KOZHIKODE: It was no surprise that when Mohammed Sabith, the index Nipah case, was admitted to the Perambra Taluk Hospital and later the Kozhikode Medical College Hospital, the cause of the disease went undetected. He was just one among the 50 per cent undiagnosed fever cases in Kerala.
It was sheer bad luck that Sabith went on to become a source of the deadly virus spread due to lack of expertise or facilities to diagnose various types of fever at the taluk level or even Medical College hospitals.
For the past two decades, various kinds of fever have been reported in the state. They spread as patients mingle with others at hospitals before the cause of the disease is established. Finally, the time may have come to establish a separate fever detection mechanism at hospitals.
The need of the hour are not big labs, but point of care testing facilities. Point of care testing is defined as a medical diagnostic testing at or near the point of care - i.e. at the time and place of patient care. As of now, due to faults in diagnosis at the lower level, doctors administer the same treatment to patients with all kinds of fever. The 50 per cent of the diagnosed fever types includes influenza, dengue, scrub typhus, leptospirosis and Kyasanur forest Disease.
Dr G Arunkumar, head of the Department of Virus Research, Manipal University, said if these diseases are identified properly at taluk-level hospitals, the state can easily treat the 40-45 per cent of fever patients.
“The undiagnosed cases can be referred to higher-level health facilities and samples can be sent for testing at more equipped labs,” he said.
When facilities to identify these diseases at the taluk-level hospitals are set up, there will be a drastic change in how patients are treated. In dengue fever cases, patients succumb because of lack of diagnostic facilities at smaller hospitals. “Doctors at these hospitals fail to identify the dengue. The patient then reaches the MCH or private hospitals when the disease is at a critical stage,” he said. If a doctor at the taluk hospital is able to identify the disease, then the number of deaths can be contained. This also leads to a decrease in referrals to bigger hospitals.
“When the diagnosis of diseases improves at the lower level, it will help the MCH and others to concentrate on the 50 per cent of the undiagnosed cases,” he said.
As of now, the quality of point care testing is less. When it improves, the quality of diagnosis will see a marked change. For example, when point of care testing was widely used, the diagnosis of HIV improved, he said.
If point of testing facilities are set up at lower-level hospitals, all tests can be completed within a day. This will help doctors take decisions without delay.