Vascular surgeon criticises Delhi government's action against labs testing asymptomatic patients for COVID-19

At a time when the Delhi government is locked in a row with RML Hospital over coronavirus testing, and is probing several private labs for testing asymptomatic patients, a surgeon’s plea to allow unhindered testing has gone viral on Twitter. Ambarish Satwik, a vascular surgeon, put out a detailed thread why instinctive testing as prescribed by doctors is necessary even if it lies outside the guidelines issued by the Indian Council of Medical Research (ICMR).

Thread. Consider this a plea. Busy hospitals (some of them designated covid hospitals) and labs are being probed and barred from covid testing in the middle of a pandemic for testing asymptomatic cases (particularly those being admitted for other reasons). 1/n

— Ambarish Satwik (@AmbarishSatwik) June 5, 2020

Satwik said that any unrelated surgery on an asymptomatic  COVID-19 patient can be catastrophic, because research shows a high risk of pulmonary complication in COVID-19 patients who underwent surgery. “Surgical patients: as will be evident in this Lancet paper, the 30 day mortality in patients who tested positive for COVID is 23.8 percent. Pulmonary complications occurred in 51.2 percent cases. It is catastrophic to operate in the times of COVID-19, if the patient is COVID-19 positive,” Satwik said quoting a Lancet study. The study in question noted that postoperative pulmonary complications occurred in at least half of patients who underwent surgery but were later found to be coronavirus positive. The study also linked surgery on COVID-19 patients with higher mortality. “Consideration should be given for postponing non-urgent procedures and promoting non-operative treatment to delay or avoid the need for surgery,” the study notes, indicating that COVID-19 testing may well be an instrumental part of pre-operative procedures, and may help doctors a vital call on whether or not to attempt surgical procedures. Satwik also pointed out, “Hospitals are duty bound to prevent COVID-19 cross-infections as those sick enough to be admitted (for other conditions) in the middle of a pandemic constitute the most vulnerable cohort.” Satwik also suggested that the ICMR guidelines being adhered to in stopping hospitals from testing may well be dated. “The ICMR document outlining strategy for COVID-19 testing in India hasn’t been updated since 18 May, 2020. We are smack bang in the middle of community transmission and according to the said document, even a patient with symptoms of Influenza-like illness (not residing in a containment zone and not a contact of a lab confirmed case) cannot get tested for COVID-19. I would submit that the ICMR guidelines on testing should not be considered as revealed commandments from a deity that are unalterable and cannot be questioned or challenged, particularly when you’re armed with evidence and scientific data that flies in its face,” he said. Satwik’s tweets come at a time when the Delhi government is caught in a verbal spat with the Central Government-run Ram Manohar Lohia Hospital over COVID-19 testing. The Delhi government alleges that the RML RML Hospital was giving out “erroneous” COVID-19 test results and violating government norms of submitting the same within 48 hours, a claim denied by the hospital and Union Health Minister Harsh Vardhan. Addressing a press conference in the National Capital, AAP spokesperson Raghav Chadha said the Delhi government re-tested 30 samples from Ram Manohar Lohia (RML) Hospital which were declared COVID-19 positive. He said 12 of these samples were found to be negative and the result of two samples was inconclusive. The RML Hospital, in a statement, however, said the dates of sampling were different and there was a gap of 7-14 days when resampling was done. It said quality checks are being done with the All India Institute of Medical Sciences (AIIMS) and the National Centre for Disease Control (NCDC) and the results are concordant. The hospital also maintained that there was no backlog anymore and regular quality checks were being done. “We are doing quality checks with AIIMS and NCDC and the results are concordant. Our positivity is more as all hotspot cases, family clusters and high-risk contacts of lab confirmed cases are more in our screening centre. Also, we do not have any backlog now. The problem existed earlier when adequate testing kits were not available,” it said in a statement. Chadha had earlier alleged that there was an error of 45 percent in RML’s coronavirus testing. The Delhi government has also initiated a probe against eight testing labs, seven private and one government-run, for allegedly collecting samples against ICMR protocol,  The Times of India reported. The government ordered chief district medical officers to suspend the registration of all phlebotomists — personnel who collect samples — associated with these labs, pending investigation. These labs won’t be able to collect samples for testing on their own and the state would not send them samples for testing, the report said. This comes despite the fact that testing remains lowest in India when compared to other nations badly hit with the virus. According to Worldometer, a platform that compiles crucial coronavirus metrics from around the world, India ranks seventh amongst nations worst hit by the pandemic and has the worst testing rate per million population when compared to all other nine nations. For perspective, India (rank 7) tests 3,181 people out of every one million people, whereas Turkey (rank 10) is testing 26,220 people per million population; US (ranked 1) is conducting 59,197 tests per million population. With inputs from PTI