THIRUVANANTHAPURAM: With the state reporting high number of daily Covid cases and TPR continuing to stay above 10%, health experts have asked authorities to revise strategies to tackle the pandemic. IMA calls for more RT-PCR than antigen tests
Notwithstanding the relief brought by the launch of Covid-19 vaccination, the increasing spread of the pandemic continues to be a cause for major worry in the state.The state accounts for 40 per cent of the total active cases in the country, with a test positivity rate (TPR) — indicating the spread of infection — six times higher than the national average.
The weekly average of TPR has crossed an uncomfortable 10 per cent. At 30,000, the case per million is the worst in the state, after Delhi. All these factors have raised concerns among health experts, who have called for a revision in the strategies to tackle the pandemic.
The Indian Medical Association (IMA) has warned the state government to act fast before the situation becomes dangerous. The association has cited the situation in Ernakulam and Kozhikode districts, which have been recording high number of daily cases for some time and have recently achieved the dubious distinction of crossing the one-lakh mark in total confirmed cases.
The IMA has not only questioned the relaxations in restrictions that reportedly led to a surge in cases but also the Covid containment strategies of the government. The IMA said the state must do more RT-PCR tests to identify Covid patients. It also urged the government to enforce isolation and observation more strictly.
“There has been a marked departure from the Covid-appropriate behaviour. While it is important to bring life back to normal, it should not be done by playing with the lives of people. More stringent measures will have to be brought in sooner than later,” said IMA state president P T Zacharias, in a statement. “The high rate of virus spread is a matter of concern. It could be because of the new mutation, faulty testing methods, demographic peculiarity etc. We need to introspect and find a solution,” said Padmanabha Shenoy, immunologist and rheumatologist.
The IMA has also joined the experts in seeking measures to improve contact testing and surveillance testing which, according to them, have ceased to exist. “The testing strategies have been changed to focus mostly on symptomatic patients or those with high pre-test probability,” said a source.
However, a section of experts do not consider the current situation alarming. R Aravind, Infectious Diseases Department, Medical College Hospital, Thiruvananthapuram, said the state has been managing the situation well. “It is not a worrying trend. What we are seeing is a continuation of the long plateau of daily cases being reported in the last four to five months,” he said.
According to him, many countries have stopped relying on TPR to decide on the Covid strategy. “The strategies adopted in the initial stage of the pandemic should not be the ones used when it is in progress. Even the WHO has raised the recommended TPR level from 2 to 5,” he said. Meanwhile, the state health department has been tight-lipped on the new situation. Despite repeated attempts, Health Minister K K Shailaja could not be contacted. Director of Health Services Dr Sarita R L said she was not authorised to speak to the media.
Antigen vs RT-PCR test
Health experts have questioned the over-reliance on antigen tests, which are only 50 per cent sensitive compared to the RT-PCR test — considered the gold standard test for Covid-19.
Antigen tests form 66.25 per cent of the 92,89,304 tests conducted in the state so far. For testing, the state uses various kinds of antigen kits approved by the Indian Council of Medical Research (ICMR). However, the varying results of antigen tests have caused confusion among the public. There have been reports of antigen tests of the same person giving different results.
“The trouble is when a person tested positive in an antigen test goes out with a negative certificate after another test,” said a source. “There has been instances in which the antigen tests were rejected for giving unreliable results.” According to him, false negative results would lead to further spread of infection. The Center for Disease Control and Prevention of the US, has prescribed PCR test for persons testing positive in antigen test.
However, ICMR has issued no such guidelines. Here, all antigen positives are considered Covid positive cases. “Each new batch of antigen test kits should be validated with PCR test,” said Padmanabha Shenoy. According to R Aravind, there is a growing tendency in developed countries to rely on antigen tests as the containment strategies have shifted focus to symptomatic and vulnerable population.