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Utilising coronavirus testing capacity is the key
The need to rope in more labs and private players is made clear by the problems plaguing government testing and sample collection centres, where experts admit there exists a clear infection risk because of long hours of waiting and overcrowding.
New Delhi: The government’s decision to open the gates for private facilities to test for the coronavirus infection has the potential to urgently scale up the country’s testing capacity that experts say is necessary to effectively fight the deadly disease that has claimed 7,500 lives worldwide.
But experts warn that if diagnosis criteria is not relaxed and more people allowed for testing, the benefits of allowing private labs might be nullified and India left fighting an uphill battle against the infection that can dramatically expand in reach over a few days.
Currently, the Indian authorities limit testing to only government facilities for only people with a history of travel abroad, who have come in close contact with someone testing positive for the virus, or health workers. Only people showing symptoms are tested.
But the strict eligibility criteria and limited number of testing centres – 72 in a country with a population of 1.3 billion people – has ensured that many people are finding it difficult to get tested.
Moreover, the need to rope in more labs and private players is made clear by the problems plaguing government testing and sample collection centres, where experts admit there exists a clear infection risk because of long hours of waiting and overcrowding.
India currently tests the lowest number of people per capita among major countries grappling with the coronavirus outbreak: a mere 8.6 tests per million, compared with 4,831 per million in south Korea, 2,820 in China and 533 in the United Kingdom, which has been criticised for not testing enough and reversed its “herd immunity” policy after grim projections.
“We do need to do more testing. I have made that clear. You don’t know what you are dealing with until you test. What is the harm in testing?” asked Dr Gagandeep Kang, director of Translational Health Science and Technology Institute.
A number of experts have called for private players to be roped in, testing eligibility relaxed and more aggressive diagnosis protocols adopted.
“There are enough PCR [polymerase chain reaction] machines and we have the ability to make reagents for testing. Open it up to the Indian companies. They are good at reducing cost. They can develop tests that are cheaper,” said Kang.
Even in the national capital, patients have complained of many problems. Overcrowded hospitals have turned away travellers who travelled from affected countries and wanted to get tested on the basis that they didn’t show symptoms, even though research has shown that symptoms may take up to 14 days to appear.
“I was impressed by the response of the Indian government, till I reached the sample collection centre. I have been standing here for over two hours and now I just feel like running away,” said a 27-year-old Australian national, who was standing outside the sample collection centre at Dr Ram Manohar Lohia hospital. She had travelled to Delhi for work.
On Tuesday morning, the Australian woman called the government helpline number and informed them she was fatigued and had a sore throat. “They came to my hotel and picked me up in an ambulance. All the health care workers were in complete protective gear. It was scary but it was also good. Then, they just dropped me here with my bags and asked me to wait,” she said.
For almost an hour, she couldn’t figure out what to do because none of the hospital staff posted outside the sample collection centre spoke English. “They took me inside the hospital to find someone who could explain what I needed to do,” she said.
If she had the infection, she may have infected people inside the hospital.
And it is not just her. In the corridor outside the two rooms collecting the samples at the collection centre, close to 70 people sat next to each other waiting for up to two hours. Open on all sides, several people passed by this “restricted area” all day round. There was no check on who entered the corridor.
RML hospital collects nearly 70 samples for Covid-19 each day.
But the corridor outside has hundreds of people waiting. Many reached the hospital without checking with a helpline or a doctor and waited in the queue.
Many of them were likely to be turned away after hours of waiting, and potentially exposing themselves to the coronavirus infection.
“The person I brought to the hospital today has been given the token number of 318, I think,” said the ambulance driver stationed outside the centre. It will be hours before she gets her turn.
Safdarjung hospital collects samples only for suspected patients admitted to its isolation ward. Sample collection facilities will soon start at 14 Delhi government and corporation hospitals.
“Who has the time to wait for three hours? We have a flight tonight and we just wanted to get tested to get a certificate declaring that we are virus-free. And, we were told to come to this centre but if we sit around here we are more likely to get the virus,” said Ravi Shingari, an Australian citizen of Indian origin. He and his wife travelled to London before coming to India.
Another 25-year-old woman, who did not want to be named, filled out the form asking for her contact details, address, symptoms, and travel history. But she did not wait for her turn. “I have been sitting here for a while now. I have to be somewhere now, so I am leaving. I don’t think they will even come to know who left,” she said.
She had come to the testing centre on her own after meeting up with a friend who had travelled abroad.
Some wait it out, only to be refused at the door. “In the last two hours, I have seen around 10 people being refused the test after they reach to the front of the line. They must have been waiting for a couple of hours. And, what if one of these people actually has the disease? That’s why I am waiting my turn here a little farther away,” said one of the persons waiting near the sample collection centre.
Getting information on testing is difficult on the helplines as well, with only one of the 30 calls made by the HT reporter to the toll-free number getting through.The government helpline advise people with cough and fever but no travel history to maintain personal hygiene and get in touch with district surveillance officers or a local physician.
Experts say cramped government facilities pose a clear danger.
“This is an infection risk, naturally. We are advocating social distancing and here are people who need to get tested for the disease sitting close to each other. The government has to make arrangements for a large waiting area.. or start more sample collection centres because clearly there is a need,” said Dr MC Mishra, former director of the All India Institute of Medical Science, Delhi.
He added that there was a need to ensure that people who didn’t need the tests to not show up because they are at a higher risk of getting the infection. “Someone needs to be stationed outside the centres to ask people who do not need testing to leave rather than them waiting for hours before leaving,” he said.
