Access to medical care delayed by late Covid-19 test results in India

Doctors say that this prolonged delay is compromising patients' well-being. PHOTO: AFP

BANGALORE - As the devastating second wave of the Covid-10 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 impact 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 have to currently wait between 48 and 72 hours for the results.

In most instances, a specialised machine for RT-PCR tests can produce a result around 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 for Covid-19, many patients with acute symptoms wait desperately for the results.

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

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 on April 29, Mr Jacob's mother died in her bedroom at home. At 7.30am, he got 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 to a shortage of testing kits, manpower and their inadequate capacity to handle the huge volume of samples.

Mr V. Ponnuraj, head of Karnataka Covid-19 War Room, however, blamed 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.

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Doctors say that this prolonged delay is compromising patients' well-being, leading to late hospitalisation and exacerbating 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 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 (ICMR) guidelines expect inaccuracy in 5 per cent of RT-PCR tests. It has dismissed accusations of the test being unable to detect the new variants of the coronavirus.

Experts say a Covid-19 test could fail to detect the virus if the swabs are collected too early into the phase of infection when the viral load is low, or too late after the disease has already progressed into 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 increased from 14 in February last year to more than 2,400 last month. Thousands of technicians were trained in a hurry.

The price of each RT-PCR test kit fell from more than 1,100 rupees (S$20) in August last year to less than 40 rupees today, and lab tests for patients fell from 4,500 rupees to 800 rupees.

The owner of a diagnostic lab said that "the cheapest test kits are nothing but ear buds", but the government maintains that all approved test kits meet ICMR standards.

Delayed and false negative results have led to uncounted Covid-19 deaths and unintended transmission of the virus, added experts.

Taking cognisance of these issues, doctors recommend home isolation to all symptomatic patients and order CT scans to detect infections.

On April 23, the Delhi government ordered that "no patient requiring medical aid should be denied treatment". The Karnataka government said on April 30 that it would allot beds to symptomatic patients who had comorbidity reports.

But overwhelmed private hospitals continue to insist on positive Covid-19 test reports to gate-keep the enormous number of requests for beds.

Intensivist, Dr 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-19 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?" the doctor said.

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