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Covid-19: government promises 100 000 tests per day in England by end of April

BMJ 2020; 369 doi: https://doi.org/10.1136/bmj.m1392 (Published 03 April 2020) Cite this as: BMJ 2020;369:m1392

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Rapid Response:

It shall be prudent to start testing seniors first for new corona virus infection (COVID-19)

Dear Editor,

This news regarding 100 000 tests per day in England by end of April must be welcomed [1]. It would be reasonable to start it expeditiously, first of all checking all the seniors. Amongst the elderly, those with multi-morbidities must be taken up on priority for checking COVID-19, as that is where the bad prognosis has been seen [2-3]. It will perhaps be prudent to follow up this exercise by providing proper protection and isolation of all those elderly who have returned a negative test. For all those found positive, management goals have to be individualized based on the grade of their preexisting disability or co-morbidities, present state with COVID-19 infection, and whether home based care or institutionalized care would be necessary.

This will also be helpful in ascertaining the necessity of isolation and quarantine for all the primary, secondary and tertiary contacts. Swift testing was indeed what was required. After a long time, now a light can be seen at the end of the tunnel. Complete lockdowns and curfew situations may have helped to certain extent, but are possibly some extreme measures. Now probably no more, and such dire measures may be relegated to the past.

With these tests, many more lives can be easily protected and saved, without causing undue stress and anxiety. The world already knows that total mortality is around 2 % or less, and where the maximum unfortunate outcomes lie. Since it is also known that just one amongst five of all those having COVID-19 may become symptomatic, while the rest have been found to have remained asymptomatic [4]. If our presumption is right, then this test may surprise some of the individuals most worried about catching this infection. This way it will also be able to manage the undue panic and anxiety, associated with the spread and outcome of COVID-19 and be able to rationalize the management from here on [5-8]. All healthcare personnel and ancillary staff should also be getting top priority, and thereafter the policy makers as well.

Best regards.

1. Dr (Lieutenant Colonel) Rajesh Chauhan
MBBS (AFMC), Master in Medicine (CMC Vellore), PGDGM (Geriatric Medicine), PGDDM (Disaster Management), AFIH (Industrial Health), DFM (Family Medicine), FISCD, ADHA (Hospital Administration) & LLB

2. Dr. V.T.K. Titus.
MS (Ortho), Diploma National Board (Ortho), Diploma Orthopedics
Professor & Head, Department of Orthopedics,
CMC Vellore, Tamil Nadu. INDIA.

References:

1. Iacobucci Gareth. Covid-19: government promises 100 000 tests per day in England by end of April BMJ 2020; 369 :m1392

2. Onder G, Rezza G, Brusaferro S. Case-Fatality Rate and Characteristics of Patients Dying in Relation to COVID-19 in Italy. JAMA. Published online March 23, 2020. doi:10.1001/jama.2020.4683

3. Chen Tao, Wu Di, Chen Huilong, Yan Weiming, Yang Danlei, Chen Guang et al. Clinical characteristics of 113 deceased patients with coronavirus disease 2019: retrospective study BMJ 2020; 368 :m1091

4. Day Michael. Covid-19: four fifths of cases are asymptomatic, China figures indicate BMJ 2020; 369 :m1375

5. Chauhan Rajesh. COVID 19 : Fresh approach, initiative, and opportunity. BMJ 24 March 2020. Available at : https://www.bmj.com/content/368/bmj.m1141/rr-4 Accessed on 03 April 2020

6. Chauhan R, Singh AK, Chauhan S.. Covid-19 : Catch the tiger by its tail.
BMJ 28 March 2020. Available at : https://www.bmj.com/content/368/bmj.m1190/rr-1 Accessed on 03 April 2020

7. Chauhan R, Singh AK, Chauhan S.. COVID 19: The last straw that broke a weak camel's back. BMJ 01 April 2020. Available at : https://www.bmj.com/content/368/bmj.m1199/rr-11 Accessed on 03 April 2020

8. Chauhan R, Titus VTK. COVID 19 : Alcatraz type maximum security for only those who really need it. BMJ 03 April 2020. Available at : https://www.bmj.com/content/369/bmj.m1375/rr-3 Accessed on 04 April 2020

Competing interests: No competing interests

04 April 2020
Dr (Lieutenant Colonel) Rajesh Chauhan
Consultant Family Medicine, Geriatrics,Industrial Health, Disaster Management
Dr. V.T.K. Titus, Professor & Head, Department of Orthopedics, CMC Vellore, Tamil Nadu. INDIA.
Family Healthcare Centre, 154 Sector 6-B (HIG), Avas Vikas Colony, Sikandra, AGRA -282007. INDIA.