COVID-19: Is Telangana turning away symptomatic people with no contact history?

It has been a taxing few days for 33-year-old Padma Priya, a journalist based out of Hyderabad. After developing a fever five days ago, she decided to visit King Koti Hospital in the city to get tested for COVID-19. What followed highlighted the severe discrepancies in existing testing protocols, particularly the reluctance of officials to test those who have symptoms of COVID-19 if they do not have contact or travel history. In fact, Padma Priya was told she has 85% symptoms of COVID-19 and still denied a test.

“Before I even went to the hospital, I tried contacting someone via the helpline numbers. Neither 104 nor the landline number were working, and given that I have a baby at home, I didn’t want to go to the hospital right away,” she said. However, she decided to visit the hospital after she was not able to reach anyone via the helpline.

Five days ago, she developed a fever and subsequent cold and cough. She also had a sore throat and severe body and joint pain. Despite having taken paracetamol, her fever did not subside over the course of a few days. She also noticed that there was a significant loss in her ability to smell and taste, symptoms which have been accepted by experts across the world as being indicative of COVID-19.

The doctor who examined her at the hospital refused to admit her for testing, even though he acknowledged that her symptoms matched COVID-19 – she was told she has 85% of the symptoms. Instead, she was told to go home and take antibiotics and to return if she developed any symptoms of SARI (severe acute respiratory infection), such as shortness of breath. It was only after several people took cognisance of the issue on Twitter, where she had shared her experience, did officials concede to test her.

“Not only did they outright say that they wouldn’t test me, the doctor also stated that even if I did have COVID-19, that I was ‘young enough’ that my immune system would fight it off,” she said.

Padma Priya is not the only one. There have been several incidents (most of which have gone unreported) of individuals with symptoms indicative of coronavirus disease not being tested in view of the protocols laid down by the Telangana state government. Many of them are being sent back from the outpatient (OP) wards of Gandhi Hospital and King Koti Hospital, located in the city.

A similar incident took place near Bhavani Nagar police station in old city earlier this week, where a woman tested positive. Following this, three of her primary contacts – her two daughters and a son, tested positive, while one son tested negative.

"Since Saturday night, the landlord, an old lady who stays in the same building, is showing all the symptoms of the virus, from fever and headache to body pains. But authorities are asking her to go to the OP ward at King Koti Hospital where doctors will take a call after checking on her, whether to conduct a test or not as she is a secondary contact and had not directly interacted with the positive patients," a source said.

"In many cases, people are being sent back and asked to stay at home without a test. Even asymptomatic primary contacts are not being tested in some cases. If they take samples, and the samples return positive, only then are the patients being shifted to the hospital," the source added.

A junior doctor who is involved in the frontline also confirms this. "Many times, we are asked to send back patients if they do not have any history of travel or contact. Some of us feel this is wrong, but we are just obeying orders. The state has to conduct more tests. Since the guidelines were framed, we have been testing even less than what we were doing before," he told TNM.

Sources said that the change in testing was implemented after an order by Chief Secretary Somesh Kumar dated April 22, which said, "Asymptomatic secondary contacts shall not be tested. They shall be identified, stamped and placed in strict home quarantine for a period of 28 days and monitored daily by the local multi-disciplinary surveillance teams."

The order came as a surprise to many, as in hotspots, especially in Hyderabad, several secondary contacts have tested positive for the coronavirus. Many of them were also asymptomatic.

This, despite Hyderabad reporting over 500 cases of COVID-19, with the Centre saying earlier this week that the situation was "especially serious" in the city, and other major cities like Ahmedabad, Surat, Chennai and Thane.

An Inter-Ministerial Central Team (IMCT) is also currently on a visit to Hyderabad to assess the situation. The five-member team led by Arun Baroka, Additional Secretary, Ministry of Jal Shakti, has been briefed by Director General of Police Mahender Reddy and Chief Secretary Somesh Kumar on the measures taken by authorities to check the spread of the coronavirus.

Telangana lags in testing

Hyderabad has been recognised as a hotspot of COVID-19. As per guidelines issued by the Indian Council of Medical Research (ICMR), individuals who live in hotspots who develop symptoms indicative of influenza-like illnesses (ILI) must be tested via RT-PCR within seven days of falling ill. RT-PCR, or real time polymerase chain reaction, is the standard test used to confirm if someone has COVID-19.

The World Health Organisation (WHO) has defined ILI to be any acute respiratory infection wherein the individual also has a fever and cough within a span of 10 days.

Many point out that the state is lagging behind in the number of tests being conducted. As of April 19, the state government said that it had conducted 375 tests per million people compared to the national average of 254. It also said that it had collected 14,962 samples and had a testing capacity of 1,560 per day in nine laboratories in the state. While Telangana is faring better than the national average, it is still behind states like Maharashtra, Kerala and Karnataka.

In neighbouring Andhra Pradesh for example, 68,034 tests have been conducted as of 9 am on April 26, according to data put out by the state's health department. The state has claimed that it is testing at a rate of 1,274 per million people.

Speaking to TNM, Dr Srinivasa Rao, Director of Public Health of Telangana, stated that guidelines issued by the ICMR were being followed with respect to testing.

“We are testing all the symptomatic people who report (themselves),” he stated adding that those individuals with SARI symptoms are tested while individuals with ILI are tested if the symptoms worsen. “Not all flu-like symptoms are indicative of COVID, therefore not all those with ILI are tested. We are following protocols issued by ICMR.”