Low levels of testing are hampering our Covid response

It has been more than a year since Covid-19 was first detected in Bangladesh. Much has been, and continues to be, said about the country's handling of the pandemic. From the perplexing policies on "strict" lockdowns and "lockdown lite" to the lack of enforcement of health guidelines, experts have cried hoarse about it all. But one aspect that is unfortunately absent from the conversation is Bangladesh's dismally low levels of Covid-19 testing. Although there was some talk about the low testing rates during the first few months after the virus was detected, now more than a year later, the critical issue of bare minimum testing rates seems to have faded into oblivion.

One does not have to be a public health expert or biostatistician to understand the problem at hand. In a country with a population of over 160 million, anywhere between 25,000 and 30,000 samples are being tested each day. This is a drop in the ocean. It is true that testing rates all over the world are sub-par and Bangladesh is not alone. But there is an urgent need to acknowledge that this is a serious obstacle in our Covid-19 response.

According to the Covid-19 dataset compiled by Our World in Data (which, by the way, is an excellent repository of global Covid-19 stats), Bangladesh is trailing its South Asian neighbours India, Nepal and Pakistan when it comes to new tests per thousand population. As per the latest figures (April 25-26) presented by Our World in Data, India is conducting 1.016 new tests per 1,000 people each day; Nepal 0.319; and Pakistan 0.227. Bangladesh is carrying out 0.157 new tests per 1,000 people. Developed countries with high figures for new daily tests per thousand population include the United Kingdom (21.768) and United Arab Emirates (25.9).

Most people seem to gloss over the little detail about the number of tests presented in the daily government briefings regarding Covid-19 cases. But there are a number of reasons (some quite obvious) why testing rates are so important. Firstly, with more testing, more Covid-positive cases will be detected. Patients can then be identified, isolated and treated. Without enough testing, we risk Covid-positive individuals going undetected, roaming free and unknowingly spreading the virus.

Secondly, low testing rates lead to low number of identified cases which in turn significantly influences health behaviours. People without adequate health literacy (the majority of the population) do not critically look at the official number of Covid-19 cases that are released every day through a scientific lens. They blindly rely on these figures to understand the spread of the virus. So, when they see "low" numbers of Covid-19 cases being detected, the message they receive is that the Covid-19 situation is "under control". This no doubt negatively influences people's overall health behaviour and demotivates them to adhere to health guidelines. This explains why weddings and social gatherings had resumed early this year, when Bangladesh was recording lows of 200 and 300-something cases (in February). All this must also be viewed within our cultural context where people are inherently social in nature and generally lack health consciousness.

In an article published in the website of the Johns Hopkins Bloomberg School of Public Health, the authors, both professors of epidemiology at Bloomberg School, explain the significance and implications of "percent positive" and inadequate testing. "Percent positive", quite simply, indicates the percentage of all tests that turned out to be positive. A higher percent positive points to higher transmission and suggests that there are likely more infected people who have not been tested yet. Lack of testing, on the other hand, means that the virus is spreading silently, increasing the possibility of larger outbreaks that will be hard to contain in the future. So while it is reasonable to rely on the positivity rate to understand how widespread the virus is, it is not a substitute for increased testing.

Even less attention is being given to who is being tested and where. Data on district-wise daily number of tests are not available; neither are- disaggregated data, by income and location, of those who have been tested and have tested positive. This would have given us a clearer picture of who is being tested and where, which socioeconomic groups the majority of infected people belong to, and more importantly, which groups are being left out of Covid-19 testing. One can't help but wonder how the absurd idea that the poor in Bangladesh have "immunity against corona" originated. Such unscientific claims are being spewed by even the educated sections of society. Could it be due to the lack of testing and therefore lack of detected cases among these low-income groups?

There is an urgent need to ramp up Covid-19 testing across the country. This is necessary not only to detect cases silently spreading the virus at a time when the country is well into its second wave, but also to create a strong evidence base to formulate well-thought-out strategies of containment of the virus. Data matters. Lack of proper data, as a result of low levels of testing, creates misconceptions about the spread of the virus and disincentivises people from taking preventative health measures. We must also play our part and continue to emphasise the importance of maintaining health guidelines to those we come into contact with, regardless of what the official figures say.

This is not the time to let a false sense of security set in.

Nahela Nowshin is a doctoral student at McMaster University, Canada.