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February deaths in June

14 Jun 2021

  • What’s causing the massive delays in issuing PCR test results and Covid death figures?

By Sumudu Chamara   As the Covid-19 pandemic rages on in Sri Lanka, concerns were raised about certain discrepancies between the statistics issued by the Department of Government Information and the Health Ministry’s Epidemiology Unit (website) on Friday (11) and Saturday (12). The number and nature of newly reported Covid-19 cases was not the only concern, as deaths caused by Covid-19-related complications also became a topic of discussion last week, after the health authorities issued details of a staggering 101 Covid-19-related deaths at once. According to the situation report issued on 11 June based on the statistics provided by the Health Ministry’s Epidemiology Unit, the said 101 deaths had occurred over 19 days between the period of 6 February to 9 June. Among the deaths, one death occurred on 6 February, one death occurred on 1 April, and 11 deaths occurred in May. The rest of the deaths had occurred this month. Out of the 101 deaths, 30 had occurred at the patients’ residences while 57 had passed away while they were being treated in hospital. The number of persons who had died on admission to hospital was 14. The said statistics, or the time and manner in which they were presented rather, raised concerns among the general public, as some of these deaths had occurred as far back as in February and April this year, and health services trade unions and the public questioned as to what causes such massive delays in reporting the numbers.   Delays One group that expressed strong disapproval of these delays is the Health Services Trade Union Alliance (HSTUA). Its President Saman Ratnapriya said that most details pertaining to the Covid-19 situation in the country, especially Covid-19 cases and Covid-19-related deaths, get delayed mainly due to the health authorities’ lack of organisation and also lack of a proper system to carry out that process efficiently. He also stressed that lack of proper and swift reporting renders the health authorities unable to properly plan Covid-19 management efforts. “Reporting the number of Covid-19-related deaths as well as Covid-19 cases does not take place properly in Sri Lanka, and due to that, it is difficult for either the Health Ministry or the Government to devise a proper plan to mitigate the pandemic. We have a question as to whether a country that does not process Covid-19-related data on a daily basis is in a position to successfully face the pandemic. If we take into consideration the world situation, we can see that other countries analyse data gathered daily and plan the future course of action. As far as accurate and updated information is concerned, Sri Lanka’s situation is a rather poor one.” Speaking of 101 Covid-19-related deaths being reported in a single day, he added: “Some of them died in their homes and some in hospitals. A number of more people died before being admitted to a hospital. This is indeed a tragedy; however, we do not think these figures are accurate. Not only the statistics issued on 11 June; if you look at some of the statistics issued before that, they also contain Covid-19-related deaths that occurred days and sometimes several weeks before. If the health authorities cannot handle these figures properly, it raises a serious concern about the overall management of the Covid-19 pandemic.” Emphasising that statistics about deaths should ideally be released the next day, Ratnapriya added that delays that exceed more than three to four days are unacceptable and should be addressed. He explained: “It is true that when a death occurs, a PCR test has to be carried out to determine the cause. There is a delay in this process. However, that delay cannot be as long as one-two weeks. The longest time it should take is two or three days, and the (PCR) reports also should not be delayed more than two or three days. But when we examine the dates these reports mention, they are sometimes several weeks old. What this shows is serious weaknesses in the process of collecting and announcing statistics. He also opined the main issue is not the lack of facilities but the authorities’ lackadaisicalness. “As soon as a person (confirmed or suspected Covid-19-infected person) dies, a PCR test and a rapid antigen test can be conducted and the results can be released within about six hours. However, the Health Ministry has to come up with a proper plan to do that. Facilities required for that process are available in the health sector. The issue is, despite having appointed a large number of officials for various positions, the health authorities do not take the necessary steps to do that. They just have to give more attention to Covid-19-related deaths than they do now,” he added. He added that even though a request was put forward to the Health Minister two weeks ago to obtain 75 PCR machines for regional hospitals that do not have PCR machines and the Minister issued instructions to provide the machines, so far, they have not been provided. Expressing concerns about the officials of the Health Ministry not implementing the instructions efficiently, he stressed: “Inefficiency is the main reason (behind the above-mentioned delays).”   PCR tests However, this is not the first time concerns were raised with regard to delays in issuing and communicating Covid-19-related data, especially PCR test results. Several groups including the Public Health Inspectors’ Union of Sri Lanka (PHIUSL) recently alleged that sometimes, it takes as long as seven to 10 days for the ground-level healthcare workers to send an infected person to medical facilities after receiving verified information about the PCR test results of an infected person. The Morning’s attempts to contact State Minister of Primary Healthcare, Epidemics, and Covid-19 Disease Control Dr. Sudarshini Ferandopulle and the Health Ministry Secretary to obtain more information as to what factors caused the above-mentioned delays and what steps are being taken to minimise such delays, were not successful. However, Public Health Services Deputy Director General Dr. Hemantha Herath, speaking to the media last week, said that delays pertaining to conducting PCR tests was the main reason that caused delays in ascertaining whether a person died due to Covid-19, which in turn leads to the health authorities to take more time to announce Covid-19-related deaths. He said that if a person’s Covid-19 status was ascertained through a PCR test, it takes no time (to announce the updated figures). “Most deaths occur at homes. Sometimes, even if a death occurred at a hospital, not every hospital has the necessary facilitates to carry out PCR tests. Therefore, the body of the deceased has to be taken to a medical facility that is equipped with the necessary facilities, and it takes time. The period of time (delay) that we are talking about is a result of the time spent for all these activities.” To look into the state of PCR tests, The Morning spoke to College of Medical Laboratory Science (CMLS) President Ravi Kumudesh. He noted that even though PCR tests can usually be performed within eight hours and that the test report can be issued within 16 hours, reasons such as traditional technology, delays in pre-laboratory setup, and delays in post-laboratory setup cause delays in the overall process, which then affect other activities/announcements that are based on PCR test reports. “There are no significant delays in the process of conducting PCR tests. It usually takes around eight hours, and if we need to expedite it, we need more modern technology. Modern technology makes it possible to perform PCR tests within one hour; however, Sri Lanka does not have that technology.  “A traditional PCR test consists of two main steps, namely ‘extraction’ and ‘PCR’. Under the traditional system, it takes around three hours to extract the virus from the sample, and for that purpose, there is a machine called automated extractors. The public sector (public medical facilities) has around 30 machines; however, due to various reasons, those machines cannot be used in an efficient manner, leaving technicians to manually continue the process.” Kumudesh added that the nature of the existing system, particularly the traditional methods used to handle and communicate PCR test results to relevant parties, has also caused a massive delay. He noted that this process involves many steps and parties, and therefore, it needs to be expedited and upgraded according to modern methods. “Once a PCR test is completed, its results are shared according to a traditional system. Once the test is completed, the report has to be sent to and between around six parties including virologists, medical health officers, regional health officers, and PHIs. It does not matter how fast the laboratories complete the tests, the test results get delayed each step.” Adding that there are delays in receiving samples for PCR tests, he also noted that even though conducting tests 24 hours a day is one of the feasible solutions to address these delays, laboratory technicians are not permitted to conduct PCR tests 24 hours a day. He claimed that these two factors also cause delays. He alleged that Health Ministry officials in charge of management of laboratories do not possess adequate knowledge about medical laboratory science, and that that is one of the reasons that make it difficult to get the full advantage of the available laboratory resources. He also pointed out that as a whole, it is not the PCR tests that cause delays, but rather delays and inefficiencies on the part of the health authorities. In addition, he noted that in order to expedite the process of issuing PCR test results, the authorities should also pay attention to using laboratory information management systems, which enable all relevant parties to obtain and communicate relevant information without any delay. He added that such systems are not difficult to create/procure and use, and that they could save the massive amount of time traditional information sharing methods take. “Purchasing modern extraction machines, some of which are cheaper and more efficient than the ones in use, and creating a system which equips divisional and base hospitals to also conduct point-of-care tests, will help the health sector expedite the process of conducting PCR tests. It would also expedite postmortem PCR tests.” “If the available technology was managed through the said multiple approaches, within 24 hours, Sri Lanka can increase its daily PCR testing capacity up to around 75,000, which is more or less five times the daily number of tests conducted currently,” Kumudesh said, adding that all it requires is point-of-care testing facilities, more rapid antigen test facilities, and uninterrupted supplies. During the past few months, many parties have repeatedly emphasised that managing the available resources judiciously is as important as procuring what is required, and that the health authorities must pay attention to improving its Covid-19 management efforts to streamline the management of resources. This was raised particularly after the vaccination drive commenced, as several incidents, especially priority list-related issues, also affected the smooth implementation of the drive. However, as some who spoke with The Morning underscored, the Covid-19 pandemic is a changing situation and therefore related developments need to be followed attentively. Due to the pandemic’s changing nature, it is the updated data and information that drives this process in the direct direction. Taking steps to streamline that process is of everyone’s interest.


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