When we limit our testing, we cannot deal with an epidemic because we do not know the full extent of the disease
The number of Corona positive cases and casualties is rising on a daily basis in India ever since the Government decided to open up the economy. Now we have the dubious distinction of becoming the fifth worst-affected country in the world. We are seeing a surge of over 9,000 cases daily and the number of cases is 2,58,090 while there have been 7,207 casualties.
Experts believe that we will soon reach the number one slot because we still haven’t changed our social behaviour and hygiene habits. And the only other reason for the delay in reaching the top slot is the fact that the Government is trying to control the numbers artificially.
Mumbai and Delhi continue to be the worst-affected cities in India and we are well and truly into the community spread stage now.
The number of covid-19 cases in Delhi has now crossed 27,654 and as expected, most Government and private hospitals have run out of beds with a long waiting list for patients to get into an ICU facility. This is quite evident from the appalling stories of families of sick patients running from one hospital to another in search of a vacant bed for treatment of their loved ones. One family even reached the doors of the High Court to secure a bed but unfortunately lost their loved one while waiting to get treatment. This has prompted the Delhi Government to issue a directive under which no suspected patient will be denied admission and treatment by any hospital but only serious cases will be admitted to hospitals. Any mild or asymptomatic COVID-19 patient would be discharged by a hospital within 24 hours and the area district surveillance officer (DSO) would be informed about it. This has been done to free up beds for serious cases only. This is a positive step.
On June 2, the Government came up with a new App which allows people to search for vacant beds in a designated Covid treatment facility. This, too, is a good initiative. However, the App has been found wanting as the information being fed into it is out of sync with the ground reality.
Further, instead of making it easier for people to get tested and take precautions, the Government has now set up new guidelines for covid-19 testing. The earlier criteria were stringent enough and obviously we were not testing enough numbers. Now, the new rules forbid testing of people who are asymptomatic direct contacts of Covid-19 patients unless s/he is above 60 or has comorbidities like diabetes, hypertension or cancer.
The new guidelines are more rigid than those issued by the Indian Council of Medical Research (ICMR) and are definitely not needed at a time when the city is experiencing a rampant and exponential increase in the number of Covid-19 cases.
Then on June 4, the Government decided to ban eight private labs in the city from carrying out tests for the contagion. The reason given was that the labs were not following protocols and by testing a large number of low-risk and asymptomatic individuals, they were only making money and causing delays in issuing reports for critical patients. This makes sense, but what is puzzling is that labs in private hospitals like Gangaram and Fortis, which are among the larger private covid-19 treatment facilities in the city, have also been barred from carrying out tests. The doctors at Gangaram Hospital involved in the treatment of Corona patients wonder if it makes any sense to ban a lab in a Covid-treatment facility.
In all, the ICMR had approved only 22 private labs in the city for Corona testing. Now eight of them have been issued notices and testing has stopped. This will further reduce testing capacity and cause further delays in issuing reports. In view of the rising cases, Union Health Minister Harsh Vardhan has himself stated that there is a need to ramp up testing as well as surveillance, contact tracing and containment in Delhi. Anyone who can afford it should be able to get tested by a private lab. Experts and epidemiologists have repeatedly maintained that widespread testing is the strategy for identification and containment of an outbreak. The positivity rate in Delhi has been 25.7 per cent for the last one week, the highest in the country, meaning that every fourth person tested was Corona-positive.
The rapidly rising cases have also resulted in nearly doubling of containment zones in Delhi within 12 days, from 83 on May 24 to 163 on June 5. When we limit our testing, how do we deal with an epidemic if we do not know the full extent of the disease? A study by ICMR has shown that nearly 28 per cent of asymptomatic people are positive in India. The other fallout of not testing asymptomatic people is reflected in the death rates of patients undergoing planned and elective surgery. A recent study, published in the Lancet revealed that the mortality rate was 18.9 per cent in patients with Covid-19 undergoing elective surgery.
Doctors are appalled by the Government’s decisions, which reflect a bid to artificially control the numbers in this pandemic. Many surgeons have expressed their anguish and have stated, “It does not make sense to perform an elective surgery on a patient without knowing the true extent of the risk involved.”
The medical community sincerely hopes and prays for better sense to prevail in the health department. Because additional knowledge is never harmful.
(The writer is neurosurgeon at Apollo Hospital)