With only 1 in 9 Indians with COVID symptoms taking the RT-PCR test in 2023, official caseloads likely to be severely understated as JN.1 arrives

December 21, 2023, New Delhi: With over 50,000 cases of JN.1, a new sub-variant of COVID-19, being reported in Singapore in the first week of December, the call for masks around the world is back particularly as similar cases have been detected in the US, China and now India.

In India, the Union Secretary of Health on December 18th asked states to maintain constant vigil after the JN.1 COVID variant was reported in Kerala and Tamil Nadu along with 5 COVID deaths. The letter urged states to take public health measures and reduce risk of transmission while monitoring the situation at district level. The JN.1 form of COVID, known as Pirola, or Omicron subvariant BA.2.86.1.1, commonly leads to fever, runny nose, sore throat, headache, fatigue and, in certain situations, moderate gastrointestinal problems. The US had first detected this strain in September 2023.

In India, the Government records indicate just over 2300 active COVID cases however 16 COVID related deaths have occurred in the past week raising alert. While some sample testing is being done for passengers arriving at international airports, it is quite minimal in nature. One of the top concerns that several citizens have expressed on LocalCircles is whether with low testing rate, India has the risk of being late in identifying and reporting the JN.1 variant, especially if there is risk of severe conditions in some individuals. To understand whether people are getting tested and why many are reluctant to get a COVID test done, LocalCircles conducted a survey between Nov 20th – Dec 18th, 2023. The survey received over 24,000 responses from citizens located in 303 districts of India. 67% respondents were men while 33% respondents were women. 41% respondents were from tier 1, 35% from tier 2 and 24% respondents were from tier 3, 4 and rural districts.

76% of respondents admitted that they or immediate family members “did not take any COVID test despite symptoms”

The first question in the survey asked respondents, “In 2023, when you or immediate family members had symptoms like cold, fever, fatigue, respiratory issues, etc., how did you undertake a COVID test?” Out of 12,298 who responded to this query, 76% admitted that they or immediate family members “did not take any COVID test despite symptoms”; 12% stated they “took a RT-PCR test”; 6% shared that they “took a Rapid Antigen Test (RAT)”; and 6% have no clear response opting for “can’t say”. The survey data shows that only 18% of the respondents or their family members with one or more COVID symptom took a COVID test this year of which only 12% took a RT-PCR test. The positives of self or home RAT tests do not get reported in the official Government records.

Those who did not take the COVID test in 2023 despite symptoms felt it was unnecessary and just took treatment based on symptoms; Some also gave reasons like test cost, inconvenience and test accuracy

The survey next sought to know the reasons why there is reluctance in getting a COVID test done despite having similar symptoms. The question asked respondents, “What have been all the reasons that despite having COVID symptoms in 2023, you or your family members were reluctant to get a RT-PCR test done?” This question received 12,137 responses with all of them stating that they “didn’t see any point in testing, we just took treatment based on symptoms and recovered”. Some of the respondents also pointed to other reasons for not undergoing the COVID test: 7% indicated “it is inconvenient”; 7% felt “it is expensive”; and 7% stated “we took the RT-PCR a few times but the test isn’t necessarily accurate anymore”.

In summary, the study indicates that with COVID JN.1 variant rising globally and a few cases reported in India, the risk of late identification in communities is high. This is largely due to the fact that people despite COVID symptoms are not undertaking a COVID RT-PCR test with just 1 in 9 doing so per the survey. The risk becomes high if the new JN.1 variant causes severe disease in some individuals especially senior citizens or those with co-morbidities. If that is observed, the Government should consider testing all arriving passengers from countries with high caseloads as well as providing free COVID testing at multiple locations in every district.