Can the non-inclusivity of asymptomatic individuals in national testing guidelines be questioned?
With the opening of nationwide lock-downs, the intra population movement is on an exponential rise. Although existing government guidance on COVID 19 testing is thorough to include all symptomatic individuals, and effective surveillance and contact tracing practices are being followed. This initial strategy was justified due to initial similarities between SARS CoV 1 and SARS CoV 2, including high genetic relatedness, transmission primarily through respiratory droplets, and the frequency of lower respiratory symptoms with both infections having a mean period of 5 days for the development of symptoms. However, the trajectories of both infections took a drastic turn, where SARS CoV 2 demonstrated a much greater population transmission potential.
The key factor in the transmissibility of SARS CoV2 is the high level of viral shedding (the successful release of live virus) in the upper respiratory tracts. For infections such as influenza, asymptomatic persons have much lower viral shedding from the upper respiratory tract and shorter duration of viral shedding, which lowers the population transmission rates.
In the case of SARS CoV 2, researchers have discovered a high percentage of viable virus in culture 1 to 6 days prior to onset of symptoms.
How can the national efforts for COVID 19 containment be further improved?
Stage-wise implementation of mandatory asymptomatic personnel screening using RT PCR testing.
Stage 1: Clinical personnel
Stage 2: Travellers (mandatory for all individuals taking flights, buses and trains between states). All passengers must receive an OK to board clearance based on the results of the RT PCR. The availability of cost-effective RT PCR testing priced at INR 1000 is critical for the large-scale integration of testing into the aviation sector (so that both passengers and airlines can jointly bear the cost of testing).
Stage 3 (Very Critical) Deployment of A.I. enabled citizen tracking and risk classification solution (Aarogya Setu V 2.0) that is #1 mandatory for all citizens, and #2 engages in more stringent movement tracking using GPS to feed the A.I. systems with data points critical to enable precise contact tracing and precision targeting of sample collection and diagnostic resources for medium to high risk asymptomatic citizens. The citizens of our nation need to measure which is the lesser of two evils, loss of temporary privacy under the disaster management act or massive economic slowdown/starvation?
Finally, our nation certainly has the resources to test, manufacture and develop smart IT solutions that can effectively track and target asymptomatic COVID 19 cases on a population scale.