This month, Gujarat saw its Covid-19 testing policy revised twice, largely owing to the scrutiny it came under before the Gujarat High Court.
In June till date, the state has tested more than 1.02 lakh samples, which was a third of the total tests since the first case was reported on March 19. On Friday, the Ahmedabad Medical Association (AMA) pushed for 40,000 tests in a day before the HC.
In addition a letter dated June 19, sent by director general of ICMR Balram Bhargava to all state chief secretaries advised ramping up testing in containment zones and even primary health centres by not just RT-PCR method but also antigen testing and other confirmatory tests like CBNAAT and TrueNAT. The ICMR has also recommended rapid antigen testing for “asymptomatic high risk contacts” of positive patients. Gujarat is yet to start antigen tests.
As per the Covid dashboard, on June 17, Gujarat tested 7,228 samples in a 24-hour cycle, marking a new high. Notably, for the month of June, testing has not dropped below 4,300 and there were only six days when testing was less than 5,000.
The increased testing capacity has come only after the government reluctantly opened up testing at private labs and did away with the hospitalisation clause on June 11. Since June 11, nearly 41,400 tests were conducted. After the unlocking on June 1, the average cases reported daily from the state has gone up to 450-500, from 300-400
Justifying the various testing policy revisions, a top state health department official explained that as a government body it was better to be “conservative,” and went on to add, “in fact, we were one of the first states to go even beyond the ICMR guidelines where the ICMR did not prescribe tests prior to any operative procedure but we did.”
However, this had come with a caveat in Gujarat where such testing prior to operative procedures required approval of a government nodal authority such as the chief district health officer or the medical officer of health or a medical superintendent. This policy saw pushback from the medical fraternity and after directive from the Gujarat HC, on June 2, the health department issued a fresh notification permitting pre-operative testing minus government authority’s nod, but added another clause where only indoor patients, that is those admitted in hospitals first, could be tested.
A Vadodara-based retired professor, who has been advising the local administration with respect to Covid-19 related issues, said, “The idea behind requiring hospitalisation prior to testing (as per June 2 notification) was to prioritise patients. If one had severe symptoms, they would require hospitalisation anyway and with samples restricted to the priority patients, the results can come sooner, which is important to decide the course of treatment and also serves the purpose of protecting the frontline health workers. The idea is not to deny anyone the right to get themselves tested but the challenge is to strike a balance between judicious mix of testing in a not too delayed manner versus restricting testing at the first signs of symptoms. Symptoms should be evaluated along with exposure, if a said person came in contact with a positive person and other such factors (particular to covid19).”
The state health department official also added that the rationale behind restricting testing was to “control the panic” and contain scope of “irregularities” in private laboratories. Delhi private labs had faced allegations of profiteering. Gujarat’s decision to gate-keep testing in private labs resulted also from the fact that though the private laboratories charged Rs 4,500 per test, “the actual cost ranged at around Rs 2,500”, said the government official.
“We felt that when we (government labs) had the capacity, and when we had entered a rate contract of Rs 2,000 with private labs in case of overflow, we did not feel the need to open up. Else it can lead to misuse also. Plus the sensitivity of this test (which is at nearly 70 per cent) can also give false negatives,” said the official.
Government and private functionaries, however, agree that permitting tests for all is not viable “because it only gives a false sense of security.”
“People who can afford a test in a private lab are those who can (afford to) have the option of home isolation where they may have a room with an attached bathroom and a caregiver… But at the time when numbers are going up, if we had opened up the tests as well, it would have been a little chaotic… Testing is not treatment,” said the official.
Some experts believe that the latest revision of June 11 that permits a test for a symptomatic patient if prescribed by an MD doctor, “may not necessarily be coming from a scientific point of view but may have had the public sentiment factored in.” Now the demand is to allow MBBS doctors prescribe a Covid-19 test as that would give access to rural areas.
Gujarat at present has 34 laboratories approved by the ICMR to conduct RTPCR tests for Covid-19, 20 of them government labs and the remaining are private. 24 of these are labs situated in the three districts of Ahmedabad, Surat and Vadodara. However, as has been pointed out at the Gujarat HC by the Ahmedabad Medical Association, seven labs — two government and five private — are awaiting approval from the state authorities. The AMA is also seeking testing laboratories in each of the 33 districts.
📣 The Indian Express is now on Telegram. Click here to join our channel (@indianexpress) and stay updated with the latest headlines