Testing times: The only way to fight corona is through rigorous testing.

Byline: Haris Gazdar

TESTING is the starting point of most scientific conversations about Covid-19. Public health systems in Pakistan have been rightly focused on addressing the supply side - the availability and deployment of testing capacity. Nationally, we are able to do 10,000 tests daily, and this number is not yet rising rapidly enough to support us through any post-lockdown strategy. Even as we increase testing capacity, a critical issue remains neglected: who actually gets tested? This question requires urgent answers and redress if we are to have a realistic chance of containing the spread of the virus post-lockdown, and ensuring that there is sufficient critical care available for those who will require it.

On paper, 'who actually gets tested' depends on a combination of two processes: who asks for a test, and of those who ask, who qualifies to be tested. The easier one first: who qualifies for a test? Tests are rationed everywhere in the world. Some people such as travellers from outside the country are subjected to mandatory testing. For the rest, there are guidelines that are issued nationally for identifying and testing suspected cases. A person may qualify as a 'suspected case' depending on her or his symptoms, travel and contact history, and occupation (e.g. health workers). According to National Institute of Health data, there were over 25,000 more tests conducted nationally than there were 'suspected cases'. These were paid for privately by individuals, and may not have conformed to guidelines, and their number has declined in the last two weeks.

Now the more difficult question: who asks for a test, and why? Testing strategy depends on individuals coming forward and identifying themselves as possible suspected cases. How sound is the assumption that suspected cases will come forward?

Viability of any post-lockdown containment strategy depends on catching symptomatic cases early, and then tracing others with contact history

This question is less critical in functioning public health systems such as the National Health Service in the UK where there are established norms in the population of referring to public health services in the event of any health-related contingency. What about a situation in countries like Pakistan where individuals are not linked with public health services?

The private sector is the predominant supplier of a wide range of services, including hospital care for a majority of the population, and there...