India’s Prime Minister, Narendra Modi, has pledged to ramp up testing to one million per day over the next few weeks to tackle one of the world’s worst outbreaks of the coronavirus.
But can he achieve this, and are the tests being used reliable?
How much testing is India doing now?
At the start of August, around half a million tests were being carried out each day across India on a week’s average, according to the international comparison site, Our World in Data. Daily figures released by the Indian government are slightly higher than this.
This is a large number but should be put in the context of the size of India’s population.
It carries out around 36 tests each day for every 100,000 people. In comparison, the figure for South Africa is 69, for Pakistan it’s eight, and for the United Kingdom it’s 192.
Prime Minister Modi’s ambition is to double this number to achieve a million tests each day for a country with a population of more than 1.3 billion.
What kind of tests is India using?
While boosting testing is regarded as a key part of the battle against the coronavirus, it’s the type of testing which experts say is causing concern.
The one that’s been most commonly used globally is a PCR (polymerase chain reaction) test, which isolates genetic material from a swab sample.
Chemicals are used to remove proteins and fats from the genetic material, and the sample is put through machine analysis.
These are regarded as the gold standard of testing, but they’re the most expensive in India and take up to eight hours to process the samples. To produce a result may take up to a day, depending on the time taken to transport samples to labs.
In order to increase its testing capacity, the Indian authorities have been switching over to a cheaper and quicker method called a rapid antigen test, more globally known as diagnostic or rapid tests.
These isolate proteins called antigens that are unique to the virus, and can give a result in 15 to 20 minutes.
But these tests are less reliable, with an accuracy rate in some cases as low as 50%, and were originally meant to be used in virus hotspots and healthcare settings.
It is worth noting that these tests only tell you if you are currently infected and are different from antibody tests that tell you if you were infected in the past.
India’s top medical research body, the Indian Council of Medical Research (ICMR), has approved the use of three antigen tests developed in South Korea, India and Belgium.
But one of these was independently evaluated by the ICMR and the All Indian Institute of Medical Sciences (AIIMS), which found that their accuracy in giving a true negative result ranged between 50% and 84%.
“The antigen test will miss more than half of truly infected cases,” Professor K Srinath Reddy, of the Public Health Foundation of India told the BBC.
This can be for various reasons like the swab sample wasn’t good enough, the viral load in the person or even the quality of the testing kit.
The ICMR had issued guidelines saying those with negative results from an antigen test should also get a PCR test if they show symptoms, to rule out a false negative.
Are rapid tests recommended globally?
Rapid or diagnostic tests may or may not use antigens in detecting the virus.
In the UK, the most common type of rapid test has an error margin of 20% for giving false negative results.
But the rapid test kits developed by Oxford Nanopore are said to pick up 98% positive cases, although that needs independent checking by researchers and health experts.
Both these rapid tests use genetic material, not antigens, hence are more reliable.
The United States is vying to develop such diagnostic kits you could buy at a store, swab your nose or saliva and get the results within minutes, like pregnancy test kits.
But the FDA guidelines for approval of such kits say that their performance has to be nearly as good as lab tests.
The US is already using antigen test kits by BD and Quidel which have a sensitivity of 71% and 81% respectively, higher than those used in India.
Are Indian states missing coronavirus cases?
Many Indian states, which decide their own testing protocols, have been increasingly turning to the rapid antigen test.
ICMR announced on 4 August that up to 30% of the total tests conducted in the country were antigen tests.
Delhi was the first state to begin antigen-based testing in June, and many other states followed suit. It began using them on 18 June, although there is no data publicly available until 29 June.
We’ve looked at data from 29 June to 28 July, which shows Delhi conducted a total of 587,590 tests, of which 63% were antigen tests.
Delhi has boosted antigen testing
But the available data shows that less than 1% of those who tested negative in an antigen test went on to have a PCR test, and 18% of those who did tested positive.
The recorded infection rate in the capital has fallen in recent weeks, but experts suggest that could be because many cases have been missed.
The authorities have now asked testing centres to conduct more PCR tests.
But data shows that more than 50% of the tests conducted are still antigen tests, despite the Delhi High Court’s order that it should be used only in hotspots and healthcare settings.
The southern state of Karnataka started using antigen tests in July, aiming for 35,000 a day across 30 districts. Although they haven’t been able to achieve the target, the number of antigen tests has been going up, and the number of PCR tests coming down.
Karnataka ramps up antigen tests
Available data suggests that in the last week of July, 38% of those who initially tested negative but had symptoms and then took a PCR test, came out positive.
In Telangana state, the government also ramped up antigen testing in July.
Although the state does not provide daily data on how many PCR and antigen tests are conducted, there are currently only 31 government and private labs equipped to do PCR tests, as against 320 government facilities for antigen tests.
India’s worst affected state, Maharashtra, first began antigen tests in Mumbai. The city’s municipal corporation reported that 65% of those who had symptoms of Covid-19 tested negative in the antigen test, but went on to be positive in a PCR test.
Dr Anupam Singh, a public health expert, says there are some advantages to the rapid tests: “It allows a faster detection process and means you can quickly detect highly infectious individuals with a high viral load who might be so-called super-spreaders.”
But he also has concerns about this strategy, which can potentially miss many infections.
“As PCR testing requires higher investment and resources, the authorities have switched to a focus on reducing deaths, and catching highly infectious people – the low-hanging fruits,” says Dr Singh.
So the switch to rapid antigen testing may satisfy performance targets and meet public demand for more testing.
But it runs a real risk of not revealing the true extent of the outbreak – unless it’s backed up by continued PCR testing.
A Former Government Minister Is Leading Calls By Tory MPs For Boris Johnson Not To Put The Country Back Into Lockdown
5 min read
The former minister Simon Clarke is leading calls by Tory MPs for the country not to be put back into a full lockdown amid a surge in coronavirus cases.
The Middlesborough MP made a “plea for proportionality” to Matt Hancock in his first contribution to the Commons since standing down as a local government minister earlier this month.
Speaking to PoliticsHome he said: “I’ve seen constituents commit suicide during the first lockdown. When you get those emails it’s quite sobering about the human cost about what it is that we’re demanding of people.
“And it made me reflect that we should lever do so lightly, and that frankly if there are intervening measures before we get to those – then I would strongly hope we would exhaust all of them.”
Speaking ahead of a statement by Boris Johnson on Tuesday, where he is expected to introduce tighter restrictions to prevent the spread of Covid-19, Mr Clarke warned: “there are very, very significant economic tradeoffs” to such measures.
He is calling for a “graduated tradeoff” of freedom “rather than fire off all our artillery now”, adding it will be “a very long winter if we moved into lockdown now”.
Although he is in favour of local lockdowns he added: “But I just think a suite of national measures which set the economy even further back, and really do impose massive restrictions on people’s quality of life, are to be avoided as such time as they are totally unavoidable.”
Mr Clarke urged his former colleagues to “maintain fundamental liberty for people at this stage of autumn” after suggestions it may take six months to tackle the virus.
With the ‘rule of six’ only recently introduced he called for “other rules kick in before preventing households to mix”, saying “things which cut across basic human freedoms and basic human needs are to be avoided until they are an absolute last-ditch option”.
A growing number of Tory MPs have also expressed concern over what they see as a growing lack of parliamentary scrutiny over Coronavirus legislation.
Peter Bone MP told PoliticsHome: “I think there’s a growing number of MPs who think you shouldn’t be making these significant regulations without parliamentary approval.”
He said the powers were handed over via emergency legislation but it was when there wasn’t “a functioning Parliament”, at the time, and MPs should not get a chicane to defat, amend and vote on them.
As an example he said the “rule of six” would likely have still been passed, but perhaps amended not to include children or a month-long sunset clause.
Asked whether Number 10 had been ignoring its own MPs, Mr Bone said: “Well I think they get used to it, they got used to in an emergency just doing it ,and they’ve continued. There is a drift within government to a more presidential type of government.
Clarke’s call to avoid lockdown was backed up in the Commons by the ex-transport secretary Chris Grayling, who said he did not believe there is a case for a new national lockdown.
He told the Commons: “Given the huge consequences of this virus for people in our communities on their mental health, particularly the younger generation who are paying a very heavy price, can I say to him that given those regional variations – and in the full knowledge of all the pressures that he is facing – I do not believe the case for further national measures has yet been made.”
Mr Hancock replied: “He’s absolutely right that there are some parts of the country where the number of cases is still thankfully very low and so the balance between what we do nationally and what we do locally is as important as the balance in terms of what we do overall.”
Another former minister – Sir Edward Leigh – said public consent for lockdowns is “draining away”.
Addressing the House of Commons, he said: “The trouble with authoritarianism is that’s profoundly inimical to civil liberties, it is also increasingly incompetent, it relies on acquiescence and acquiescence for lockdowns, particularly national ones, is draining away.
“If you tell a student not to go to a pub, they will congregate in rooms, even worse.”
Mr Hancock said in his reply: “As a Conservative, I believe in as much freedom as possible consistent with not harming others.”
But fellow Tory MP Pauline Latham called for more Parliamentary scrutiny of such decisions, saying: “Could I remind the Secretary of State, I think he’ll be going to a Cobra meeting tomorrow, could he explain to the Prime Minister that we actually live in a democracy not a dictatorship and we would like a debate in this House?”
Mr Hancock replied: “Yes, there absolutely will be a debate in this House on the measures… that we have to use. We do have to move very fast.”
The chairman of the 1922 Committee of Conservative backbenchers, Sir Graham Brady, then asked the minister if: “Balancing the measures to tackle Covid with the other health consequences such as cancer patients going undiagnosed or not treated in time and the economic and social consequences is a political judgment?”
He added: “And does he further agree with me that political judgments are improved by debate and scrutiny?”
Mr Hancock replied: “Yes I do and I do come to this despatch box as often as possible. I’m very sorry that I wasn’t able to come on Friday for Friday’s decision but the House wasn’t sitting.”
He added: “The more scrutiny the better is my attitude.”
GE: Industrial giant will stop building coal-fired power plants
In a dramatic reversal, one of the world’s biggest makers of coal-fired power plants is to exit the market and focus on greener alternatives.
US industrial giant General Electric said it would shut or sell sites as it prioritised its renewable energy and power generation businesses.
It comes ahead of a US Presidential election in which the candidates hold starkly different views on coal.
NGO the Natural Resources Defense Council said the move was “about time”.
GE has said in the past it would focus less on fossil fuels, reflecting the growing acceptance of cleaner energy sources in US power grids.
But just five years ago, it struck its biggest ever deal – paying almost £10bn for a business that produced coal-fuelled turbines.
In a statement, the firm suggested the decision had been motivated by economics.
Russell Stokes, GE’s senior vice president, said: “With the continued transformation of GE, we are focused on power generation businesses that have attractive economics and a growth trajectory.
“As we pursue this exit from the new build coal power market, we will continue to support our customers, helping them to keep their existing plants running in a cost-effective and efficient way with best-in-class technology and service expertise.”
US President Donald Trump has championed “beautiful, clean coal” at a time when other developed countries are turning away from polluting fossil fuels.
In a bid to revive the struggling US industry, Mr Trump has rolled back Obama-era standards on coal emissions. But it has not stopped the decline as cheaper alternatives such as natural gas, solar and wind gain market share.
GE said it would continue to service existing coal power plants, but warned jobs could be lost as a result of its decision.
The firm is already cutting up to 13,000 job cuts at GE Aviation, which makes jet engines, due to the pandemic.
In a tweet, the Natural Resources Defense Council said: “Communities and organizers have been calling on GE to get out of coal for years. This is an important and long overdue step in the right direction to protect communities’ health and the environment.”
China’s Xinjiang government confirms huge birth rate drop but denies forced sterilization of women
But CNN’s reporting found that some Uyghur women were being forced to use birth control and undergo sterilization as part of a deliberate attempt to push down birth rates among minorities in Xinjiang.
In its response, the Xinjiang government strongly denied the claims of genocide, arguing instead that the Uyghur population has been “growing continuously” during the past decade and that Zenz’s report was not “in line with the real situation in Xinjiang.”
According to the government, the population of Xinjiang rose by more than 3 million people, or almost 14%, between 2010 and 2018, with the Uyghur population growing faster than the region’s average rate.
“The rights and interests of Uyghur and other ethnic minorities have been fully protected,” the response said. “The so-called ‘genocide’ is pure nonsense.”
Birth rate plunges
But the government didn’t dispute the rise in sterilizations or the gap in the ratio of new intrauterine devices (IUDs) between Xinjiang and the rest of mainland China. While IUD implants have plunged in China overall, falling to just 21 per 100,000 people in 2018, in Xinjiang they are becoming increasingly common.
The Xinjiang government said in its response that the birth rate in the region had dropped from 15.88 per 1,000 people in 2017 to 10.69 per 1,000 people in 2018. The fax said that the drop was due to “the comprehensive implementation of the family planning policy.”
The Xinjiang government attributed the sudden drop in population to Beijing’s family planning policies finally being properly implemented in the region after 2017.
“In 2018, the number of newborns decreased by approximately 120,000 compared with 2017, of which about 80,000 were because of better implementation of family planning policy in accordance with law, according to estimates by the health and statistics department,” the response to CNN said. The government insisted that those who complied with the family planning policies did so voluntarily.
The government attributed the remaining 40,000 fewer babies to increased education and economic development, resulting in fewer children in the region. The Xinjiang government did not include the 2019 birth figures for the region.
“As a part of China, Xinjiang implements family planning policies in accordance with national laws and regulations, and has never formulated and implemented family planning policies for a single ethnic minority,” the response said.
But Zenz pointed out that changes to the natural birth rate should take place over several years or even a decade, not in the space of 12 to 36 months.
In reference to the government’s claims that compliance with the family planning policies were voluntary, Zenz questioned how likely it was that “17 times more women spontaneously wanted to be sterilized.”
“Han Chinese academics from Xinjiang have themselves written that the Uyghurs resist any type of contraceptive (and especially sterilization),” he said in a statement to CNN.
In their fax, the Xinjiang government also attacked Zenz personally, saying that he was “deliberately fabricating lies” and accused him of being a religious fanatic who believed he was “led by God” to oppose China.
Zenz dismissed the Chinese government’s allegations, saying they were “resorting to personal attacks” because they couldn’t disprove his research. “Far more egregious than these personal attacks on me are Beijing’s smears against the Uyghur witnesses,” he said in a statement.
Attacks on women
The Xinjiang government also zeroed in on claims made by two female Uyghurs quoted in CNN’s article — Zumrat Dawut and Gulbakhar Jalilova.
Dawut said she had been forced into sterilization by the local government in Xinjiang when she went to a government office to pay a fine for having one too many children. Dawut also said she had been in a detention center in Xinjiang for about three months from March 2018.
In their response, the government said that Dawut had never been inside a voluntary “education and training center,” the name used by the Chinese government for the alleged detention centers, and that she had signed a form agreeing to the procedure known as tubal ligation.
Jalilova claimed she suffered humiliation and torture while inside the camps and said she was raped by one of the guards.
The Xinjiang government confirmed Jalilova’s claims that she had been detained for 15 months from May 2017, alleging she was arrested “on suspicion of aiding terrorist activities.” In August 2018 she was released on bail, after which she returned to Kazakhstan.
In their statement, the government denied that Jalilova had been raped or tortured, saying that all of her “rights were fully guaranteed” and the staff who were in her cell could prove it.
When asked to respond to the Chinese government’s statement, Jalilova stood by her claims and demanded the Xinjiang authorities provide their proof. “Why don’t they show a video? Why don’t they show a photo during my time in prison showing that I was well fed and not beaten. The cameras were working 24 hours,” she said.
“I am a citizen of Kazakhstan, what right did they have to detain me for a year and a half?”
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