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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

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

24,20,23,922Cases
20,36,06,535Active
3,34,95,808Recovered
49,21,579Deaths
Coronavirus has spread to 195 countries. The total confirmed cases worldwide are 24,20,23,922 and 49,21,579 have died; 20,36,06,535 are active cases and 3,34,95,808 have recovered as on October 21, 2021 at 4:33 am.

India

3,41,27,450 18,454Cases
1,78,831 733Active
3,34,95,808 17,561Recovered
4,52,811 160Deaths
In India, there are 3,41,27,450 confirmed cases including 4,52,811 deaths. The number of active cases is 1,78,831 and 3,34,95,808 have recovered as on October 21, 2021 at 2:30 am.

State Details

State Cases Active Recovered Deaths
Maharashtra

65,96,645 1,825

29,333 1,075

64,27,426 2,879

1,39,886 21

Kerala

48,79,790 11,150

83,333 2,476

47,69,373 8,592

27,084 82

Karnataka

29,84,484 462

9,103 26

29,37,405 479

37,976 9

Tamil Nadu

26,90,633 1,170

14,058 268

26,40,627 1,418

35,948 20

Andhra Pradesh

20,61,810 523

5,566 88

20,41,924 608

14,320 3

Uttar Pradesh

17,10,058 11

112 6

16,87,048 17

22,898

West Bengal

15,82,813 867

7,491 63

15,56,315 795

19,007 9

Delhi

14,39,466 25

310 12

14,14,066 37

25,090

Odisha

10,36,532 559

4,387 106

10,23,849 451

8,296 2

Chhattisgarh

10,05,735 34

185 3

9,91,979 36

13,571 1

Rajasthan

9,54,393 1

38 0

9,45,401 1

8,954

Gujarat

8,26,340 14

176 9

8,16,077 22

10,087 1

Madhya Pradesh

7,92,709 9

82 3

7,82,104 6

10,523

Haryana

7,71,116 15

133 7

7,60,934 8

10,049

Bihar

7,26,036 3

30 12

7,16,345 15

9,661

Telangana

6,69,556 191

3,968 28

6,61,646 162

3,942 1

Assam

6,07,427 308

3,610 25

5,97,859 282

5,958 1

Punjab

6,02,113 32

232 16

5,85,331 15

16,550 1

Jharkhand

3,48,486 25

142 14

3,43,209 11

5,135

Uttarakhand

3,43,773 8

176 1

3,36,199 6

7,398 1

Jammu And Kashmir

3,31,299 78

800 3

3,26,070 80

4,429 1

Himachal Pradesh

2,21,936 110

1,394 46

2,16,815 64

3,727

Goa

1,77,706 47

597 23

1,73,755 70

3,354

Puducherry

1,27,521 42

461 29

1,25,208 71

1,852

Manipur

1,22,970 71

1,360 2

1,19,706 66

1,904 3

Mizoram

1,15,207 741

10,263 505

1,04,548 1,243

396 3

Tripura

84,351 2

95 7

83,440 9

816

Meghalaya

83,158 79

761 21

80,958 58

1,439

Chandigarh

65,312 2

24 1

64,468 3

820

Arunachal Pradesh

55,043 12

138 7

54,625 19

280

Sikkim

31,800 17

175 6

31,232 22

393 1

Nagaland

31,659 18

255 8

30,728 10

676

Ladakh

20,886 3

34 0

20,644 3

208

Dadra And Nagar Haveli

10,676

2 2

10,670 2

4

Lakshadweep

10,365

0 0

10,314

51

Andaman And Nicobar Islands

7,646

7 1

7,510 1

129

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