Flaws in testing protocol, withholding data pose big risk

IMPHAL, 2nd Aug: As the number of Covid-19 confirmed cases continue to surge taking the situation to the edge of community spread, flaws in testing protocol and withholding data by the state health authority are posing great risk to the safety of the state and its people.
Like elsewhere, three types of testing methods are being used in the state – RT PCR, TrueNat and Rapid Antigen Test. Though all the testing methods do not give 100 per cent correct results and there are always possibilities of false results, RT PCR is considered the most accurate testing mechanism. In the RT PCR method, the virus RNA is amplified and converted into DNA, and as such detection rate is high. TrueNat is a chip-based, portable RT-PCR machine, originally developed as a portable diagnostic tool for tuberculosis by Goa-based startup Molbio Diagnostics. Its working principle is same with RT PCR but takes less time to give results. However, the device, being a portable one, cannot process large number of samples at one go.
On the other hand, Rapid Antigen Test (RAT) is the quickest form of testing developed for Covid-19 and it resembles the common pregnancy testing strip in look and indication of results. This testing method detects a specific (spike) protein only found in the virus which is recognised as foreign agent by the human body’s immune response. As per expert opinion positive results detected in RAT are true positive but it is not same with negative results. The advantage of RAT is that it is cheap when compared to other methods and infected persons can be isolated from others quickly. It reduces the burden from RT PCR test.
Since the process does not involve amplification of the protein like that in RT PCR, there are possibilities of false negative if a sample has too little antigen to be detected. As per ICMR guideline, negative results of RAT in high risk zone should be confirmed by RT PCR tests so that false negative results could be detected. Recently, there were instances of around 15 per cent of negative results from RAT turning out to positive in Delhi, and 65 per cent of such cases in Mumbai.
In the state, the government is using RAT in hotspot areas like in Jiribam and Thoubal as well as some potential hotspot areas in other districts. Several positive cases were detected from these hotspot areas but no confirmatory RT PCR tests were taken up for those who got negative results. As maximum of the cases in the state are asymptomatic, false negative results in these hotspot areas if left without confirmatory test could prove disastrous for the state and its population, especially those in the vulnerable age group and those with co-morbid conditions.
At the same time, close contacts of employees of some government hospitals, who were found positive of Covid-19, are called up for testing and their tests are conducted through RT PCR. After collecting swab samples, they are sent to home where the family members spend their times together and test results come two or three days later. In case one of the family members is found positive, he/she will be shifted to Covid Care facilities while the rest of the family members will be left for home quarantine.  The problem in this situation is that the family members spend their time together for the last two or three days and there are possibilities of the infected person transferring the virus to the others and thus nullify the test results.
Some medical officers told The People’s Chronicle that such high risk population should be screened for infected persons by RAT first and those with negative RAT results should be tested again either with TrueNat or RT PCR to minimise the risk of further spread of the virus.
On the other hand, withholding data and information from the public or media is also another threat to the safety of the state and its populace. In such times of epidemic, medical practitioners are required to provide patient information to the government as the pandemic falls under the notifiable diseases category. The whole purpose of making certain diseases notifiable is that the government could take up prompt action to prevent further spread and minimise risk.
Since the beginning of the pandemic, both the central and state governments have been calling to make the fight against the pandemic a people driven movement. However, the state health authority has been failing to provide proper and up-to-date information to the public. Withholding such information was okay when the infection was limited in the quarantine centres and Covid zones. Once it goes out in the community, it becomes necessary to notify the public and provide ample time to take certain precautions to prevent further spread of the virus. On the contrary, the state health authority is giving its best efforts to filter as much information as possible and share little to the public reducing the press statements of IDSP and Covid-19 Common Control Room to a mere scoreboard but nothing.
During a random interview with several local clubs, the club members said that relying solely on the information provided by the patient for the contact tracing purpose is also a major question that the authority needs to think over. The question is how much sincere the patient is in providing information or how much can he/she remember whom they met or talk.
No matter how hard the authority hide information of patients, people will eventually come to know, and by that time, it might be too late to contain the spread. Instead of hiding such information, the authority could release some information, even if not the names, of the patient like their proper address could help local clubs take up preventive measures.
Unless the government plugs these loopholes, it would be impossible for the authority to contain the spread and the result could prove disastrous.

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