Optimum Testing Strategy for COVID-19 and Its Effect on Health Expenditure in India: An Experience of the Initial 155 Days of the Pandemic

India has gradually increased its testing capacity of COVID-19 by mid-September 2020 However, the level of testing is substantially low in comparison with many high- and middle-income countries Evidently, the pandemic in India is likely to be prolonged and affect millions in comparison to other countries, due to its huge population size The possibility of a sudden upsurge of infections may turn overwhelming, jeopardising the health system, if an appropriate testing policy is not immediately adopted, given that the public health expenditure capacity of India has remained at a suboptimal level Against this backdrop, a descriptive analysis has been carried out using the published data of the number of infections, tests and daily COVID-19 cases and public health expenditure data published by different sources and available in the public domain The analysis suggests that a differential strategy is required to deal with the situation, which varies across states and depends upon the health spending capacity of individual states and their population size, among other factors The specific strategy recommendations would be as follows First, the testing rate should not be too high or too low, and this can be assessed using a marker: marginal return on testing Second, India should follow the upper-middle-income-country standard in assessing the testing rate Third, as a long-term strategy, there is a need to strengthen the public health system to avert a future catastrophe in the form of such pandemic