When people were initially (January-February 2020) dragged to the testing centre for novel coronavirus testing, many had wished and prayed even to God that they should turn negative for the virus purely due to the senseless quarantine process and associated social stigma. But in due course of time, the Government of India and several states have shown high sensitivity and wisdom in diluting the norms and as on date, only the symptomatic people needs to be tested and otherwise the person is assumed to be negative for the virus.
This sensitivity shown by the Government led by Modi and several states has made the life of people easy and fearless.
The big question is, should we turn negative or positive if we were forced to take COVID 19 test?
Many may wish, they should turn negative for the virus, but turning negative has a catch and risk. The risk is high when someone who does not have any symptom; fever and otherwise absolutely normal but is forced to take the test purely because of a possible contact history.
In several ways, the negative result can pose risk and confusion than corona positivity. The above speculation or possibility includes all odds, such as error in test, sampling, and inefficiency of the chemist, sensitivity and specificity of RT-PCR etc.
Before we enter into the scientific aspect of the risk possibility associated with tested negative for coronavirus (those people who were dragged for testing without any symptoms), we must ask a fundamental question, when onward a person may show the viral genome by RT-PCR from the date of contraction of the virus?
Let us assume, today a person has contracted the virus and coincidently he or she has given sample for RT-PCT test on the same day. The sample may be process on the same day and the result may be shared, if he or she is positive for the virus. Otherwise no information will be provided to the person and therefore it is confirmed that he or she is negative for the virus, the person was negative for novel coronavirus.
Imagine, after two or three days if the same person develop fever and other clinical symptoms of COVID 19, the probability of person assuming his or her medical problem to be not COVID 19 is quite high because, from their point of view of scientific logic that just two or three days prior to his sickness only he was tested negative for viral genome.
The above tested negative for coronavirus may create two sets of dangers viz.,
- The person may neglect or may view his medical problem casually due to test negativity for coronavirus and may slip into advanced stage of COVID 19 and only then he may seek medical care. By the time it could be too late to do anything for the patient.
- Due to the high probability of his relatives and friends also to assume his or her (due to test negativity for the virus) problem to be not COVID 19 is high and hence the chance of others contracting the virus from such source is high.
Should the Government and test centres tell to all those who turned negative for the virus that they have nothing to celebrate due to test negativity and instead must watch out for symptoms? If we serve such unnecessary warning, are we not ridiculing the very meaning of RT-PCR test? To serve the above warning why should we conduct test and instead we can tell everyone in India are positive for the virus but medical support is required only when there is any health complication.
Can we afford to stand firm just to prove our science is right, argue that the person was negative for the virus on a particular day but the very next day the person would have contracted the virus and hence turned positive? Then how many tests we need to conduct and at what frequency? If the person confirms to strict quarantine, then from where else he or she would have contracted the virus?
It is always wise to test people only those with symptoms and not based on possible history of contact. We are virtually living in a ‘World of Corona’ and therefore any day we may contract the virus and in most instances, the source can be understood only at notional level. Therefore symptoms and signs of disease should be the norm for testing and those with obvious history of contact with a positive individual may be at best advised to follow self-quarantine and observe for any clinical signs for at least 5-10 days for to decide whether any testing should be done or not and hospitalized treatment is required.
Testing for the virus is only a part of the diagnosis and not treatment because COVID 19 does not have any proven drug, despite diagnosis. Many people often confuse over testing and treatment.
In a country like India, through quarantine and regular testing methods, we cannot prevent the spread of the virus. Instead we must focus on possible medical care and treatment to the acute COVID 19 patients. Even those with mild symptoms should be encouraged to follow simple self-medication norms instead of complicating their life. Those virtually with no symptoms must be allowed to live freely.
In a country like India, diagnosis of the disease or early detection of the pathogen either to treat the patient or to prevent the spread of the pathogen and disease, is not that easy. We must realize the above bitter truth. Further various government departments availing the test facility because it is free of cost when obviously there is no such requirement (testing people without any symptoms) must be avoided so that the usefulness of the test kit meant for the poor people can be achieved easily.
The privilege and freebie (free COVID 19 test) the government department should avail only when the officials or staff show signs and symptoms and not on those who are hale and healthy. Because someone tested positive or tested negative means nothing as long as the virus is not eliminated from India.
The test can give only the present state whether the viral genome is at detectable level or not by RT PCR. More than the virus, we must worry about the medical complications and the risk/vulnerable group. Instead of the above, keep testing people and declaring negative can only lead to greater complication.
The null hypothesis that we must follow is that all Indians are positive for the virus and the test must be conducted on those who present clinical symptoms of the disease.
There are several people with definite history of contact with the corona tested positive individuals have not even contracted the virus. When such is the reality, testing norm should be more practical and sensible and should not lead to greater complication later.
A person tested negative today and if he developed COVID 19 the next or subsequent day will be forced to assume the problem is not due to coronavirus and may ignore or treat the problem lightly until the problem become worse. To avoid such scientific and statistical risk probability, COVID 19 testing must be conducted only on those with symptoms and complaint and not on those who are healthy. Regular temperature monitoring through infrared thermal gun alone is sufficient.
Another important dimension also government must recognize about RT-PCR testing. The RT-PCR testing was done more to prevent the pandemic than for the diagnosis because no treatment is available for the disease.
Therefore the diagnosis is more for preventing the disease transmission than for treatment. Considering the scientific details available about the virus and the disease as on date, even RT-PCT testing can be abandoned fully because it does nothing but siphoning the money of government or may give some additional revenue to corporate hospitals.
Let people with complains of COVID 19 reports to the hospital and they can be treated. If people could manage the problem at home, let us encourage and support such system. The testing cost can be diverted to better health care and medication because RT-PCR test based diagnosis is not going to help us to offer better and early treatment or to prevent the spread of the disease. Let us understand the risk of corona tested negative to stop the testing and start treating the patients.
Written by Dr S Ranganathan.
Follow him @drsranganathan