Covid-19 testing declines in Odisha even as cases continue to rise

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Odisha’s coronavirus disease (Covid-19) positive cases may have gone up by around 80% between May 19 and June 19, and the contagion has spread across all 30 districts in the state, but the daily test count has gone down significantly in the interim. The low test count is being attributed to a host of factors such as the malfunctioning of machines and skewed demand and supply ratio among laboratory technicians and frontline workers combating the pandemic.

Consider this: Odisha had reported 1,052 Covid-19 positive cases and 22 of the 30 districts in the state were in the pandemic’s clutches on May 19, including 74 cases in a single day and 4,536 tests were conducted on that day alone.

A month on, Odisha’s Covid-19 tally stood at 4,836 and the contagion has spread across all the 30 districts. On June 19, 17 laboratories in the state conducted 3,167 tests and the day’s count was 179 fresh Covid-19 positive cases.

The state has added over 3,700 or 80% of its total Covid-19 positive cases in exactly a month’s time, triggering panic among the worried state government officials.

On June 18, they drew the Supreme Court’s (SC) attention that they anticipate a further spread in the viral outbreak, and pleaded a stay against organising the annual Rath Yatra festival in Puri next week -- a major draw for tourists and pilgrims -- while raising concerns over the maintaining of social distancing norms. The apex court has acceded to the state government’s plea.

The state government has also resorted to mandatory weekend shutdowns in 11 worst-hit districts, including Bhubaneswar, in a bid to contain the spread of the viral outbreak.

There has also been a growing concern over the mismatch between the daily spike in Covid-19 positive cases and the number of tests being conducted.

The laboratories across the state tested 63,709 samples between May 1 and 18 and 868 tested Covid-19 positive, while the corresponding figure between June 1 and 18 was 57,040 and 2,432 positive.

The average daily tests between May 1 and 18 stood at 3,540, but came down to 3,169 between June 1 and 18, despite the growing number of Covid-19 positive cases.

In May, chief minister Naveen Patnaik had announced that the daily test count would go up to 15,000 from June following the influx of migrant workers from other states amid the nationwide easing of lockdown restrictions, which were enforced from March 25 to contain the spread of the pathogen.

Though the daily test count crossed 5,000 for a few days following the CM’s announcement, including 5,612 on May 16, the figure has since then gone down significantly, as the laboratories are conducting tests anywhere between 2,500 and 3,800 on any given day.

Last week, Shalini Pandit, director, National Health Mission (NHM), Odisha, defended the low daily test count while citing revised guidelines issued by the Indian Council of Medical Research (ICMR), which stated that only symptomatic and high-risk contacts need to undergo tests.

“We’ve conducted over two lakh tests so far. Besides, the tests per million population in the state is higher than the national average. Positivity rate per lakh population in the state is 9.3%, as compared to Maharashtra (88%), Delhi (205%) and the national average of 25%,” she said.

Epidemiologists, however, refused to buy into her arguments and warned against a spike in the viral outbreak, which is likely to have been precipitated by the rising graph of Covid-19 positive cases and an inversely proportionate daily test count.

Odisha had reported one Covid-19 positive case in every 250 people tested until end-April. While currently, the corresponding figure stands at 1:26.

“This indicated that there is a viral outbreak, which calls for more testing. As per the health protocol, usually about 1% of the population suffers from influenza-type illnesses. At least 4.2 lakh people in Odisha must be in that bracket, who are in dire need of undergoing tests, along with the migrant returnees, who are symptomatic. Aggressive testing, tracing and treating is the only mantra to effectively contain the Covid-19 pandemic,” said an epidemiologist of a government-run hospital, requesting anonymity.

Virologist Jacob John, a former principal of Christian Medical College, Vellore, Tamil Nadu, said aggressive tests could only help ascertain the spread of the contagion.

“People living outside the quarantine centres need to be tested in a bid to come to the conclusion that there’s no community transmission. While this has been the emerging trend in Tamil Nadu, Maharashtra and Delhi, how does one know that’s not the case with Odisha?” he asked.

State officials – albeit off the record -- attributed the low test count to malfunctioning machines and the lack of an adequate number of laboratory technicians because of a high daily volume of swab samples.

Odisha, however, has failed to overcome this endemic problem, unlike Assam, which is conducting 10,000 Covid-19 tests daily.

“In June, the Cobas 6800 machine at Regional Medical Research Laboratory in Bhubaneswar malfunctioned for over 10 days, which led to a major disruption in conducting tests. Similarly, the RT-PCR (reverse transcription-polymerase chain reaction) machine at Institute of Life Sciences in Bhubaneswar could not function for a few days due to non-technical issues. The laboratory technicians, too, are overworked because of an exponential rise in the volume of swab samples. Each sample takes up to 10 hours to test and a technician can only do that much. The state health authorities have been instructing the district collectors to send samples in lesser quantity because of these infrastructural constraints,” said a health official, requesting anonymity.

However, the turnaround time for the availability of a test result has come down from five days in mid-May to 48 hours.

But slip-ups are being routinely reported such as a government driver in Puri district had to wait for five days in June until his report showed that he has tested Covid-19 negative. “You could well imagine my mental condition. I was worried for all those days, as I was constantly thinking who all I might have infected,” said the driver.

Many people, who run the risk of contracting SARS-CoV-2, which causes Covid-19, are also complaining about the state government’s laxity in denying them the opportunity to undergo tests.

For instance, over 80 migrant returnees had staged a sit-in at a high school in Gajapati district – the worst-hit in Odisha – in May as they were not allowed to undergo tests.

They claimed that though they were made to spend a fortnight at a quarantine centre, their swab samples were not collected.

Similar complaints have come from other quarantine centres in Balasore, Ganjam and Bhadrak districts.

“A few of us had been running a fever and were symptomatic. But our swab samples were still not collected,” said a migrant worker at a quarantine centre in Balasore district’s Bahanaga block.

Accredited social health activist (ASHA) and Anganwadi workers, who are at the frontline of combating the pandemic such as the collection of swab samples, are finding themselves in a bind because of the growing workload and the skewed demand and supply ratio.

In early June, an ASHA worker, Savitri Swain, was assaulted by a group of fishermen from neighbouring Andhra Pradesh in Paradip because they did not want to be quarantined.

While in May, ASHA and Anganwadi workers had faced the ire of people at a containment zone in Rourkela town, when they had gone to collect their swab samples.

“It’ a real challenge. Many of us don’t have proper personal protective equipment (PPE) units unlike the doctors at dedicated Covid-19 hospitals. We’ve only face masks and hand gloves to protect us from the pathogen. I start my day’s work, dreading when I’d get infected. I’ve no option, but to carry on,” said a health worker, who did not wish to be named.

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