The story of testing in #COVIDー19 #COVID19India is revealing. Initially RT-PCR was being done in few government centers. Capacity was rapidly increased across country in Govt areas such as medical colleges. With more demand there came the private sector to chip in. 1/n
Then came socialist activists who demanded that the private sector test for free and petitions were filed. Some backed out and some stayed and later a price capping was done. So we had more increase in capability as India tried to follow the @WHO mantra of test, test, test 2/n
It was now May and with media comparing states, there was weariness about state models and some decided to take control of the situation aka control testing. Some bureaucrats were replaced and others sidelined so that everyone fell in line. Now it gets interesting 3/n
My friends mom in Delhi died of COVID19 in mid May. He and his kids never got tested. Similarly a Pediatric friend in Ahmedabad got admitted with COVID19 & his family was not called for testing. Govts decided that testing contacts gives positive which shoots up numbers 4/n
These contacts don’t die cause often young or kids and hence why sweet infection numbers and lead the states charts and display that you are not in control. But reduced cases didn’t mean deaths will not happen and hence your death rate (deaths over cases) became high. 5/n
How does one explain that? Say that the virus might have mutated and the bad one has entered your state. Except Maharashtra most states didn’t differentiate between infection fatality rate and case fatality rate. The CFR for Maha was 5-10 times Italy in various age groups 6/n
Now that the IFR seemed higher it was time to reduce death rates. @ICMRDELHI put out a good document on writing death certificates in #COVIDー19 However most states used this to ensure that anyone of COVID19 who has a comorbid condition is not reported as COVID19 death 7/n
Anyone who knows the least about #COVIDー19 knows that healthy people without comirbid conditions are not likely to die of COVID19. With application of this measure deaths stopped happening in most states. Now we have the absurd situation that India has less deaths than US 8/n
India has today 23 deaths per million while US has 451 per million when we have 1/17 of their ICU beds capacity and half their beds. We have less nurses and doctors and of course less GDP spent on health. 9/n 
While in May contacts were not being tested now we have reached a situation where even symptomatic ones are not being tested. My neighbor with fever for a week, HRCT suggestive of #COVIDー19 has been told that RT-PCR will not be done. From contact tracing & testing to 10/n
To not testing obvious symptomatic #COVIDー19 patients it has been a short time of 2 weeks. My neighbour lives in a GUJ which has 1/4 numbers of testing compared to Maha and TN. This strategy succeeded in bringing Gujarat from position 2 on the table to 8 with WB above it 11/n
Coming back to private lab testing & stifling then with price control, now we see that the state labs in Govt control are not being useful to patients as doctors are not making decisions about testing. Doctor proposes tests, Bureaucracy disposes. A patient has a right 12/n
Patient has a right to get tested if he is symptomatic & having a private setup helps him have the freedom to pay and get it. This example shows how socialism can be anti-people once those in power wield it. I would in interested in knowing how the rights of the 13/n
How the rights of the patient & doctor are being affected by this scenario when the control of doctors to manage patients is being taken away as a bureaucrat is deciding who gets tested. And we are not even yet discussing testing before routine surgery, etc 14/n
In #COVIDー19 if a patient who is symptomatic is not being tested what are the rights of patient that are being denied? Can doctor be held responsible since he has advised and the test not done? Can the patient take the government to court? @AnantBhan @johnlantos @spkalantri 15/n
My neighbor currently has a saturation of less than 90 on room air & is searching for a bed in Anand as he wants to shift out from municipal hospital since he feels he is not being care for adequately. What can we doctors do to improve the situation? Are we helpless? 16/n Finish
