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72 (
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); 107-109
doi:
10.25259/IJMS_148_2020
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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

Department of Oncology, Shalby Hospital, Mumbai, Maharashtra, India
Department of Medical Oncology, Bhagwan Mahaveer Cancer Hospital, Jaipur, Rajasthan, India
Department of Medical Oncology and Hematology, Apollo Cancer Institutes, Hyderabad, Telangana, India
Department of Medical Oncology/Hematoncology/BMT, Asian Institute of Medical Sciences, Faridabad, Haryana, India
Department of Medical Oncology, Sir Ganga Ram Hospital, New Delhi, India
Bone and Soft Tissue, Tata Memorial Hospital, Mumbai, Maharashtra, India
Corresponding author: Purvish M. Parikh, Department of Oncology, Shalby Hospital, Mumbai, Maharashtra, India. purvish1@gmail.com
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This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-Share Alike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.
How to cite this article: Parikh PM, Bapna A, Krishna MV, Mehta P, Aggarwal S, Gulia A. 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. Indian J Med Sci 2020;72(2):107-9.

Abstract

In terms of the absolute number of COVID-19 positive cases, India is among the top four countries in the world. There is a lot of unwarranted criticism about the alleged inadequacy of COVID-19 testing in India. The facts available from international and publicly available online non-government source covering the entire world show otherwise. While India is fourth in terms of an absolute number of cases, its rank is 132nd in terms of cases per million population and 107th for deaths per million population. These are indications that India is doing much better in the battle against COVID-19 than it is getting credit for. The correct benchmark for the adequacy of testing is the percentage of COVID-19 positive results as compared to the total number of tests performed. India ranks 5th (out of 215) in this respect – being better than some western countries such as the USA, Spain, and France. Thus, the Indian strategy for COVID-19 testing is better and more appropriate than the majority of other countries with the large absolute number of positive cases.

Keywords

Adequacy of testing
Ratio to population
Coronavirus
Trends
Comparison

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 132nd 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 107th. 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.

Table 1:: World rank of actual COVID-19 status of the four top countries – per million populations (adapted from Parikh PM 3M India.in).
Country Absolute number of COVID-19 positive cases Cases per million of population
Total cases World rank (out of 215) No World rank (out of 215)
USA 2,162,406 1st 6535 11th
Brazil 867,882 2nd 4084 26th
Russia 537,210 3rd 3681 39th
India 333,380 4th 242 132nd

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 5th, with 5.77% positive tests which appear to be significantly better than some European countries such as Spain (rank 6th), France (Rank 9th), and the USA (rank 8th).

Table 2:: COVID-19 testing status of most affected countries – tests are done and percentage positivity (adapted from Parikh PM 3M India.in).
Country Absolute number of COVID-19 positive cases Absolute number of tests Adequacy of testing – Percentage of positive tests (ratio of positive tests to total number of tests; lower percentage is better) (%) Rank of adequate testing (least number of positive cases per tests performed) Number of COVID-19 tests that would have been required if testinggave the level of positivity as India
Total cases World rank (out of 215) No Rank Total tests required Change in testing required to match India’s level (percentage) (%)
USA 2,162,406 1st 24,795,407 1st 8.72 8th 37,452,816 +51
Brazil 867,882 2nd 1,604,784 9th 54.08 15th 15,031,694 +837
Russia 537,210 3rd 15,161,152 2nd 3.54 1st 9,304,463 −39
India 333,380 4th 5,774,133 4th 5.77 5th Reference Reference
UK 295,889 5th 6,772,602 3rd 4.36 3rd 5,124,789 −24
Spain 291,008 6th 4,826,516 5th 6.02 6th 5,040,251 +4
Italy 236,989 7th 4,620,718 7th 5.12 4th 4,104,643 −11
Peru 229,736 8th 1,360,839 11th 16.88 12th 3,979,022 +193
Iran 189,876 9th 1,269,194 12th 14.96 10th 3,288,647 +159
Germany 187,706 10th 4,694,147 6th 4.00 2nd 3,251,063 −31
Turkey 178,239 11th 2,632,171 8th 6.77 7th 3,087,095 +17
Chile 174,293 12th 840,150 14th 20.75 13th 3,018,750 +259
France 167,220 13th 1,384,633 10th 11.35 9th 2,896,246 +109
Mexico 146,837 14th 406,547 15th 36.12 14th 2,543,213 +526
Pakistan 144,478 15th 897,650 13th 16.09 11th 2,502,355 +179

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.

Declaration of patient consent

Patient’s consent not required as there are no patients in this study.

Financial support and sponsorship

Nil.

Conflicts of interest

The authors Purvish M. Parikh and Ashish Gulia are on the editorial board. They do not have any competing interests.

References

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