Low testing and delay in results a concern in UP

Testing rates have picked up in recent weeks but lag behind high caseload states

LUCKNOW/NEW DELHI: Rajkumar Patel, a resident of Manikpur town in Uttar Pradesh’s Chitrakoot district, gave his swab samples to the local authority after he developed symptoms of Covid-19. A week had passed and Patel, 45, was still waiting for the test result. When he finally receive it, it was positive.

“I have visited the local community health centres; the doctor prescribed some medicine, he told me to stay at home till the test report comes. I was worried that other members of the family might be infected,” he said.

Chitrakoot’s chief medical officer, Dr Vinod Kumar Yadav, said the report on a Reverse Transcriptase -Polymerase Chain Reaction (RT-PCR) test, considered the gold standard of Covid-19 testing, takes around six to seven days. Samples collected from suspected Covid-19 patients are being sent to the Maharani Laxmi Bai Medical College in Jhansi, located 290 km from Chitrakoot.

When the backlog of samples increased in the Jhansi laboratory, the district administration started sending them to a government laboratory in Prayagraj, located 150 km away, which still takes five to six days. The district is conducting 250 rapid antigen tests and 20 TrueNat tests daily besides RT-PCR tests to accelerate the pace of testing, Yadav said.

Delays in the delivery of test results amid an increase in the number of infections is adding to the anxiety of people of Uttar Pradesh.

The first 1,000 cases (1,184) came up on April 20, 49 days after the first case reported (March 2). On June 9, UP crossed the 11,000 mark (11,335 cases) and since then every 48 hours, the fresh case count has been rising by more than 1,000. The doubling rate — the time it takes for the cases to double — in the state is 24 days, worse than the national average of 29.3 days. Among the high case-load states, UP’s doubling rate is only worse than two states, Karnataka and Andhra Pradesh (Chart 1).

Director General, Health, Dr DS Negi said although the trajectory of cases was still on an upward trend, there is a silver lining in that the case fatality rate (number of people dying of Covid-19, at 1.6%, remains low.That compares with a national average 1.9%.

In April, the case fatality rate was 1.2%. It increased to 4.1% in May and then came down to 3.0% in June and to 1.0% in July.

In a study conducted by the state health department, it was found that comorbidity (the existence of another serious disease) was one of the main reasons for the death of patients. Delays in testing and admission of patients in hospital for treatment also contributed.

Additional chief secretary (health and family welfare) Amit Mohan Prasad said, the recovery rate of Covid-19 patients in UP was 61.16% (compared to a national average of 70%). Until Monday, out of the 131, 763 coronavirus infected patients detected in Uttar Pradesh, 80,589 had been discharged from hospital treatment after recovering.

Dr Rajendra Prasad, former director of the Vallabhbhai Patel Chest Institute and former head of pulmonary department at King Geoge’s Medical University (KGMU), said the infection rate in Uttar Pradesh is 5-6% compared to 20% in Delhi and Mumbai at their peak in July. Uttar Pradesh is likely to reach its peak in September, and then start to plateau, he said. Prasad said Uttar Pradesh was working to ramp up testing. Until July 23, it had tested 1.705 million samples since the start of the pandemic. Until June 24 since the beginning of March, 600,000 samples had been tested. The state conducted a record 109,516 tests on August 20, taking the total tally of tests to upwards of 4.18 million. The state is conducting more tests than the 140 samples per one million target prescribed by the World Health Organization (WHO), he said.

To be sure, although daily testing has picked up, overall tests per million is 18,600, significantly lower than the national average of 25,109. In contrast, other highcaseload states such as Andhra Pradesh, Tamil Nadu, Karnataka and Maharashtra have all fared far better than UP with 58,881, 52,693, 34,300 and 27,995 tests conducted per million residents, respectively (Chart 2).

Laboratories in the state are testing 35,000 to 40,000 samples daily; in March, a mere 60 samples were tested daily. The state government is also increasing the number of laboratories for Covid-19 testing. In March, the samples were being tested only in KGMU, the count of labs conducting the tests have increased to 33.

Uttar Pradesh has set the target of conducting 60,000 to 80,000 rapid antigen tests per day.The state is working to increase the number of RT-PCR tests from 35,000 daily to 50,000 to 60,000.

Around two-thirds of all tests in the state are antigen tests, much higher than the national average. A high dependence on antigen tests, which throw up more false negatives (they identify infected people as uninfected), leads to two major problems – under-detection of cases, and tilting data metrics such as positivity rate and case distribution, HT reported on Thursday.

Despite the increase in testing, the positivity rate in the state has not changed much. According to recommendations by WHO, the positivity rate from a region that has a comprehensive testing programme should be at or below 5% for at least 14 days before it can be considered that the outbreak is under control in the region. In case the positivity rate rises, WHO recommends increasing testing numbers for prolonged periods of time till the number drops below 5%.

In UP, although the positivity rate has remained relatively low, the low per capita testing numbers may be masking the true infection rate. In fact, despite the recent increase in number of tests, the positivity rate has not dropped at all (Chart 3), which may not be a good sign.

In mid-July, the state added seven new laboratories in the district hospitals of Gonda, Moradabad, Bareilly, Varanasi, Mirzapur, Aligarh and Lucknow. The state government has also decided to set up new laboratories in government medical colleges located in Jalaun, Ambedkar Nagar, Saharanpur, Banda, Badaun, Azamgarh, Ayodhya, Firozabad, Basti and Bahraich districts. The laboratories will test using the RT-PCR method.

Yet, experts caution that delays in delivering the test results is a cause of concern for both the patients undergoing the tests and the community at large.

“Reports should come the same day (as the tests are done). When you give a report on the fourth or the fifth day, crucial time is lost {in treatment},” .said Professor TN Dhole, former head of the department of microbiology at the Sanjay Gandhi Institute of Medical Sciences.

Experts say public flouting of Covid-19 protocols was a key reason behind the increase in the case tally. “A majority of offices are now open and while stepping out, frequently people forget to maintain protocols such as physical distance and wearing masks correctly,” said Dr Kauser Usman, a senior faculty member KGMU.