The Karnataka Health Department on Wednesday said that it would continue testing deceased patients, who suffered from Influenza-Like Illnesses or Severe Acute Respiratory Infection (SARI), for the novel coronavirus. The same was confirmed by Pankaj Kumar Pandey, state Commissioner of Health and Family Welfare Services in a series of tweets.
This development comes a day after the clause pertaining to tests on deceased patients with a history of ILI and SARI was done away with by the state government. However, the Health Department restored the clause on directions from the government of India. Many COVID-19 patients have underlying ILI, SARI and other respiratory conditions even though they do not travel or contact history.
Dr Giridhar Babu, a member of the technical committee, which advises the state government to make interventions based on daily data of COVID-19 cases, said the decision was reversed based on the recommendation given by them. Dr Babu is an epidemiologist at Public Health Foundation of India.
“I cannot tell you why they took that decision in the first place but they have reversed it after we wrote to the Health Department,” he told TNM.
Accordingly, the Health Department said that it would collect swab samples within six hours of the death of such patients. In case of coronavirus positive reports, all primary contacts of the deceased would subsequently be tested. He said that the state government is committed to test more people for the coronavirus in an effort to control the transmission.
The move to not test deceased patients with related symptoms had attracted criticism from the epidemiology fraternity, who feared it would lead to further increase of untraced cases. Even the state’s nodal officer for COVID-19 testing Dr CN Manjunath expressed dissatisfaction over the move.
When asked about what led to the decision and the subsequent U-turn, Dr V Ravi, the head of Neurovirology at the National Institute of Mental Health and Neurosciences (NIMHANS) said, “You should ask this question this to the Additional Chief Secretary (Jawaid Akhtar).”
Dr Ravi is also part of the committee, which advises the state government to make interventions based on daily data of COVID-19 cases.
While TNM could not elicit a response from Pankaj Kumar Pandey or Jawaid Akhtar, a source claimed the decision was taken following a video conference between state and Union government’s health department officials.
Need for testing symptomatic dead patients
Karnataka is doing significantly better compared to other high-population states in terms of managing the COVID-19 pandemic, and this has been attributed primarily to efficient contact tracing, containment measures and testing.
Karnataka has 96.86 COVID-19 cases for every million population is the sixth highest in the country for the number of tests per million population, according to data tabled by the State War Room as of June 9. While the positivity rate of India on average is at 6%, Karnataka has a positivity rate of 1%, meaning 1 person tests positive for COVID-19 for every 100 people tested.
Further analysis by the War Room showed about 65% of 60+ years COVID-19 patients die if they have SARI. An official explained that it is important for persons who are elderly and who have comorbidities or who have SARI to reach the designated hospital at the earliest. He added that it is to be noted that most of the deaths occured when infected elderly or persons with SARI and other symptoms delay reaching designated hospitals.
“Average days spent at hospital by recovered patients is about 15 days but the average days spent in hospital of patients who died is about 3.5 days. So persons dying are reaching designated hospitals too late and hence, recovery becomes tough. So in case of breathlessness or SARI, patients should approach government designated fever clinics and get tested,” he added.
‘No shortage of test kits’
While it is unclear what led the Health Department top brass to take the decision of not testing deceased patients with symptoms, officials in the department denied that shortage of testing kits was an issue.
Dr N Manjushree Additional Director, Karnataka State Drugs Logistics and Warehouse Society (KSDLWS) confirmed the state has enough stocks of Reverse Transcription Polymerase Chain Reaction (RT-PCR) kits to perform 10,000-plus tests everyday for the next 30 days.
Until May 18, the state, on average, was testing less than 5,000 daily. It began performing more than 10,000 daily tests since May 28. So far the highest single day tests were done on June 3 with 15,197 tests.