Delay in COVID-19 test results at Delhi’s RML Hospital causes confusion, increases risk of virus spread

An analysis of the COVID-19 swab tests of a month conducted at Ram Manohar Lohia Hospital under the Central government in Delhi have shown that the results of more than half of the COVID-19 tests are delayed by at least a week, sometimes 10 days. After 10 days, at least one-fourth of the results come back as ‘indeterminate’, forcing the person to undergo another test before a conclusive result. The hospital conducts an average of 400 tests a day.

According to the hospital authorities, the delay has occurred due to a shortage of testing kits. And this is state of affairs in the Capital of the country. Contrary to the experience in hospitals, Indian Council of Medical Research deputy director Dr Raman R Gangakhedkar said on May 2 that the country can conduct 1.25 lakh tests a day.

As per the health department guidelines, labs are required to send their test results with 24 hours, but not later than 48 hours.

This delay has raised the heckles of both the staff and the suspected patients as they have been made to repeat the tests again. Results of at least 30 tests conducted on May 12, came back as ‘indeterminate’ on May 19, eight days after the initial test. And they came with the note that the test must be conducted three days later again. At least 65 tests which were sent to the lab on May 8 came back only on May 16. On April 30, results of 46 tests came back as ‘indeterminate; the tests were sent on April 24.

There is delay even in the case of negative test results. Results of at least 65 persons which were sent on May 8, came back on May 16 as negative. Tests of another 60 people taken on April 25 came back negative five days later on April 30.

To complicate the matters further, the lab doesn’t mention the date of sending the results back to the patient, in case there has been a delay of more than 10 days. Results of several tests which were conducted on May 10, came back positive only on May 22.

On May 22 afternoon, a medical staffer working with Ram Manohar Lohia Hospital in the National Capital got a call from the local municipal corporation informing him that he had tested positive for COVID-19. The call surprised and shocked him. The test results had come after 12 days of the test being conducted. By then his quarantine period was over and he had been in his ward for six days already.

The healthcare professional had completed his duty in the COVID-19 ward in the first week of May. After his duty, he was quarantined. On May 10, he had taken a swab test. The results were expected on May 12. But, the result hadn’t come even by May 15, which was when his quarantine period got over. When the results didn’t come even by May 17, he was asked to join duty on the same day. Six days and severalpatients later, he tested positive.

The problems are three-fold here. First, the swab sent to RML’s own lab took more than a week to send results. This is not an isolated case. This is the norm. National Herald has accessed documents of RML swab tests where it can be seen that the test results since the beginning of April have been taking more than a week to come back. A number of such swabs come back with the result ‘indeterminate’, meaning the person has to undergo the test again. Only symptomatic patients are admitted in the hospital. An asymptomatic person is likely to interact with several more people, ensuring the transference of the virus

Secondly, the medical staff was asked to join work even before his results had come in. This would mean that he was asked to leave the quarantine centre and go home. As a result, his family and a number of patients at RML Hospital were unwittingly exposed to the virus. In the non-COVID-19 areas, medical care professionals do not wear personal protection equipment either, exposing them to the virus from patients too.

Thirdly, now the central government has removed the mandatory quarantine period and testing of health workers on COVID-19 duty. The ministry order also states that provisions should be made only for regular ‘thermal’ screening of healthcare staff on COVID-19 to detect Coronavirus. This is despite there being enough evidence that thermal screening is unlikely to detect or contain the virus.

Acknowledging the delays, the RML medical superintendent Dr Minakshi Bharadwaj said the delays were due to the shortage of RT-PCR test kits. “The kits were not available and that is why it was taking time. Our load is tremendous. Whenever we get the kits, we are giving the test results the second day itself. As we are a central government institution, ICMR has to give us the RT-PCR test kits. There was a shortage of kits. Everyone faced it. The health ministry and ICMR will have more details about this,” said Bharadwaj.

The RT-PCR (or the reverse transcription polymerase chain reaction) method rapidly detects the severe acute respiratory syndrome–associated coronavirus (SARS-CoV). These tests can detect influenza viral RNA or nucleic acids in respiratory specimens with high sensitivity and high specificity.

Bharadwaj pointed out that when they faced an extreme shortage of kits, they tried to purchase directly. “It was difficult, and they took very long to come because of the lockdown. Finally, we have got the test kits and the back log is being cleared,” added Bharadwaj.

National Herald made several calls to Indian Council of Medical Research deputy director Dr Raman R Gangakhedkar and Dr Nivedita Gupta from the division of Epidemiology & Communicable Diseases but got no response. This article will be updated as and when they respond.

The pendency of COVID-19 test results is not unique to RML. According to the Delhi health bulletin, of the total number of samples collected by the Delhi government, there are 2,074 results pending as of May 20. It may include tests at private labs for government samples but it doesn’t include the samples collected by private labs. The website hasn’t been updated after May 20.

The Delhi government began putting put the number of pending tests after the Delhi High Court ordered it to do so. “Though the Delhi government is putting out some of the data, but not all of it. The duration of pendency cannot be gleaned from the govt data. At RML the pendency is between 6-12 days, but we don’ know situation with other hospitals. The current data put out by the Delhi government is limited to govt samples and does not include the test reports pending for samples collected independently by private labs. They stopped giving the total reports pending data on May 16,” underscored Malini Aisola, co-convenor of All India Drug Action Network (AIDAN).

The Delhi government’s health website mentioned that there were 5,080 test results pending at both public and private testing labs on May 16. A day earlier, there were 4,997 tests pending and on May 13, there were 4,795 tests pending across the capital. The number has only been increasing. Currently, the number of pending tests in Delhi remain unknown.