Donald Trump snaps at WHO and India quietly sidestepped some of its advisories on virus

GS Paper III

Topic: Science and Technology

Prelims: Rapid Antibody-based Test

Mains: Dangers associated with Rapid Antibody-based Test

What’s the News?

The public snub to the World Health Organisation (WHO) and a threat to cut its funding is characteristic of Donald Trump, and may not find an echo in New Delhi.

Indian Government Reaction in contrary to WHO recommendation:

  • The government has politely sidestepped the periodic “advice” from the WHO and, instead, leaned on the Indian Council of Medical Research (ICMR) and the experience of several state governments — from Kerala and Uttar Pradesh to Rajasthan and Maharashtra.
  • This despite the fact that the WHO has been, like with immunisation, TB and other neglected tropical diseases, closely working with the Centre and states on the novel coronavirus outbreak, and its staff are helping state governments ramp up training and capacity-building.

Divergence between Indian government and WHO:

  • Most recently, on April 3, the government’s advisory on the use of masks while stepping out of the house was at variance with that of the WHO, which said this should be only for those who are symptomatic, health workers, or caregivers to COVID patients.
  • On January 30, WHO Director General Tedros Adhanom Ghebreyesus said that WHO did not recommend travel restrictions to China — in fact, it was opposed to such an idea. This despite the fact that the same day, the WHO’s International Health Regulations Emergency Committee raised a global alert on the need for containment, surveillance, detection, isolation, and even contact tracing. By this time, India’s first advisory on avoiding non-essential travel to China dated January 25, was already in place.
  • Three days after the WHO statement, India advised citizens to refrain from travel to China, a step up from its earlier advisory.
  • On March 16, Ghebreyesus said that the WHO’s key message is “test test test”. On March 22, ICMR head Dr Balram Bhargava said: “There will be no indiscriminate testing. Isolation, Isolation, isolation.”

ADDITIONAL INFORMATION:

  • On March 26, addressing the virtual G-20 summit to deal with Covid, Prime Minister Narendra Modi’s remarks were telling when he underscored the need to “strengthen and reform intergovernmental organisations like WHO”.
  • WHO officials declined to comment on points of difference with the government.
  • Henk Bekedam, the WHO Representative to India, said: “India is at a crucial juncture in its fight against COVID-19. It is a moment that must be fully seized.
  • WHO has been working closely with the Ministry of Health and Family Welfare and various state governments on preparedness and response measures for COVID-19, including surveillance and contact tracing; laboratory and research protocols; risk communications; hospital preparedness; training on infection prevention and control and cluster containment plan.
  • WHO stands together in solidarity with the government in its firm resolve to overcome this unprecedented challenge.”

As ICMR ramps up rapid testing, WHO says use only in research settings

GS Paper III

Topic: Science and Technology

Prelims: Rapid Antibody-based Test

Mains: Dangers associated with Rapid Antibody-based Test

What’s the News?

  • India is currently in the process of introducing rapid antibody tests in some settings as Indian Council of Medical Research (ICMR) finalised a rapid antibody tests in clusters or where there is large-scale migration or gathering
  • However the World Health Organization (WHO) advised the use of a host of rapid tests only in research settings.
  • This is the latest in a series of divergences in India’s strategy to fight the Novel Coronavirus Disease (COVID-2019) from what the WHO considers appropriate.

Type of Tests:

There are two types of tests that are used to diagnose the coronavirus disease. These are the Reverse Transcription Polymerase Chain Reaction (RT-PCR) and the Rapid Antibody-based Test.

Rapid Antibody-based Test vs. RT-PCR Test

  • The Reverse Transcription Polymerase Chain Reaction (RT-PCR) Test determines if a person has a virus even before the symptoms occur. DOH considers this method as the most accurate.
  • The Rapid Antibody-based Test or Immunologic method, on the other hand, determines the presence of an antibody after a person exhibits the symptoms. It provides a result with limited certainty and is not used to confirm the coronavirus disease.
  • RT-PCR Test is preferred because it determines the exact virus before a person show symptoms.
  • Meanwhile, the Rapid Antibody-based Test only determines the presence of antibodies which only shows after infection. It could give a False Negative result in asymptomatic persons.

Rapid Antibody-based Test danger:

  • The Rapid Antibody-based Test may provide this kind of result to persons who do not show any symptoms.
  • This could give a wrong sense of security to the person with COVID-19 who is not infected with the disease.
  • It is dangerous because the person is unaware that he or she is infected and can infect other people as well.
  • Before these rapid tests can be recommended, they must be validated in the appropriate populations and settings. They should not be used in any other setting, including for clinical decision-making, until evidence supporting use for specific indications is available,” WHO has said in a scientific brief dated April 8.

Indian scenario:

  • India is currently in the process of introducing rapid antibody tests in some settings. It is faster than the usual nucleic acid-based test for the virus- a polymerase chain reaction (PCR) test. The rapid test takes less than 30 minutes.
  • However, only the PCR test is capable of identifying an early infection. Only after the antibodies have developed, which takes several days, can the serological test come in. Even for serological tests, the positives will have to go through the PCR filter.

Steps needed:

  • Rapid Antibody-based test kits serve only as a complementary test kit to evaluate if a patient is already free of coronavirus infection after undergoing the required 14-day quarantine.
  • Person with positive results using the Rapid Antibody-based Test need to be isolated and samples will be taken for RT-PCR testing. It is only when the PCR testing registers positive that the person will be declared a COVID-19 case.
  • It is only when the RT-PCR Test returned a negative result that the person can be considered free of COVID-19 infection.

Conclusion:

  • Till date, 16 antibody-based rapid tests have been validated at NIV Pune,
  • On rapid tests based on detection of antibodies, WHO says: “Based on current data, WHO does not recommend the use of antibody-detecting rapid diagnostic tests for patient care but encourages the continuation of work to establish their usefulness in disease surveillance and epidemiologic research.”