COVID-19 testing in mild cases not necessary, may drive panic, say top virologists

China Covid-19 Crisis

Top virologists associated with the Indian Academy of Science have said that in a country like India carrying out COVID-19 testing on all suspects or mild upper respiratory infections may dilute the efforts to test in high-risk groups, who need particular attention.

“If testing of asymptomatic and mild cases is encouraged, case numbers of Covid-19 will rise, which may drive panic and dilute resources,” said an advisory issued by the academy. “Therefore, the emphasis should be upon the testing of all severe acute respiratory infections (SARI) cases particularly in high-risk groups”.

Incidentally, the advisory which was circulated among the academy members came a day before the Union health ministry released results of COVID-19 tests carried out on international passengers in India since December 24 when random sampling of 2 percent of passengers in every flight had begun in the wake of rising coronavirus cases in China.

The details shared by the ministry on January 5 said that 124 of the 19,227 passengers who were tested upon arrival in India between December 24 and January 3 had tested positive for COVID-19.

Samples from all the positive patients were then subjected to whole genomic sequencing, as part of the Centre’s effort to step up COVID-19 surveillance, and the reports of 40 samples so far have confirmed the presence of 11 different Omicron sub-variants.

“Majority of these sub-variants have been present in India for the last several months, so at the moment we do not see any reason to worry even though constant vigil is required,” said a senior official in the health ministry. “Also, all 124 positive patients had been isolated and none of them has been found to have severe disease.”

The advisory by the academy drafted by Dr Gagandeep Kang, who is associated with the Christian Medical College, Vellore, and Dr V Ravi, a neurovirologist with the National Institute of Mental Health and Neurosciences, stressed that although local flare-ups of infection may happen, COVID-19 will be endemic and will continue to cause respiratory tract infections along with other circulating respiratory pathogens.

“Hence the focus for testing should not just be for Covid but should include other respiratory viruses that can cause severe acute respiratory infections such as Influenza and Respiratory Syncytial Virus, especially in high-risk groups,” it said.

Also read | As testing rises 3-fold, COVID-19 cases in India register slight increase

In India, where the population has been extensively exposed and vaccinated, it added that testing all suspects or mild upper respiratory infections may dilute the efforts to test in high-risk groups, who need attention based on specific etiology.
Omicron sub-variants are dominating now

The World Health Organization has “Omicron sub-variants under monitoring” as a category that includes BA.2.75, BA.4.6, XBB, BA.2.3.20 and sub-lineages of BA.5 (BF.7 and BQ.1).

“Since Omicron infections are not more severe than previously seen variants, the increased immune evasion of XBB is not a major concern in previously infected or vaccinated generally healthy individuals, but its evolution and spread should continue to be tracked,” said the advisory.

‘No need for boosting for all'

COVID-19 vaccine booster doses may have only limited benefits for younger people, the advisory said but added that this does not mean that boosters may not be needed in the future.

“Data that are generated on new variants, on antibodies waning by age and by the vaccine will help future decisions on boosting,” it stressed.

A fourth dose may have a minimal incremental benefit in some vulnerable people in India but is not accessible in the country at this time, the academy said.

Sources in the ministry, meanwhile, said there was no consideration at this point to allow those who have taken their booster COVID-19 shots to take a fourth one.

In India, less than 30 percent of the eligible population—those aged above 18 years—has received boosters so far and despite the worries following the COVID-19 spike in China, the uptake of precautionary doses in the country has been low.

Also read | MC Explains | Why COVID-19 is spiking in China and whether you should be worried

There was a brief rise in demand for booster shots during December 24-28 last year, shows the government figures, but after that, this number has consistently fallen again.

Indian Medical Association, the largest body of doctors in the country, has asked the government to permit healthcare practitioners to receive fourth COVID-19 shots, or second booster doses, saying that the protective effect of vaccines lasts only 9 months to one year.

But many experts say there is no concrete evidence to suggest the benefit of a second booster even though many countries have done that.