Dozens of patients, including some doctors, whose Computed Tomography (CT) scan revealed acute lung involvement, suggestive of viral pneumonia, have refused to undergo COVID-19 tests. Doctors cite fear of being tracked by health workers, contact tracing by the police and the stigma of isolation in neighbourhoods as reasons.
Despite having associated symptoms like dry cough, sore throat and fever these patients have chosen not to undergo RT-PCR tests for the diagnosis of COVID-19, and instead, have decided to quarantine themselves at home.
By not undergoing the Indian Council of Medical Research (ICMR)-recommended treatment protocol, these patients have not just risked their lives, but have also exposed their families to the infection.
A worrying trend
“The trend is worrying because we will be missing out on testing their family members, friends and contacts, which is crucial in containing the spread of the virus. If CT-Chest reports reveal lung involvement, the patient must undergo a test for COVID-19. This should be made mandatory and not optional. The State Health Department should send an advisory to all scan centres that if CT-Chest reports indicate viral pneumonia, the authorities concerned must be alerted,” said senior interventional cardiologist D. Prabhakar.
Since the Tamil Nadu government allows asymptomatic patients testing positive for COVID-19 to remain under home quarantine, there is no need for anybody to think that they will be hospitalised or isolated in a government facility, he said. “By not disclosing facts and refusing to undergo tests for COVID-19, people who know they have the virus will only be doing more harm to themselves and society,” he said.
False negatives
While patients with symptoms refusing to undergo COVID-19 tests and walking away from private hospitals or nursing homes is one issue, there is another dimension to pandemic management that has turned a challenge for healthcare professionals — the case of patients getting negative RT-PCR test results. This when their CT scans suggest the infection.
According to senior consultant, Infectious Diseases, Apollo Hospitals, V. Ramasubramanian, there have been many cases where CT scans and other health parameters have indicated the presence of COVID-19, but RT-PCR test results have returned negative. In such cases, patients have to be convinced that they were infected, so that isolation and treatment protocols can be commenced.
“I saw at least two cases in March where RT-PCR tests came out negative but clinically I was fully convinced that the patients had COVID-19. In a more recent case, a patient who underwent a renal transplant tested negative, but the CT scan suggested otherwise. I had to explain to the patients how their clinical diagnosis clearly suggested the presence of the virus. There is no universal standard for COVID-19, there will always be an exception. RT-PCR is only 70% sensitive…we have to consider other health parameters to diagnose,” Dr. Ramasubramanian said.
P. Balaji, dean, Government Stanley Medical College Hospital (GSMCH), Chennai, said that when patients presented symptoms of COVID-19, doctors convinced them to undergo an RT-PCR test. “If patients do not cooperate, we contact their family members and explain the necessity for conducting the test for COVID-19. In case they too are not convinced, we involve Chennai Corporation health officials to ensure that the patient undergoes the test. There is no question of allowing a person suspected to be carrying the virus to go untested,” he said.
C. Sridhar, head of the Department of Medicine, GSMCH, said that patients who tested negative in RT-PCR tests, but had strong symptoms of COVID-19 like lung involvement or other classic symptoms suggestive of the virus were being admitted to the triage ward until confirmation. “Patients whose RT-PCR test results come out negative, but who have symptoms, are less likely to transmit the virus. However, we take all due precautions to separate them from the others…a follow up is also conducted after their discharge from the hospital,” he said.
