An increasing number of undocumented people are taking medications for Covid-19 symptoms but are not getting tested, and without contact tracing, tests become mostly irrelevant
Ever since Anju Monoara – a woman living in Kazipara, Dhaka – was diagnosed with Beta Thalassemia around two years ago, her body temperature sometimes increases.
Usually, the rising temperature is a sign of decrease in Anju's blood haemoglobin level.
About two weeks ago, the 36-year-old woman had a fever, at a time when the Mirpur area was dotted with the highest number of Covid-19 cases in the capital. Her family promptly separated her from others at home.
By the fifth day, she began suffering from a loss of smell and shortness of breath, sending out an alarm.
Her husband considered taking her to one of the kiosks set up at different points in the capital to collect samples for Covid-19 tests, or the labs that have been carrying out Polymerase Chain Reaction (PCR) tests for identifying novel coronavirus cases.
But, what if Anju had not contracted the virus? Why put her at a higher risk of getting the infection while standing in long queues for hours to provide her sample?
Anju stayed home and consulted a doctor. The physician also discouraged her from going through the hassle of being tested because of the delay in obtaining results, and prescribed treatment right away.
She had a cough on the eleventh day, but she felt less fatigued and an inhaler helped ease her breathlessness by that time.
Inadequate data for pandemic projections
Like Anju, an increasing number of people – who remain undocumented – are taking medications for Covid-19 symptoms, but are not getting tested.
There are realities that have brought this into practice. Doctors in and outside Dhaka say it takes five to ten days to get results. In one of the recent instances, a person named Mainul Islam gave his sample at Barguna District Hospital on June 5 and his report came out on June 12.
The result returned negative, but he needed oxygen support for days before he recovered and went home.
Amid the rush of suspected Covid-19 patients, samples pile up at the PCR labs, sent from upazila and district-level hospitals.
Some lots end up being discarded because their quality deteriorates and healthcare providers try to work their way back – searching for the suspected patients to collect samples again and transport those to the labs for retesting.
Meanwhile, patients, if not admitted to a hospital, might be spreading the novel coronavirus infection in their communities.
This is the backdrop against which clinicians are suggesting isolation and treatment with the onset of the signs because the country has already stepped into the fourth stage of the pandemic – when the infection is widespread.
Such a scenario brings into question how accurate the infection curve is, drawn from the 24-hour-cycle health bulletin by the Directorate General of Health Services (DGHS), based on PCR test results.
M Mushtuq Husain, an adviser to the Institute of Epidemiology, Disease Control and Research (IEDCR), said separate data should be recorded of suspected Covid-19 patients identified with symptoms and by alternative medical means like an X-ray.
And these numbers should be incorporated in the health bulletin to help understand the magnitude of the pandemic in the country.
"The partial picture that is portrayed by the partial data," as epidemiologist Kinkar Ghosh of Dhaka Shishu Hospital said, "makes the infection curve unpredictable."
Asked if increasing the testing capacity might fix the anomalies, Mushtuq said unless and until the virus transmission is contained, "it does not matter how much we intensify the testing – it will not reap any benefit."
Tests lose purpose
To contain the transmission, doctors or healthcare providers must follow up on every patient who has tested positive, isolate the person and trace their contacts to make sure they stay in quarantine. If any of the contacts begins showing symptoms, they should be tested too.
"The IEDCR had been doing all of this until April when the DGHS took over the job. That was followed by a significant leap in the number of tests being conducted every day, but the health directorate could not reach patients in many cases, let alone trace their contacts," said Mushtuq.
Contact tracing is a rigorous procedure and requires manpower.
At the Shishu Hospital, four of the five people involved in the process fell sick with Covid-19. The hospital's lab takes no more than 50 samples from the children's facility because it has to test samples from other private and public hospitals as well as from outside Dhaka including Brahmanbaria, Cumilla and Munshiganj.
Moreover, many hospitals refer patients to the facility for a Covid-19 test before emergency medical procedures – a heart operation, for example. On June 21, of seven outpatients from whom samples were taken, five needed urgent medical attention that depended on the test results.
About 35 percent of the children being tested come out as asymptomatic Covid-19 patients.
The Shishu Hospital had already stopped tracing contacts of outpatients because it was burdensome on the existing manpower. Now, tracing contacts of the inpatients has also become an uphill task.
With the mounting pressure for tests, doctors counsel guardians – especially mothers – to stay home with their children, isolated.