At a Covid-19 testing centre in Pune. (Express file photo by Arul Horizon) FEAR psychosis and social stigma associated with Covid-19 infection is causing a section of the suspected patients in towns and villages of Marathwada to avoid undergoing RT-PCR or Rapid Antigen Tests and instead opt for expensive, and often unnecessary, chest CT scans and multiple blood tests.
Private clinics often provide OPD consultation or hospital admissions to these patients treating the ailment as ‘Covid-like illness’. Doctors, however, say that this results in sub-standard treatment and delay in providing life saving antibiotics. This they say results in increased mortality among these patients and unabated spread the virus among familiy members in absence of following Covid-19 protocols.
By visiting multiple hospitals and clinics, The Indian Express found that persons with Covid-19 symptoms were going for unprescribed blood tests for biomarkers such as CRP (C Reactive Protein), D Dimer, LDH (Lactate Dehydrogenase) and Ferritin to determine severity of illness. Many also go for a CT Scan of the chest to see if pneumonia has set in, even before they see a doctor.
While RT-PCR and Antigen tests are done without charge at government hospitals and may cost Rs 750 to Rs 1200 at private facilities, biomarker tests and CT Scans costs many times higher and also may prove harmful in the long run.
Dr Ravi Shinde, a physician in Pathri town in Parbhani District, whose Varad Hospital is the only facility with Covid infrastructure in the town of about 40,000, said that patients are extremely reluctant to go for RT-PCR or Antigen tests.
“It’s very difficult to persuade them to go for a Covid test. There is a great degree of fear about coronavirus infection in the rural areas and minority communities. In the initial days of the pandemic, the infection got stigmatised and the stigma still persists. Then there are some people who are Covid deniers. Many patients reach the hospital with blood test reports and CT scan already done. In most cases these reports are unnecessary,” said Shinde, adding that such patients in absence of a definite diagnosis continue to spread the virus among family members and others.
Dr Shinde said that lack of a solid diagnosis affects the treatment given to the patients. “Compared with patients whose illness is clinically diagnosed as Covid, those who are reluctant to get tested receive sub-standard treatment, especially during the first few days of admission. This group may have higher mortality rate,” said Dr Shinde.
Apart from fear and stigma, relatives of the patients and patient themsevels, also worry that a confirmed Covid infection will lead to the government seizing the dead body and thus depriving the family from conducting an honourable last rites.
Abdul Khalid, son of Abdul Hassan (68) who had reached Prabhani’s Hayat Hospital complaining of extreme fatigue, weakness and chest pain, said that on advice of a relative who had suffered similarly in the past, he got his father tested for CRP, D-Dimer and got a chest scan done before heading to the hospital.
“I was told that these tests will be enough to the start treatment. If it is so, testing for Covid is unnecessary and will create panic in the family and will also cause trouble in conducting a proper funeral in case something bad happens,” said Khalid.
Nandikesh Kadam, who works with a prominent diagnostic lab in Parbhani town, said that everyday dozens of patients reach the lab for Covid-19 related tests without a prescription. “After developing symptoms people consult with others who have suffered in the past and may know a few things about these tests which indicate the severity of infection. They go for a ‘Covid profile’ (a group of biomarker rests indicating degree of inflammation and immune response) and often for a CT scan. If these indicate considerable severity, they approach a doctor. If the inflammation is low and pneumonia hasn’t set in or is mild, they manage it at home,” said Kadam.
Dr Subhash Salunkhe, advisor to Maharashtra Government for Covid-19 response, said that this was a real problem, if only in private hospitals, and would require aggressive awareness campaign to dispel fear and stigma associated with the illness as well as active efforts from private medical practitioners to instill confidence among the relatives and patients to go for proper diagnosis.
Dr Salunkhe, however, made it clear that the state government has directed the not to deny admission to patients in absence of a Covid test.
“We have directed the doctors not to wait for a Covid test result to start the treatment depending on clinical symptoms. But they must conduct either RT-PCR and Rapid Antigen Tests for the patients because these are important diagnostic tools which will determine the course of the treatment,” said Dr Salunkhe.
He said that he will raise the issue in the meeting of the state’s task force and ensure that a message is sent to medical associations across the state that the private medical practioners must press for a proper diagnosis through requisite Covid tests.
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