Coronavirus Outbreak Explained: What Is Pool Testing And Can It Expedite COVID-19 Detection In The Country?

Coronavirus Outbreak Explained: What Is Pool Testing And Can It Expedite COVID-19 Detection In The Country?

In pool testing, samples of throat swabs from two to five people are mixed together and tested in a single unit and individuals are screened individually only when the pool test result is positive
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Coronavirus Outbreak Explained: What Is Pool Testing And Can It Expedite COVID-19 Detection In The Country?According to the Indian Council of Medical Research, 'Pool testing' for COVID-19 may help increase the testing capacity of the country. Experts explain how
Highlights
  • Pooling of more than 5 samples is not recommended: ICMR
  • Uttar Pradesh is the first state in the country to start pool testing
  • Pool Tests can help in saving testing kits and other lab resources

New Delhi: “We have a simple message for all countries – test, test, test,” said Dr. Tedros Adhanom Ghebreyesus, Director General at the World Health Organisation (WHO) last month while chairing the daily media briefing. Highlighting the importance of testing large number of people, he said that more test will enable identifying, isolating and treating the infected person and their contacts in order to protect the others from getting infected and thus breaking the chain of transmission of COVID-19. While WHO has urged the countries to conduct mass testing for coronavirus, short supply of testing kits has been a problem, as per experts. Therefore, in a bid to increase the number of samples tested using the limited testing kits available, experts and policymakers have called for ‘pool testing’ which was earlier used to detect large outbreaks and invisible community transmission, such as of Trachoma, HIV (Human Immunodeficiency Viruses), the virus that causes AIDS (Acquired Immunodeficiency Syndrome) and other communicable diseases. But what is pool testing and how effective is it likely to be? Experts explain all about it.

Also Read: What Is Herd Immunity And Can It Control The Coronavirus Pandemic?

What Is Pooled Testing?

Dr. Ramana Dhara, Professor at Indian Institute of Public Health (IIPH), Hyderabad explains pool testing as a process that involves swab samples from mucous membranes of the nose or throat of two to five persons are combined in a test tube and tested for SARS-CoV-2, the virus that causes COVID-19 using the real-time reverse transcription-polymerase chain reaction (RT-PCR) procedure. RT-PCR is used for detecting infection or the presence of specific genetic material from any pathogen or virus. If the result is negative, all individual samples in that pool are regarded as safe while if a pooled sample tests positive, each person in the pool is tested individually to find out who is affected.

According to a research paper published on the Bulletin of the WHO titled ‘Pooled-sample analysis strategies for COVID-19 mass testing: a simulation study’, pool testing can enhance pandemic surveillance in settings with low to moderate prevalence of infection. The authors of the paper, Andreas Deckert, Till Bärnighausen, and Nicholas Kyei of Heidelberg Institute of Global Health, Heidelberg University, Germany said that group sizes up to 25 samples in a population of 150 000 could be used for pool testing. However, the Indian Council of Medical Research (ICMR) suggests that not more than five samples should be pooled. Dr. Ambarish Dutta, Associate Professor, Indian Institute of Public Health (IIPH) Bhubaneswar, said that with a higher number of pooled samples there are higher possibilities of missing positive samples with a low viral load in the pool of negative dominant samples.

Also Read: Coronavirus Outbreak Explained: Why Is A Lockdown Important?

Pool Testing Can Help Overcome The Shortage Of Test Kits

Dr. Dhara asserted that pool testing helps in reducing the total number of testing kits used for testing communities. He said,

When there is a limited testing capacity, multiple samples are pooled and tested to save on the number of tests. It’s a community screening strategy which helps to implement timely infection control measures. It also saves a lot of resources — time, cost and manpower.

He also highlighted that if the viral load in an area increases which means the number of infected patients increases, then pool testing will not be as effective and individual testing needs to be done.

Therefore, the biggest drawback of the pool testing, according to Dr. Dhara is that it can be used only at those places where the infection rate is low. He also said that pool testing can miss individuals in whom the virus has not started developing yet.

Also Read: Coronavirus Outbreak Explained: What Is The Difference Between Pandemic And Epidemic?

Pool Testing In India

According to Dr. Rakesh Sahay, Endocrinologist and Diabetologist, and Professor at Osmania Medical College in Hyderabad, Uttar Pradesh (UP) and Andaman and Nicobar Islands are the first areas to start pool testing after the ICMR assessed the feasibility of this strategy and laid out an advisory about it. The feasibility study was conducted at ICMR’s Virus Research & Diagnostic Laboratory (VRDL) at King George’s Medical University (KGMU), Lucknow. The study demonstrated performing real-time PCR testing for COVID-19 with multiple samples (upto five) is feasible when the prevalence rates of infection are low. In its advisory, ICMR said,

Pool testing may also be used for community survey or surveillance among asymptomatic individuals, but is strictly prohibited in cases of individuals with known contact with confirmed cases and healthcare workers (in direct contact with the care of COVID-19 patients).

In the last 10 days, UP has ramped up its testing capacity because of pool testing technique. While the state was earlier criticised for not testing enough, is now testing more than 3,500 samples per day which is currently highest in the country, according to the Directorate of Medical and Health Services, UP. Chief Secretary of Andaman and Nicobar Islands Chetan B Sanghi tweeted recently.

According to Dr. Dhara, Maharashtra has recently received approval from the Central government for using pool testing and the states of Odisha, Rajasthan, West Bengal and Gujarat may soon follow, to increase testing and curb the spread of infection.

In the context of COVID-19, pool testing was proposed in Germany and Israel. The United States of America and Italy are also using pool testing strategy to increase testing.

According to Dr. Dhara, India urgently needs to scale up its testing in order to tackle the current pandemic. In India, testing has increased from 5,000 on April 1 to about 30,000 a day within three weeks, this number has to increase exponentially to find out if there is an undetected infection in the community. As of April 23, about five lakh samples have been tested, according to ICMR but this is not enough for a country with a population as big as more than 130 crore, say Dr. Sahay.

Also Read: Coronavirus Outbreak Explained: What Are The Different Stages Of COVID-19 Transmission

World

3,22,27,134Cases
90,11,771Active
2,22,32,414Recovered
9,82,949Deaths
Coronavirus has spread to 188 countries. The total confirmed cases worldwide are 3,22,27,134 and 9,82,949 have died; 90,11,771 are active cases and 2,22,32,414 have recovered as on September 25, 2020 at 3:43 am.

India

58,18,570 86052Cases
9,70,116 3734Active
47,56,164 81177Recovered
92,290 1141Deaths
In India, there are 58,18,570 confirmed cases including 92,290 deaths. The number of active cases is 9,70,116 and 47,56,164 have recovered as on September 25, 2020 at 2:30 am.

State & District Details

State Cases Active Recovered Deaths
DistrictCases
Akola757
Aurangabad1974
Dhule228
Jalgaon1039
Mumbai45478
Mumbai Suburban5363
Nagpur692
Nashik1575
Palghar1421
Pune9920
Satara629
Solapur1291
Thane13660
Yavatmal150
Ahmednagar190
Amravati291
Beed54
Bhandara41
Buldhana88
Chandrapur32
Hingoli208
Jalna201
Kolhapur646
Latur139
Nanded176
Nandurbar42
Parbhani78
Raigad1462
Ratnagiri350
Sangli145
Gadchiroli42
gondia69
Osmanabad125
Sindhudurg114
Wardha11
Washim13

1282963 19164

275404 1521

973214 17184

34345 459

DistrictCases
Chittoor319
Guntur511
Krishna557
Kurnool795
Sri Potti Sriramulu Nell*296
Anantapur428
East Godavari356
Prakasam104
Srikakulam183
Visakhapatnam103
West Godavari199
Y.S.R.205
Vizianagaram23

654385 7855

69353

579474 8807

5558 52

DistrictCases
Bengaluru Rural40
Bengaluru Urban529
Mysuru107
Bagalkote103
Ballari60
Belagavi337
Bidar219
Chikkaballapura149
Dakshina Kannada179
Dharwad61
Gadag45
Kalaburagi669
Mandya346
Tumakuru36
Uttara Kannada95
Vijayapura201
Chamarajanagara0
Chikkamagaluru19
Chitradurga14
Davangere204
Hassan205
Haveri24
Kodagu4
Kolar29
Koppal5
Raichur369
Ramanagara3
Shivamogga67
Udupi1176
Yadgir538

548557 7710

95568 897

444658 6748

8331 65

DistrictCases
North Goa57
South Goa69

30552 673

5822 176

24347 490

383 7

DistrictCases
Chengalpattu1314
Chennai23324
Kanchipuram503
Madurai322
Namakkal83
Ranipet133
Thanjavur130
Thiruvallur774
Thiruvarur67
Tiruppur116
Vellore71
Virudhunagar185
Ariyalur444
Coimbatore188
Cuddalore477
Dharmapuri15
Dindigul175
Erode75
Kallakurichi324
Kanniyakumari110
Karur88
Nagapattinam99
Perambalur133
Pudukkottai53
Ramanathapuram119
Salem258
Sivaganga46
Tenkasi103
The Nilgiris17
Theni129
Tiruchirappalli119
Tirunelveli433
Tirupathur45
Tiruvannamalai496
Tuticorin333
Villupuram509
Krishnagiri43

563691 5692

46405 156

508210 5470

9076 66

DistrictCases
Kannur357
Kottayam73
Alappuzha76
Idukki40
Kasaragod333
Kollam118
Kozhikode90
Malappuram119
Palakkad224
Pathanamthitta98
Thiruvananthapuram104
Thrissur106
Ernakulam60
Wayanad36

154456 6324

45993 3135

107850 3168

613 21

DistrictCases
Raipur46
Korba100
Balod41
Baloda Bazar85
Balrampur17
Bastar2
Bemetara21
Bijapur2
Bilaspur100
Dantewada0
Dhamtari6
Durg31
Gariyaband10
Janjgir-Champa56
Jashpur77
Kabirdham52
Kanker19
Kondagaon0
Korea39
Mahasamund54
Mungeli87
Narayanpur0
Raigarh47
Rajnandgaon52
Sukma0
Surajpur9
Surguja14

95623 2272

36038 188

58833 2060

752 24

DistrictCases
Hyderabad2475
MedchalMalkajgiri75
Ranga Reddy183
Suryapet87
Vikarabad40
Warangal Urban32
Adilabad22
Jagitial77
Jangoan8
Jayashankar Bhupalapally9
Jogulamba Gadwal40
Kamareddy11
Karimnagar17
Khammam26
Kumuram Bheem Asifabad8
Mahabubnagar30
Mancherial43
Medak11
Nalgonda33
Narayanpet3
Nirmal21
Nizamabad76
RajannaSircilla16
Sangareddy26
Bhadradri Kothagudem5
Mahabubabad10
Mulugu3
Nagarkurnool8
Peddapalli5
Siddipet7
Wanaparthy1
Warangal Rural4
YadadriBhuvanagiri40

181627 2381

30387 350

150160 2021

1080 10

DistrictCases
Baleshwar190
Bhadrak137
Jajapur322
Dhenkanal36
Kalahandi33
Kendrapara164
Khordha238
Koraput16
Sundargarh102
Anugul26
Balangir129
Bargarh16
Boudh34
Cuttack155
Deogarh33
Gajapati61
Ganjam581
Jagatsinghapur91
Jharsuguda8
Kandhamal28
Kendujhar34
Malkangiri20
Mayurbhanj73
Nabarangpur2
Nayagarh86
Nuapada69
Puri103
Rayagada2
Sambalpur16
Sonepur29

196888 4340

35092 545

161044 3779

752 16

DistrictCases
Barwani60
Bhopal1880
Dewas140
Dhar132
East Nimar266
Gwalior211
Indore3839
Jabalpur276
Ujjain799
Agar Malwa15
Alirajpur3
Betul35
Burhanpur351
Chhindwara16
Dindori29
Harda4
Hoshangabad37
Khargone196
Mandsaur112
Morena109
Raisen71
Ratlam51
Sagar228
Shajapur39
Shandol14
Sheopur26
Tikamgarh18
Vidisha37
Anuppur22
Ashoknagar13
Balaghat9
Bhind87
Chhatarpur35
Damoh26
Datia12
Guna8
Jhabua14
Katni3
Mandla15
Narsinghpur17
Neemuch319
Niwari0
Panna20
Rajgarh31
Rewa39
Satna24
Sehore12
Seoni2
Shivpuri15
Sidhi17
Singrauli13
Umaria10

115361 2304

22744

90495 2327

2122 45

DistrictCases
Ahmadabad17125
Anand107
Arvalli134
Banas Kantha147
Bhavnagar146
Gandhinagar410
PanchMahals107
Surat2311
Vadodara1555
Bharuch56
Botad55
Chhotaudepur37
Dang5
Dohad43
GirSomnath45
Jamnagar63
Kachchh99
Kheda98
Mahesana159
Mahisagar125
Narmada25
Naysari35
Patan105
Rajkot135
SabarKantha101
Surendranagar55
Tapi6
Valsad47
Amreli16
DevbhumiDwarka22
Junagadh31
Morbi4
Porbandar11

128787 1408

16327

109079 1505

3381 14

DistrictCases
Ajmer379
Banswara91
Bharatpur563
Jaipur2177
Jhalawar329
Jodhpur1748
Kota503
Nagaur500
Alwar90
Barmer34
Bhilwara250
Bikaner112
Chittorgarh188
Churu81
Dausa61
Dholpur60
Dungarpur374
Hanumangarh31
Jaisalmer53
Jhunjhunu64
Karauli17
Pali352
Rajsamand140
SawaiMadhopur26
Sikar231
Tonk171
Udaipur724
Baran59
Bundi5
Ganganagar8
Jalore164
Pratapgarh14
Sirohi130

122720 1981

18993 1

102330 1965

1397 15

DistrictCases
Faridabad867
Sonipat404
Ambala93
Bhiwani60
CharkiDadri43
Fatehabad38
Gurugram2950
Hisar98
Jhajjar114
Jind38
Kaithal48
Karnal104
Kurukshetra55
Nuh68
Palwal120
Panchkula39
Panipat78
Rohtak145
Sirsa50
Yamunanagar19
Mahendragarh47
Rewari56

118554 1698

18889

98410 2063

1255 22

DistrictCases
Agra933
Aligarh215
Amroha80
Bareilly17
Bijnor157
Bulandshahr166
Firozabad190
Gautam Buddha Nagar1119
Kanpur Nagar286
Lucknow386
Mathura129
Meerut504
Moradabad252
Muzaffarnagar117
Rae Bareli78
Rampur203
Saharanpur298
Sant Kabeer Nagar132
Varanasi243
Auraiya37
Ayodhya120
Azamgarh138
Baghpat68
Bahraich73
Balrampur49
Banda27
Basti214
Bhadohi60
Budaun23
Etah52
Etawah46
Ghaziabad794
Ghazipur159
Gonda59
Gorakhpur166
Hapur225
Hardoi49
Jalaun41
Jaunpur194
Jhansi41
Kannauj69
Kasganj16
Kaushambi6
Mainpuri46
Mau48
Mirzapur22
Pilibhit15
Pratapgarh15
Prayagraj30
Sambhal116
Shamli40
Shravasti23
Sitapur32
Sultanpur97
Unnao42
Ambedkar Nagar92
Amethi206
Ballia60
Barabanki168
Chandauli38
Chitrakoot4
Deoria143
Farrukhabad36
Fatehpur3
Hamirpur3
Hathras43
Kanpur Dehat4
Kheri72
Kushi Nagar67
Lalitpur3
Maharajganj85
Mahoba3
Shahjahanpur25
Siddharth Nagar159
Sonbhadra10

374277 4591

61300

307611 4922

5366 67

DistrictCases
Central4817
East2472
New Delhi3405
North3059
North East1914
North West5463
Shahdara1580
South2329
South East2446
South West2391
West4768

260623 3834

31125 289

224375 3509

5123 36

DistrictCases
Dhubri30
Goalpara19
Marigaon50
Baksa14
Barpeta28
Biswanath16
Bongaigaon12
Cachar80
Charaideo29
Chirang6
Darrang20
Dhemaji47
Dibrugarh61
Dima Hasao86
Golaghat203
Hailakandi57
Hojai89
Jorhat24
Kamrup42
Kamrup Metro276
KarbiAnglong13
Karimganj85
Kokrajhar37
Lakhimpur57
Majuli2
Nagaon143
Nalbari23
Sivasagar20
Sonitpur27
South SalmaraMancachar4
Tinsukia84
Udalguri28
West KarbiAnglong5

165582 2091

29830

135144 2432

608 11

DistrictCases
East District3
North District0
South District3
West District0

2692 64

607 32

2054 31

31 1

DistrictCases
Buxar134
Gaya115
Munger188
Patna279
Rohtas256
Arwal52
Aurangabad75
Banka134
Begusarai243
Bhagalpur266
Bhojpur103
Darbhanga143
Gopalganj123
Jehanabad178
Kaimur (bhabua)105
Lakhisarai72
Madhepura82
Madhubani199
Nalanda123
Nawada122
PurbiChamparan138
Purnia135
Saran101
Siwan139
Vaishali87
Araria68
Jamui47
Katihar175
Khagaria253
Kishanganj75
Muzaffarpur96
Pashchim Champaran57
Saharsa88
Samastipur139
Sheikhpura118
Sheohar20
Sitamarhi73
Supaul87

174071 1217

13015 57

160178 1156

878 4

DistrictCases
24 Paraganas North1031
24 Paraganas South281
Darjeeling97
Howrah1435
Jalpaiguri88
Kalimpong18
Kolkata2777
Maldah235
Medinipur East153
Medinipur West159
Hooghly604
Murshidabad125
Nadia139
Paschim Bardhaman70
Purba Bardhaman130
Alipurduar39
Bankura116
Birbhum206
Coochbehar210
Dinajpur Dakshin50
Dinajpur Uttar216
Jhargram9
Purulia66

237869 3196

25221 120

208042 3014

4606 62

DistrictCases
South Andamans33
Nicobars1
North And Middle Andaman1

3744 32

189 23

3503 9

52

DistrictCases
Pondicherry111
Karaikal2
Mahe4
Yanam0

24895 668

5097 244

19311 418

487 6

DistrictCases
Anjaw0
Changlang31
Dibang Valley0
East Kameng0
East Siang1
Kamle0
KraDaadi0
KurungKumey0
Leparada0
Lohit3
Longding0
Lower Dibang Valley0
Lower Siang0
Lower Subansiri0
Namsai2
PakkeKessang1
Papum Pare8
Shi Yomi0
Siang0
Tawang1
Tirap0
Upper Siang1
Upper Subansiri0
West Kameng0
West Siang1

8416 283

2331 115

6071 168

14

DistrictCases
Dimapur20
Kiphire3
Kohima7
Longleng0
Mokokchung0
Mon8
Peren2
Phek1
Tuensang3
Wokha0
Zunheboto0

5730 59

1088

4626 90

16

DistrictCases
Dadra And Nagar Haveli20

2977 15

190

2785 30

2

DistrictCases
Ranchi148
Bokaro16
Deoghar5
Dhanbad32
Garhwa80
Giridih19
Hazaribagh110
Jamtara2
Koderma58
Simdega48
Chatra1
Dumka5
East Singhbum170
Godda2
Gumla28
Khunti10
Latehar14
Lohardaga8
Pakur4
Palamu27
Ramgarh75
Sahebganj0
SaraikelaKharsawan20
West Singhbhum21

76438 1349

12841

62945 1386

652 4

DistrictCases
Gomati74
North Tripura14
Dhalai196
Khowai24
Sepahijala174
South Tripura53
Unakoti49
West Tripura45

24130 341

6378

17487 509

265 5

DistrictCases
Kargil77
LehLadakh43

3969 36

1022

2893 49

54 3

DistrictCases
Anantnag395
Bandipora175
Shopian255
Srinagar300
Baramulla271
Budgam110
Ganderbal37
Jammu138
Kathua53
Kulgam295
Kupwara231
Rajouri39
Ramban151
Reasi26
Samba25
Udhampur155
Mirpur0
Muzaffarabad0
Doda27
Kishtwar10
Poonch35
Pulwama108

68614 1104

19451

48079 1549

1084 22

DistrictCases
Chamba29
Hamirpur117
Kangra105
Sirmaur11
Solan32
Una41
Bilaspur21
Kinnaur2
Kullu4
Lahaul And Spiti0
Mandi21
Shimla10

13386 337

3984 34

9252 293

150 10

DistrictCases
Jalandhar297
Ludhiana293
Patiala132
Amritsar485
Barnala25
Faridkot74
Firozepur50
Gurdaspur154
Hoshiarpur140
Kapurthala44
Mansa31
Moga65
Pathankot86
S.A.S Nagar137
Sangrur107
Shahid Bhagat Singh Nagar (Nawanshahr)99
Sri Muktsar Sahib71
Tarn Taran163
Bathinda60
Fatehgarh Sahib57
Fazilka53
Rupnagar (Ropar)74

105220 1756

20679

81475 2231

3066 76

DistrictCases
Haridwar94
Dehradun370
Nainital323
Almora71
Bageshwar31
Chamoli36
Champawat45
PauriGarhwal36
Pithoragarh43
Rudraprayag30
Tehri Garhwal110
Udam Singh Nagar83
Uttar Kashi24

44404 684

11507

32355 1031

542 13

DistrictCases
Bishnupur7
Chandel5
Churachandpur32
Imphal East10
Imphal West21
Jiribam3
Kakching2
Kamjong5
Kangpokpi26
Noney1
Pherzawl3
Senapati6
Tamenglong2
Tengnoupal9
Thoubal18
Ukhrul4

9537 161

2106

7369 261

62

DistrictCases
Chandigarh313

10968 242

2482

8342 293

144 4

DistrictCases
East Khasi Hills22
East Garo Hills0
East Jaintia Hills0
North Garo Hills1
Ribhoi0
South Garo Hills0
South West Garo Hills4
South West Khasi Hills0
West Garo Hills5
West Jaintia Hills1
West Khasi Hills1

5078 117

1977

3058 199

43 1

DistrictCases
Aizawl10
Champhai0
Hnahthial0
Khawzawl0
Kolasib11
Lawngtlai2
Lunglei2
Mamit8
Saiha0
Saitual1
Serchhip0

1786 73

681 63

1105 10

0

DistrictCases
Lakshadweep District0

0

0

0

0

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