Coronavirus: Global situation

Access to medical care delayed by late test results

A health worker being tested for Covid-19 yesterday at an interstate bus station in Moradabad city in Uttar Pradesh. In India, delayed and false negative results have led to uncounted Covid-19 deaths and unchecked transmission of the virus, experts s
A health worker being tested for Covid-19 yesterday at an interstate bus station in Moradabad city in Uttar Pradesh. In India, delayed and false negative results have led to uncounted Covid-19 deaths and unchecked transmission of the virus, experts say.PHOTO: BLOOMBERG
A health worker at a Covid-19 testing site set up in a school bus at Panchayat House in Uttar Pradesh yesterday.
A health worker at a Covid-19 testing site set up in a school bus at Panchayat House in Uttar Pradesh yesterday.PHOTO: BLOOMBERG

Even as a devastating second wave of the pandemic rips through India, people across the country are being made to wait up to three days to receive results of their reverse transcription-polymerase chain reaction (RT-PCR) tests for the coronavirus.

Experts say this delay may directly affect a patient's access to medical care and, thus, their chances of survival.

After swab samples from the nose and throat are collected for the RT-PCR tests, patients now have to wait between 48 and 72 hours for the results.

In most instances, a specialised machine for RT-PCR tests can produce a result in one to two hours. If samples need to be transported, the turnaround time is longer.

As most states allot hospital beds only to those who test positive, many patients with acute symptoms wait desperately for results.

"The government helplines all ask for a positive test result first," said Mr Claudien Jacob, who could not find a hospital bed anywhere in Bangalore for his 71-year-old mother, who was burning up with fever and had a rapidly dropping blood oxygen saturation level.

After two days of frantic calls, a volunteer found her an oxygen cylinder to use at home. By this time, Mr Jacob, his father, wife and children were all showing symptoms of Covid-19. On the third day, the oxygen ran out.

At 7am last Thursday, Mr Jacob's mother died at home. At 7.30am, he received a text saying she was Covid-19 positive.

"What is the use, tell me? I'll bury the test result with my mother," said Mr Jacob, seething with quiet rage and grief.

Labs and hospitals blame the delays in test results on a shortage of testing kits, manpower and their inadequate capacity to handle the huge volume of samples.

Mr V. Ponnuraj, head of the Karnataka Covid War Room, however, blames the backlogs on labs not uploading the test results in the centralised portal.

In Delhi, Mumbai, Kolkata and Lucknow, RT-PCR results are available after an average of two days, sometimes longer.

Doctors say this prolonged delay is compromising patients' well-being, leading to late hospitalisation and worsening the bed crisis.

"Late test results mean that the patients start looking for beds late, and after scrambling around, they arrive at the hospital on the sixth or seventh day from when they noticed their first symptom. By this time, eight of 10 patients already have pneumonia or are under severe respiratory distress," said pulmonologist Jalil Parkar from the Lilavati Hospital in Mumbai.

Physicians also note many "false negatives". Health officials in Karnataka, Andhra Pradesh, Delhi and Maharashtra admitted to receiving several reports of symptomatic Covid-19 patients testing negative.

The officials, however, said it was not possible to quantify such false negatives.

The Indian Council of Medical Research guidelines expect inaccuracy in 5 per cent of RT-PCR tests. It has dismissed accusations that the test is unable to detect the new variants of the virus.

Experts say a Covid-19 test could fail to detect the virus if the swabs are collected too early in the infection when the viral load is low, or too late, after the disease has already spread to the lungs.

The quality of test kits and ability of technicians collecting and processing samples are also factors. The number of Covid-19 test labs in India rose from 14 in February last year to more than 2,400 last month. Thousands of technicians were trained in a hurry.

According to experts, delayed and false negative results have also resulted in uncounted Covid-19 deaths and unchecked transmission of the virus.

Taking these issues into account, doctors have recommended that all symptomatic patients isolate at home, and that CT scans be done to detect infections.

On April 23, the Delhi government ordered that "no patient requiring medical aid should be denied treatment". And last Friday, the Karnataka government said it would allot hospital beds to symptomatic patients who had comorbidity reports.

But overwhelmed private hospitals continue to insist on positive Covid-19 test reports as a means of screening the enormous number of requests for beds.

Intensivist Vivek Shenoy from the Rajshekhar hospital in Bangalore, which has 30 critical-care beds, said he saw "two breathless patients" with negative Covid-19 reports last week.

"Our Covid ward is full, so I admitted one as a patient of severe acute respiratory infection but had to send the other one home. Where do I put everyone?" he said.

A version of this article appeared in the print edition of The Straits Times on May 05, 2021, with the headline 'Access to medical care delayed by late test results'. Subscribe