Monitoring COVID-19 where capacity for testing is limited: use of a three-step analysis based on test positivity ratio

In an effort to monitor coronavirus disease 2019 (COVID-19), many countries have been calculatingthe ratio of cases confirmed to tests performed (test positivity ratio – TPR). While inferior to sentinelsurveillance, TPR has the benefit of being easily calculated using readily available data; however,interpreting TPR and its trends can be complex because both the numerator and the denominator areconstantly changing. We describe a three-step process where the ratio of relative increase in cases torelative increase in tests is accounted for in an adjusted TPR. This adjusted value more appropriatelyreflects the case number and factors out the effect of changes in the number of tests done. Unadjustedand adjusted TPRs are then assessed step-wise with reference to the epidemic curve and thecumulative numbers of cases and tests. Use of this three-step analysis and its potential use in guidingpublic health interventions are demonstrated for selected countries and subnational areas of the WorldHealth Organization South-East Asia Region, together with the Republic of Korea as a reference. Todate, application of the three-step analysis to data from countries of the region has signalled potentialinadequacies of testing strategies. Further work is needed on approaches to support countries wheretesting capacity is likely to remain constrained. One example would be enumeration of the averagenumber of tests needed to detect one COVID-19 case, which could be stratified by factors such aslocation and population. Such data would allow evidence-informed strategies that best balance thehighest detection rate with the prevailing testing capacity.

Veterinary public health capacitybuilding in India: a grim reflection of the developing world’s underpreparedness to address zoonotic risks

Veterinary public health (VPH) is ideally suited to promote convergence betweenhuman, animal and environmental sectors. Recent zoonotic and emerginginfectious disease events have given rise to increasing calls for efforts to buildglobal VPH capacities. However, even with their greater vulnerability to suchevents, including their economic and livelihood impacts, the response from lowand middle-income countries such as India has been suboptimal, thereby elevatingglobal health risks. Addressing risks effectively at the human–animal interface inthese countries will require a clear vision, consistent policies, strategic approachand sustained political commitment to reform and refine the current VPH capacitybuilding efforts. Only then can the discipline serve its goal of disease prevention,poverty alleviation and support for sustainable livelihoods through improvementsin human and animal health.