In Marathwada, fear and stigma stop symptomatic patients from going for RT-PCR or antigen testing

Many going in for unprescribed, expensive blood tests and chest CT scan; others fear government could seize body in case of death and deny proper last rites to families.

Fear psychosis and social stigma associated with Covid-19 is causing a section of people in towns and villages of Marathwada to avoid RT-PCR or rapid antigen testing and, instead, opt for expensive, and often unnecessary, chest CT scan and multiple blood tests.

Private clinics provide out-patient consultation or hospital admission to such persons, treating the ailment as a “Covid-like illness”. Doctors, however, said this resulted in substandard treatment and delay in providing life-saving antibiotics. They added that it also resulted in increased mortality and unabated spread of the virus among family members in absence of any safety protocol.

By visiting multiple hospitals and clinics, The Indian Express has found that those with symptoms of Covid-19 are going in for unprescribed blood tests for biomarkers, such as C-reactive protein (CRP), D-dimer, lactate dehydrogenase and ferritin, to determine severity of the illness. Many are also going in for a CT scan of the chest to see if pneumonia has set in, even before they go to a doctor.

While RT-PCR and antigen testing are done free of cost at government hospitals and may cost Rs 750 to Rs 1,200 at private facilities, biomarker tests and CT scan cost more and may prove harmful in the long run.

Dr Ravi Shinde, a physician in Pathri town of Parbhani district, whose Varad hospital is the only facility with Covid infrastructure in the town with a population of about 40,000, said patients were extremely reluctant to go for RT-PCR or antigen testing.

“It’s very difficult to persuade them to go for a Covid test. There is a great degree of fear about the infection in rural areas and minority communities. In the initial days of the pandemic, the infection was stigmatised, and that still persists. Then there are some who are Covid deniers. Many patients reach the hospital with blood test reports and CT scan already done. In most cases, these reports are unnecessary,” said Shinde, adding that such patients, in the absence of a definite diagnosis, continued to spread the virus among family members and others.

Dr Shinde also said lack of a solid diagnosis affected the treatment given to the patients. “Compared with patients whose illness is clinically diagnosed as Covid, those who are reluctant to get tested receive substandard treatment, especially during the first few days of admission. This group may have higher mortality rate,” he said.

Apart from fear and stigma, patients and their relatives worry that a report confirming the infection would lead to the body being seized by the government in case of death, thereby denying the family of conducting the last rites.

Abdul Khalid, son of Abdul Hassan (68), who reached Parbhani’s Hayat Hospital complaining of extreme fatigue, weakness and chest pain, said on the advice of a relative, who had suffered in a similar manner, he got his father tested for CRP, D-dimer, and even got his chest CT scan done before heading to the hospital.

“I was told that these tests will be enough to start the treatment. If it is so, testing for Covid is unnecessary and will create panic in the family and also cause trouble in conducting a proper funeral in case something bad happens,” Khalid said.

Nandikesh Kadam, who works with a prominent diagnostics laboratory in Parbhani, said dozens of patients were undergoing Covid-related tests without a prescription on a daily basis. “After developing symptoms, people consult with others who have suffered in the past and may know a few things about these tests. They go for a ‘Covid profile’ (a group of biomarker tests indicating degree of inflammation and immune response) and often for a CT scan. If these indicate considerable severity, they approach a doctor. If the inflammation is low and pneumonia hasn’t set in or is mild, they manage it at home,” Kadam said.

Dr Subhash Salunkhe, adviser to the state government for Covid-19 response, said this was a real problem, if only in private hospitals, and would require determined awareness campaigns to dispel the fear and stigma associated with Covid. He added that it would also need active effort from private medical practitioners to instil confidence among patients and their relatives to go in for proper diagnosis.

Dr Salunkhe, however, also said the state government had directed not to deny admission to patients in the absence of a Covid test. “We have directed doctors not to wait for a Covid test report and to start treatment depending on clinical symptoms. But they must conduct either RT-PCR and antigen testing because these are important diagnostic tools that determine the course of treatment,” he said.

He added that he will raise the issue during a meeting of the state’s task force and ensure that a message was sent to medical associations across the state that private medical practioners must press for proper diagnosis through Covid testing.

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