Global kudos for Lankan researchers

• Leading international journal publishes global analysis by Lankan researchers at Institute for Health Policy showing that testing was most important intervention for controlling COVID-19 during pandemic’s first wave

There is no international consensus on how to best tackle COVID-19 before an approved vaccine is rolled out and much debate has been ongoing about the necessary extent of lockdowns, whether masks are essential, and on the importance of testing.

Although the World Health Organization (WHO) urged the world in March to “test, test, and test,” policymakers and medical experts in Sri Lanka could not agree on what could be termed as ‘adequate testing’. The Ministry of Health did not significantly increase testing or testing capacity after the first lockdown ended in May.

Realising that there was a critical gap in the international research, a multi-disciplinary team of Sri Lankan researchers at the Institute for Health Policy (IHP) launched a study to find out the importance of testing. Their study, the first to look at this question, has just been released by Health Affairs, a leading international health policy journal published in the United States.

It uses data from around the world to examine the impact of testing on the spread of COVID-19 in 173 countries between March and June 2020. This work contributes to the world’s understanding of how best to control COVID-19.

The study found that among interventions, the intensity of PCR testing had the largest influence on spread: a 10-fold increase in the ratio of tests to new cases reduced average COVID-19 transmission by 9%.

Increasing PCR testing reduced COVID-19 cases and deaths, and it was the most important predictor of how well countries contained the pandemic. The study also found that lockdowns did not slow the virus in most countries, and that masks and school closures had less impact than high levels of testing and isolation.

Dr. Ravi Rannan-Eliya, the lead investigator, says: “We knew that several countries in our region, such as China, Vietnam and Australia, were doing well, but the experts never agreed on why—whether it was to do with masks, lockdowns or something else. Our research clearly shows that their better performance was driven by higher levels of PCR testing.”

The research has important implications for Sri Lanka. It provides strong scientific evidence that the country’s rate of PCR testing was never enough to effectively control COVID-19 and prevent a second wave. Findings also imply that WHO and US government guidelines on testing are not sufficient—most countries need much more testing to control COVID-19.

“For us to keep the country safe in the next two years, we should learn from the countries that successfully controlled the pandemic without a vaccine. We need to seriously invest in expanding national capacity to do PCR tests and make routine testing the new normal. The global data are clear—this is the best way to avoid lockdowns and school closures, and to protect our economy,” says Dr. Rannan-Eliya, who is also the Executive Director of IHP

The research was done drawing entirely on IHP’s own resources, without any external funding. As Dr Rannan-Eliya notes: “When we started this research during the first lockdown, we wanted to help the country, and we never imagined it would be published internationally. Finding funding for doing international research in Sri Lanka is never easy. Our small team took pay-cuts and worked long hours under difficult conditions to do this work. We are really proud of what we did without outside help. I hope it will inspire other Sri Lankan researchers—we don’t always have to depend on outside research, we too can contribute substantially to international policy debates.”

IHP is an independent, non-profit research institute in Colombo that works to improve health systems and social policies in Sri Lanka and the Asian region. Its goals are to lead to more informed health policy and thus better outcomes for all people by conducting independent research and by providing objective analysis and training. More at: http://www.ihp.lk/

The IHP team consisted of doctors, economists, statisticians, laboratory experts and GIS specialists. It was led by Dr. Rannan-Eliya, who is a physician, public health specialist and economist who qualified at Cambridge and Harvard universities.