KEY CHALLENGES IN 💉COVID TESTING 💉
Special Thanks & Design Credits to Ankita Mathew , ILLUSTRATOR, Ex-Eaton Technologies, XLRI MBA 2020 -22, DTU 2013-17 | Linkedin: https://www.linkedin.com/in/ankita-mathew-21206a16b | Instagram: @thecookieemonstress . . . DO CHECK OUT HER WORK!
To know more about her excellent work, visit ~ https://arunimarajan.com/
In conversation with the health journalist Ms. Arunima Rajan …
She is Mumbai-based freelance health, business, and lifestyles writer. Her work has featured in reputed publications such as The Guardian, The Christian Science Monitor, The Economic Times, Daily News & Analysis and Deccan Herald among others. The conversation portrayed in the form of Q&A highlights the key ground challenges faced in COVID19 testing and the potential impact of new testing approach recommended by the ICMR July 1st.
It's very cumbersome on healthcare facilities and health care workers to have to clinically evaluate and strongly justify each and every possible Covid patient for testing. It places a heavy burden on already our overburdened facilities. What is your take on it? And your personal experience while treating patients at hospital?
As Indians we have learnt from a very young age to do more with less. The same goes to the manner in which doctors prescribe COVID19 tests. We constantly have to battle for the middle ground where we neither over test or under test our patients and following the latest guidelines and protocols has eased this battle to an extent. From our experience we have found out that the symptomatic patients who reach out to us are more accepting to the notion of testing if we recommended the same after extensive history taking and examination.
The real challenge for physicians however lies in persuading the potential and confirmed contacts of COVID +ve patients to undergo rapid antigen or RT-PCR testing. What concerns us is not that they would be positive, but that they could be potential super spreaders who could possibly make a lot more high risk individuals critically ill if not forced into self-quarantine.
The time spent in convincing such reluctant contacts to test themselves or better restrict themselves to home quarantine for the prescribed period takes considerable amount of our time away from active practice and it would benefit us immensely if the baseline awareness increase amongst people.
Why is it important to educate patients about false positives and negatives related to COVID testing as well as anti body testing?
Any practitioner who is handling covid19 would tell you that, they don’t rely on one modality alone for confirming diagnosis. It's always a combination of history of contact, history of presenting complains, clinical evaluation, radiological assessment and yes of course, RT-PCR testing. So when highly symptomatic patients test negative, we have to go the extra mile to persuade them to continue the prescribed medication and to stay vigilant. And in exceptional cases were completely healthy patients test positive, we shift gears and take up the role of a counsellor to address their apprehensions and answer their queries.
The concept of antibody testing however, is still not set in stone as we don’t know how long the antibodies will last. There are multiple research papers published so far that are laying claim at both ends of the spectrum, so it's hard to comment as of now.
EXPERT OPINION ~ Dr. Marudhupandian MD, CEO - Pon Malligai hospitals | 27+ years of experience in Medicine| Currently handling COVID19 patients
“The Sensitivity of RT PCR is only around 70 to 90 percent, one of my patients who was RT-PCR negative despite having severe symptoms. I was not convinced so I ordered CT chest and he turned out to have opacities highly suggestive of COVID19 with a lung severity assessment score of 33. Later, this patient had to be shifted to ICU. So it is vital that we put in the extra time to educate patients.”
Do you think the workload would increase many fold after the new ICMR rule?
The Recommendation made by Health Secretary Preeti Sudan and ICMR director general Dr Balram Bhargava on July 1st to allowing all registered medical practitioners (including ones belonging to the private sector) to prescribe covid19 tests, is considered a welcome move by the fraternity, provided every physician takes the onus upon him/herself to recommend only the necessary quantum of tests after obtaining elaborate history and performing thorough clinical evaluation. This suggestion when executed as intended would naturally lead to early diagnosis and improvement in prognosis of patients by overcoming obstacles to testing.
The exercise of private physicians recommending COVID19 has already been in practice in cities like Chennai and this activity has only empowered us towards contributing better to the greater common objective of containing COVID19 through the philosophy of Test-Track-Treat. However in places where this is not the norm, it would take some time for the testing centres to increase their capacity, if such an increase in demand was not anticipated.
With regards to the workload, yes it will increase overall workload but one has to take a step back and analyse that such an allowance is intended to share the burden more efficiently, rather than increasing work per healthcare worker. This is because there is immense unrealized capacity both in terms of manpower & facilities on the private sector and we can serve our country better with further collaboration with the Government.
Do we have enough test kits for all the patients?
This is a tricky question to answer because we frankly don’t know how many individuals are possibly affected as of now. IMCR has so far approved 1,049 centres for testing of which 761 belong to the public sector and 288 belong to the private sector, and this number is gradually increasing. In addition to this, ICMR has approved point-of-care rapid-antigen tests for diagnosis and more such tests are being validated to increase the available options to citizens. Based on the latest recommendations, all symptomatic patients in high incidence areas would be tested via Rapid-antigen screening and only who are tested negative would be re-tested via RT-PCR. Whichever way you look at it, it is a step in the right direction as it would ease the bottleneck previously created due to dependency on RT-PCR as the only test. Moreso it would reduce the wait time from nearly 24 hours for RT-PCR down to around 30 mins for Rapid-antigen.
In practice as well, we (myself, and colleagues) are yet to notice a delay in RT-PCR reporting from the registered labs due to concerns related to shortage of testing kits. I cannot comment on the scenario in other parts of the country.
