The deaths from COVID-19 in Nepal show a pattern. In mid-May a 22-year-old male was tested using rapid diagnostic test (RDT) and was negative for the coronavirus. A few days later, he died and samples were tested using the polymerase chain reaction (PCR) method which were positive for the virus.
A few weeks later a 50-year old died in Seti Hospital. He had tested negative for COVID-19 by RDT but his samples were sent for PCR tests after death and was tested positive. Last week, a 28-year-old’s PCR samples were tested positive for COVID-19 after he died, although his RDT had not found COVID-19 virus in his system.
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While the government continues to order more consignments of RDT, and keeps sending them to health centres all over Nepal, the trajectory has not been looking good for RDT for a while. With the COVID-19 peak predicted sometime in July, it is now time to abandon the ineffective RDT for COVID-19 diagnosis.
This is not the first time that epidemiologists, public health professionals, and doctors have warned the government about the ineffectiveness of the RDT. There are many things we do not know about the COVID-19 virus, but what we do know is that it is highly contagious and does not behave the same in everyone. It is time for the government to understand that PCR test and RDT are not the same and cannot be used interchangeably.
A person who acquires the virus on day one will not start to transmit the virus immediately and both the RDT and PCR test will not show the presence of COVID-19 in that person’s system. Things start moving by day four-five when the virus starts spreading rapidly around the body.
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It will start clustering around the nose, throat and lungs of the person who acquired the virus, and will be at a high risk of transmission. Yet, RDT will not detect the virus, whereas PCR tests will start to identify it. A week in, the person who acquired the virus may or may not show symptoms, but the risk of transmission is high, and PCR test will detect the virus, but RDT still will not.
Between days 11-15 the PCR test will continue to show positive results on the infected person’s sample. It is only after day 11 that RDT will also start showing a few positive results. By day 21, RDT will show more positive results, and PCR will not.
When a virus attacks a human body two types of antibodies are created to fight against it. RDT tests pick up both antibodies, but they do not peak before 9-11 days. That is the reason why RDT kits do not pick up early infections. RDT is only useful if we want to understand a source of some unknown infection, or a community’s immunity and absolutely should not be used in the diagnosis stage.
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The danger with RDT is that people with negative results can still be positive and transmit this highly contagious virus to others. Detecting the virus after Day 15 of living with the virus does not help because COVID-19 would have already spread. Since PCR test identifies the virus between day four and day 15, early detection of the COVID-19 virus is imperative, because it spreads so easily among people.
It is not enough to just say that we need more testing if all the government is going to provide are RDT kits. It is time for the Nepal government to listen to the frontline workers — the doctors, the nurses, the female community health volunteers who have first-hand experience from the field. They can tell you about the inefficacy of RDT.
In Siluchaur Primary Health Center of Rolpa, physician Prakriti Bhattarai understood early on that RDT tests were giving false positives and negatives. Through her lobbying and coordination with the village health coordinator, the health centre has switched completely to PCR testing.
The health workers are out every day in different quarantines in the district collecting samples to send to a lab in Butwal. “RDT is such a poor diagnostic kit … it has low specificity and sensitivity and as a doctor I simply can’t make diagnosis from those results,” says Bhattarai.
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