging figures and indicate that India has less cases as a percentage of its population as compared to the rest of the world. In terms of deaths per million of the total population, India ranks 107^th. Despite rather dire predictions about the volume of cases, these figures probably indicate that India has been able to contain the COVID-19 pandemic to some extent.

The other area of significant concern has been the adequacy of testing. The top 15 countries are compared in Table 2 (adapted from Parikh PM 3M India.in). To get the right perspective, we have shown the absolute number of COVID tests performed as well as the ratio of COVID-19 positive tests to the total number of tests actually performed (as a percentage). The generally accepted implication is that the lower the percentages, the higher is the adequacy of testing. Table 2 shows that Russia is the best with only 3.54% of tests being positive. India’s rank among the top 15 countries is 5^th, with 5.77% positive tests which appear to be significantly better than some European countries such as Spain (rank 6^th), France (Rank 9^th), and the USA (rank 8^th).

Rather intriguingly, if we use the level of COVID-19 testing in India as a benchmark and then compare other countries, a rather different pattern emerges regarding the adequacy of testing. There is a wide variation with several countries being seen to have inadequate testing relative to the number of cases – including France, the USA, and some South American countries. We agree that this is a single measure only and that further granular analysis is need once the pandemic resolves.^[5,6] Till hard additional data become available to the contrary, we hope that this will put to rest all complaints about India not testing enough people. Indian strategy for COVID-19 testing is better and more appropriate than the majority of other countries with a large absolute number of COVID-19 positive cases.