COVID-19 tests being ‘controlled’, decreased

Prothom Alo    7 July 2020

Public health experts say that if the government records less coronavirus cases by carrying out less sample tests, the problem won’t be solved. Hiding the actual situation will simply put everyone at risk

A health worker collects a swab sample from a child at Mugda Medical College and Hospital, as the coronavirus disease (COVID-19) outbreak continues, in Dhaka, Bangladesh, on 23 June 2020
A health worker collects a swab sample from a child at Mugda Medical College and Hospital, as the coronavirus disease (COVID-19) outbreak continues, in Dhaka, Bangladesh, on 23 June 2020Reuters

The number of tests to detect coronavirus cases needs to be increased in the country, but instead the tests are being ‘controlled’. No samples are being collected unless there are four symptoms of fever, cough, sore throat and respiratory problems.

Directives to this end have been issued to the district civil surgeons. The imposition of a fee and inadequate number of kits is further disincentive to sample testing.

Towards the end of June, 17,000 to 18,000 samples were tested. But over the last four days, from 3 July to 6 July, only 13,000 to 14,500 samples are being tested.

This is 14,890 less samples tested than in the preceding four days from 29 June to 2 July.

One in every five samples being tested is proving to be positive.

Public health experts say that if the government records less coronavirus cases by carrying out less sample tests, the problem won’t be solved. Hiding the actual situation will simply put everyone at risk.

Member of the government’s national advisory committee for coronavirus and former vice chancellor of Bangabandhu Sheikh Mujib Medical University, professor Nazrul Islam, told Prothom Alo that even if there were at least 20,000 tests a day, the trend of the virus transmission could be ascertained.

The Directorate General Health Services (DGHS) has offered no explanation as to why the number of tests is decreasing instead of increasing. From the end of May, the number of positive cases has increased in ratio of the tests. Increased numbers of tests are required at this point.

Ever since coronavirus broke out in the country in March, experts have been stressing on the importance to increase sample testing. The World Health Organization (WHO) has also been calling for increased testing.

Speaking to two divisional health directors and three civil surgeons, it was learnt that there are quite a few reasons that the testing is being controlled. These reasons include cutting costs on detecting coronavirus cases, inadequate number of kits, lessening pressure on the government testing centres, avoiding the number of untested samples from piling up and avoiding unnecessary tests of people without symptoms.

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A divisional health officer, on condition of anonymity, told Prothom Alo, one in every five samples being tested is proving to be positive.

It takes the government around Tk 3000 per test. That means, one patient is being detected for every Tk 15,000. The government is testing more or less confirmed patients in order to cut these costs.

Even after the decision to test only those with symptoms, the rate of detection has hardly changed. On 26 June, 18,498 samples were tested and the detection rate was 20.91 per cent. On 5 July, 13,988 samples were tested and the detection rate was 19.57 per cent.

If a coronavirus patient tested negative twice, only then the physician would issue a release order. That is not being followed in government hospitals. A civil surgeon said that by not conducting these second and third time tests, a lot of kits are being saved.

Spokesperson of DGHS, assistant director of the health emergency operation and control room, Ayesha Akhter, told Prothom Alo, there are many reasons for the decrease in tests. Recovered patients are not being tested for the second or third time. Due to the floods, it is difficult to collect samples from certain districts.
People wait in the queue outside of a coronavirus testing center as the coronavirus disease (COVID-19) outbreak continues in Dhaka, Bangladesh, on 2 July 2020

People wait in the queue outside of a coronavirus testing center as the coronavirus disease (COVID-19) outbreak continues in Dhaka, Bangladesh, on 2 July 2020
Reuters

With the imposition of the fee, many people are not testing needlessly. The government is first identifying patients who have the symptoms. Preparations are on to take the entire sample collection system online and so samples collection has lessened at the BRAC booths.

From the very outset there has been criticism about the insufficient number of tests being conducted in the country. According to the real-time statistics website Worldometer, Bangladesh ranks 146 among 215 countries in number of tests in proportion to its total population. Among countries with above 100,000 COVID-19 cases, Bangladesh conducts the least number of tests after Mexico.

Less sample collection at booths

The non-government voluntary organisation BRAC collects samples for coronavirus tests at booths in Dhaka, Narayanganj, Savar and Gazipur. Every day 30 samples would be collected in each booth. Speaking to concerned persons at three booths in the capital city, it was learnt that only 15 samples are being collected per booth over the past 20 days. Of these 15 samples, 10 are being done by online registration and 5 directly from the booths.

Samples testing decreases due to fees

The health services division determined a fee from 29 June for government sample testing. It costs Tk 200 to test a sample at the booth and Tk 500 for the sample to be collected from home. Prior to that, from March the government samples testing had been carried out free of cost.

People sit as they come to a coronavirus testing centre in the Mugda Medical College and Hospital as the coronavirus disease (COVID-19) outbreak continues in Dhaka, Bangladesh, on 2 July 2020

People sit as they come to a coronavirus testing centre in the Mugda Medical College and Hospital as the coronavirus disease (COVID-19) outbreak continues in Dhaka, Bangladesh, on 2 July 2020
Reuters

Speaking to Prothom Alo, the Dinajpur civil surgeon Abdul Kuddus said, the number of sample tests have almost halved since the fee was imposed on sample testing.

Patients released without tests

If a coronavirus patient tested negative twice, only then would the physician issue a release order. That is not being followed now in government hospitals. A civil surgeon said that by not conducting these second and third time tests, a lot of kits are being saved. That is the main reason such a decision has been taken, he said.

Experts said that if antigen tests are positive, then the possibility of RT-PCT tests being positive is 100 per cent. Anyone can do antigen tests anywhere very easily and at low cost. It takes 20 minutes to carry out the test.

Physicians of two hospitals assigned for coronavirus treatment have said that once a patient recovers and shows no symptoms for three consecutive days, he or she is considered recovered and then released. However, physicians of private hospitals say that a patient is only released after testing negative.

No testing in new districts

On 18 June, during the regular bulletin, the director general of DGHS Abul Kalam Azad said that RT-PCR tests would begin as soon as possible at the district level. However, 20 days on, no coronavirus testing centres have opened in any new districts. There are still no testing centres in 42 districts of the country.

Civil surgeon of Brahmanbaria, Ekram Ullah, told Prothom Alo that they had applied to DGHS a month ago for a testing centre to be set up in the district. They still have no idea when this will be done.

Call for antigen tests to be started soon

On 3 June the government’s national advisory committee called for antigen tests to be started soon. Experts said that if antigen tests are positive, then the possibility of RT-PCT tests being positive is 100 per cent. Anyone can do antigen tests anywhere very easily and at low cost. It takes 20 minutes to carry out the test.

Former director of disease control at DGHS, Be-Nazir, speaking to Prothom Alo, said, the scope of testing must be expanded to the community clinic level. This will require, along with the PCR method, to immediately start up antigen testing with rapid kits. He said, the number of tests must be increased now. Tests must be conducted if there are one or two symptoms or even no symptoms at all.

This report appeared in the print and online edition of Prothom Alo and has been rewritten in English by Ayesha Kabir.

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