The post “Random Note on Rationality in Economics” decodes how human actions fit in the concept of rationality as described in economics. Yet while that might be true at the level of individual, it might not fit the same at the aggregate level. Aggregate of individual actions might end up in totally contrary outcome at an economy or societal level. What might be rational at a level of an individual might conflict with what might be in the self-interest at family level. Similarly individual self-interest might conflict with organizational self-interest at aggregate level. In a democracy, the governments are essentially the agent of the people who are the principal. The government is expected to take care and act in the interests of their principal, the people of their land. If the objectives are conflicting then the society as a whole will face troubles. The fact that the people have to keep the government in alignment with the societal or national objectives is the agency cost, the principal component of which is the periodic review as manifested through elections at regular fixed intervals.
The context become pertinent as one seeks to decode the government strategy in seeking to combat the Wuflu caused by the virus originating in Wuhan. One of the arguments that has been used is the lack of testing in sufficient numbers in the Indian context. The current data suggests around 220 per million are being tested which compares very poorly with European and American countries. The only other country that was conservative in testing is Japan which is testing around 800 per million. There has been vociferous advocacy of the need to increase the tests in India. One of the arguments by many Western commentators in part cheered up by their Indian liberal counterparts is the underreporting of cases in India thanks to alleged under-testing. The votaries of the current testing strategy defend the current mode stating if there was under-reporting, it would have manifested in some form. The hospitals would be flooded with cases and graveyards would be overwhelmed with deaths.
A strong defence was put up a couple of days back by the Indian Council of Medical Research (ICMR). Their argument rested on a simple premise. According to data available, Japan tested 11.7 people per one positive; Italy that number is 6.7, In US its 5.3; UK its 3.4. On the contrary India is testing 24 people per positive test. In fact, India is testing a very limited pool of people who it perceives as high risk population. In this high risk population, despite increase in the number of tests over the last few weeks or so, the percentage of positives remain around 4-5% throughout. Barring Madhya Pradesh which is seeing around 10% positive rate, rest all fall less than 5% bracket. In fact even in MP, it is some clusters that are reporting quite high number of cases which is skewing the overall percentage something that was observed in Tamil Nadu too. In fact, Karnataka and Kerala both are testing similar numbers and have reported similar cases. Two states that reported higher numbers are Maharashtra and Rajasthan which have conducted higher number of tests. Yet the common consensus is Kerala has done extremely well while Maharashtra is struggling.
India according to ICMR can test more than 75000 cases per day if working in two shifts. On an average around 30000 tests are being conducted every day over the last few days or so. The testing has indeed increased. However, test kits are scarce and hence used sparingly. The same scenario exists in many other countries including UK, Japan too. However, given the high preponderance of positives in the sample population implied they have to test higher numbers. In India, since the positives are low, India can afford to test less. To overcome the possible scarcity, India is engaged in pooled testing (run tests combining five samples) something that Germany tried with fair success. The process is happening in areas with low prevalence. Further in high risk areas, mass screening followed by contact tracing is keeping the incidence low.
Often, a comparison is made with South Korea. Korea follows a very highly aggressive testing strategy. People could merely drive into a testing booth, have their swab tested and get the result in matter of minutes. Advocates of South Korean strategy feel this helped them to contain the pandemic. Korea is one of the few countries that doesn’t have a lockdown in place and in fact went ahead with parliamentary elections a couple of days back with record voter turnout. Korea rather than conscious aggressive strategy was rather thrust upon the same by compulsions. The circumstances were such that there was no alternative to aggressive testing. Korea was seeking to contain the pandemic until the Patient 31 destroyed any such ambitions. The mass gatherings of the fringe Christian sect though significant cluster following destroyed any objectives of Korean government to contain through any other means. The cluster at Daegu exploded very fast leaving virtually zero time for any reaction. The cases began multiplying in the province in geometrical proportion. Contact tracing and other means were effectively ruled out given the high costs and practically impossible conditions for execution of the same. The only strategy was to test, test and test every possible population that was prone to infection. The circumstances helped the testing to take roots. In absence of Patient 31, the Korean strategy might have been very different.
Thus any comparison with Korea might not be facile. In India, the cases grew slowly and even today, the growth is in arithmetic proportion in contrast to the growth in Europe and US. India testing criteria was quite rigorous and is being relaxed and expanded with passage of time. The number of laboratories have also expanded. The number of people being tested is increasing too. The cases however are not increasing in the same proportion. Yet, tests become very critical in mapping the clusters that have exploded. As the data shows day over day, it is a few clusters in few states that have burst out big and need strict interventions. Testing becomes critical in these areas and thus need to be expanded in these geographical clusters.
The backdrop set the stage for actions and thus the Indian testing strategy too is an outcome of the context in which one is working. High level of tests will result in decline in positives. Yet that does not rule out future infections. Second, in a scenario of high negative tests, there is always a possibility of inducing a false sense of security thus setting the stage for unintended consequences. Rather, in the Indian environments, tests should be focused and directed towards those clusters which are reporting high numbers. Rather than engagement with the population with large testing in low prevalence areas, direct them towards critical clusters.
The whole of India cannot be treated uniformly given the uneven ways the pandemic seems to have spread. There is no right or wrong size of the sample. The right or the optimum sample exists merely in theory. There is no need to even delve into the Bayesian angle in terms of determination of testing size. While there can be resort to Bayesian analysis that can be left for another day. The circumstances in each country were different. Therefore, the testing strategy too should be different. In India, rather than test across the country, test, test and test should be the focus in those few clusters and sub clusters that have borne the brunt of the pandemic.
Thoughts on Theory and Practice 