Same patient, same day, two different hospitals, two different PCR reportsExperts say misleading lab reports could be one reason for the uncontrolled spread of the virus while authorities say there could be different reasons for result variation.
Last week, doctors at Alka Hospital, Lalitpur asked M, a renal patient, to undergo a polymerase chain reaction test for kidney dialysis.
Fifty-two-year-old M, who is a local of Pandini Rural Municipality-3 of Arghakhanchi, gave swab samples at the nearby Patan Hospital.
M’s younger brother, who is also a renal patient, asked him to go to a private laboratory, which gives reports earlier than the state-run laboratory, as he was worried about risks to infected people having pre-existing conditions like renal problems.
“After giving swab samples at Patan Hospital, my brother gave samples to Star Hospital,” M’s brother P told the Post. “Health workers at Star Hospital called us the next evening to inform us that our brother had tested positive.”
The Post is not identifying them to protect their privacy.
Family members and relatives of M who were in Kathmandu tried to find a bed in a state-run Covid-19 hospital the entire night without success, as all the hospitals in Kathmandu Valley said they did not have any vacant beds.
“We found a bed in Bir Hospital at 2 pm the next day,” said P. “We took him there and admitted him in the Covid-19 ward, where other infected patients too are admitted.”
In the evening, Patan Hospital said the report was negative. M’s relatives informed the doctor about the report from Patan Hospital, but they too did not have an answer.
The next day, his relatives went to Patan Hospital to talk about the Star Hospital report, but health workers told them that there might be a problem in any one of the two results—Star Hospital’s or their own.
“My brother is in the Covid-19 ward of Bir Hospital for the last five days with other infected people,” P complained. “We are in a dilemma over whether to seek a discharge, as per the report of Patan Hospital or stay in hospital as per Star Hospital’s report. Doctors at Bir Hospital have not said anything about it.”
M’s family members were worried that their patient may get infected if he had not contracted the virus earlier.
This was a common problem of the many people who have undergone repeated polymerase chain reaction tests in different laboratories and got misleading reports.
The Post has come to know of other such cases but the individuals involved did not want to talk about it to the media.
Doctors say that misleading reports of laboratories could be one of the reasons for the spread of coronavirus in the community.
“Reports of tests on the same day on the same patients should not be different even if they are performed at two different laboratories, as the polymerase chain reaction test uses the same method and technology,” Dr Haris Chandra Upreti, former director of the National Public Health Laboratory, told the Post. “But if the external quality assurance services of the laboratories have been compromised, variations in reports may be seen.”
Of the 56 laboratories that conduct polymerase chain reaction tests across the country, the private sector operates 16. Upreti said that quality of the report depends on the quality of equipment used for tests as well as of the regents, temperature maintenance of the reagents, quality control of the laboratory, and skill of the technicians, among others.
“If the environment of the laboratory room is contaminated, test results may be different,” he added. “Authorities should find out the mistake, as the same mistake will continue if not addressed. Serious consequences will happen if problems are not fixed.”
An infected person can come out of his house and meet the people on the basis of his misleading report and spread the infection in the community, according to doctors.
The National Public Health Laboratory, which is responsible for regulating laboratories throughout the country, said that some people are seeking tests in different laboratories out of personal interest and this is not only consuming the time of laboratories but also creating confusion about test quality.
“Some need positive results to claim insurance and some need negative results for treatment of other medical conditions, to go abroad or come out of their homes,” an official at the laboratory told the Post, asking not to be named, as he was not authorised to talk to the media. “Some people, who underwent tests at other laboratories, have complained to us over the result of our reports.”
The laboratory, which periodically sends its report and samples to the World Health Organisation’s collaborating centre in Hong Kong for quality control, said that it has been monitoring the quality control practice of all polymerase chain reaction laboratories in the country.
“Both negative and positive reports of the same infected person performed on the same day in two different laboratories are correct,” Dr Runa Jha. “Different reports can come, when viral load is low, at the time of being cured or during the incubation period.”
The laboratory made a cocktail of five samples and sent to all laboratories and sought their report, which it cross-checked with its own reports.
According to Jha, the results from the different laboratories matched that from the National Public Health Laboratory.
Meanwhile, the Ministry of Health and Population said it has directed the Nepal Health Research Council to audit the laboratory reports.
“We are quite aware of the variation in laboratory reports,” Dr Samir Kumar Adhikari, joint spokesperson for the Health Ministry, told the Post. “We have asked the council to investigate the variation in lab reports.”
Professor Prakash Ghimire, chairperson of the National Ethical Board under the council, said that comprehensive evaluation will be conducted on the quality control practices of the laboratories—both state-run and private.
“We are also tasked with performing an investigation into the massive spread of infections as well as the government’s epidemiology policy evaluation,” said Ghimire. “We will start the study from this week and furnish the report at the earliest.”