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The problem with a Rs90 dengue test

The problem with a Rs90 dengue test

Diagnostic facilities which were already working at full capacity are now faced with a tidal wave of blood samples.

Omar Chughtai September 22, 2011

There is a major dengue fever outbreak in the city of Lahore. Several thousand patients have been documented, and many more have gone undiagnosed. In addition, there is a general sense of paranoia, and people are very scared of the illness.

One of the important aspects in the care of dengue fever patients is the establishment of the diagnosis. Since a large number of patients are poor and cannot afford treatment, it is important to make arrangements to make these diagnostic facilities accessible to all. However, it must also be ensured that the diagnostic facilities and resources are not wasted.

One such measure is the notification that set the rate for Complete Blood Count test (CBC) is to be at Rs90. In spirit, this is a good move as it allows all segments of society to get tested. However, there has been an unexpected consequence; a large number of people have started getting their CBC test done simply because it is so cheap. Diagnostic facilities which were already working at full capacity are now faced with another tidal wave of blood samples. As a result, the following things are happening or are bound to happen:

Because of the rush of normal patients seeking to get their test done, the actual dengue patients are being overlooked.

As the workload increases beyond the capacity of the diagnostic facilities, the reporting time for the crucial CBC test is rising. Already the reporting time at most facilities has grown to more than 12 hours.

In the rush to test these thousands of CBC samples, patients who do not have dengue fever but other illnesses such as malaria or leukemia are likely to be overlooked or ignored.

There is a finite supply of reagent needed to perform the CBC test. At present, we are consuming the reagent far quicker than it can be imported. Heaven forbid if labs start to run out of the reagents needed to perform the CBC test, we will have taken a epidemic and made it worse.

In this time of crisis, it is very important that collaborative and streamlined efforts are made by all those involved in taking care of dengue fever patients. We must focus our attention on actual patients instead of trying to cater to everyone who desires a CBC test. In addition to this, we must remember that not every patient with a fever has dengue fever. Moreover, we must all work together to educate the public about this illness.

WRITTEN BY:
Omar Chughtai An avid reader of blogs who works as Lab Director at Chughtais Lahore Lab. Omar tweets @OmarChughtai.

The views expressed by the writer and the reader comments do not necassarily reflect the views and policies of the Express Tribune.

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COMMENTS (13)

Brig (R) Waheed Uz Zaman Tariq, MBBS, PhD, DpBact (Manchester), FCPS (Pak), FRCath (London), FRCP Edinburgh | 13 years ago | Reply Of course it is easy to go back home and start working with an NGO, yet without your infrastraucture and in teh absence of your say in official terms the things become difficult and loose their meanings when you leave and come back. We need the institutions and respect the persosn while they are contributing inside the country. I am still there and volunteer for any such task provided I feel myself in a position to contribute.

Grace | 13 years ago | Reply @Brig (R) Waheed uz Zaman Tariq: With all due respect Dr. Sahib, all you need to do is take a flight home and volunteer your services to the nation. I travelled to Pakistan last year from North America which is double the distance from Europe to serve in a clinic there as do countless other patriotic Pakistanis. The world has become a small place and air travel is not such a big deal. It was more of a nuisance for me to get time off my job then link up with NGOs and hospitals in Pakistan. I wasted a few days in the formalities and meeting different people. With your existing contact network, it wouldn't be very hard to volunteer some time with your feet landing in our nation. I believe that we need to make use of our greatest assets as Pakistanis- our people themselves. Good luck and Pakistan Zindabad.

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Brig (R) Waheed Uz Zaman Tariq, MBBS, PhD, DpBact (Manchester), FCPS (Pak), FRCath (London), FRCP Edinburgh | 13 years ago | Reply The Denguevirus is a reality and is not a new to us. Patience and better understanding is needed. Moreover, what I have written already contained many professional terms.

Brig (R) Waheed Uz Zaman Tariq, MBBS, PhD, DpBact (Manchester), FCPS (Pak), FRCath (London), FRCP Edinburgh | 13 years ago | Reply Thank you Sana. It was in hurry and despite the spelling mistakes, it makes a sense. I will be more careful.

Sana | 13 years ago | Reply @Dr. Waheed Tariq with all due respect please check your spelling before submitting. Even though the information seems useful, half of it is unreadable.

Brig (R) Waheed uz Zaman Tariq | 13 years ago | Reply There was a time when we were issuing warning that the Dengue is knocking at our doors and a day may come when it will hist us badly. We ahve controlled outbreaks at Abbottabad and a big epidemic in Karachi. When we first discovered Dengue in Karachi 1994 or so, we were laughed at. Now seed has been sowna nd the crop is ripe. The diagnostic tests are multifold. When we talk of Rs 90/- test we do not know what test we are talking and what is its diagnostic value in aparticular patient. WHat are the quality control arrangements: Following is my statement given at AFIP forum. All these tets make the battery of tests used fro the diagnosis of Dengue virus infection. The antibody of IgM shows the recent infection but a word of caution is that with a subsequent infection with a different serotype (which may be more dangerous), it may not appear. It differs in different persons and may be delayed in appearnce for a week or so, thus making it at times ess valuable. Anti-Dengue IgG is sign of an infection in the apst. A rsisng titre may be of value The NS1 antigen is evidence of Viraemia (actual presence of the virus in the blood and its replication). While at AFIP we used to have C6/36, a special mosquito cell line for virus siolation and it was alive and being in use till I was posted to Peshawer in 2002. It was wonderful, hardly line, grown at 22C incubator. Moreover, we ahd in House PCR for different genotypes and the probes were very kindly gifted to me by Prof JE Banatvala of St Thomas' Hospital London. The cell line was a gift of Prof Haidu from beijing, with whom I ahd personal collaboration and he had visted us at AFIP and I have also gone there to his Lab in China. In good old days, myslef, Col Eijaz Ghani and Maj Gen Tassawer Hussian had succefully controlled many outbreaks. We were the first iN apksitan having shown the presence of Dengue on maps, when people even initaially doubted at our work, till it was independently reconfirmed by colleagues at Singapore. I as a Virologist, feel pitty for not being useful to the nation at need. we have worked day and night for the nation for 29 years but a time came when we had to move abroad. Now we are asking Sri Lankans to help us. There was a day when we were helping other countries for its control. Dr Waheed Tariq Professor of Virology,

Omar | 13 years ago | Reply Here are a few facts for your consideration: - Chughtai Lab has 10 free camps operating all over Lahore. So far almost 12,000 people have been tested for free. - Chughtai Lab lowered the rate for CBC by 20% several days before the government declared the mandatory Rs 90 rate. - Every lab has a capacity, and beyond that capacity the quality starts to get affected. The two days after the Rs 90 CBC announcement saw a huge surge in CBC tests, with more than 80% results being absolutely normal. Moreover, our reporting time grew to more than 24 hours as we struggled through thousands of normals to identify the ones who had malaria, Thalassemia and Dengue. - The surge in CBC tests has burned through the supply of reagents faster than even I expected. We are down to daily supplies from the distributors, who airlift the reagents from Karachi. Now we have started getting calls from various government departments to assess the level of reagent supply. What will happen if, Heaven forbid, there is no more reagent left in Karachi to send to Lahore. The point of my blog post was not to complain, but to merely point out that everyone who sneezes does not have Dengue. The paranoia about Dengue fueled by a hyperactive media is placing an extra burden on the system.

FAZ | 13 years ago | Reply Simple solution is to get a doctor's proper and stamped written advice compulsory for CBC. Infact it should be for every test but at least we can do it for this specific test. Its the responsibility of Labs to implement this. But alass they are also Pakistanis......lust of money is genetic!! Mr. Shahbaz, your "danda" is needed asap!!!

Omair Shakil | 13 years ago | Reply @ Ameera: With thousands already infected and the death toll climbing, I don't blame people for being paranoid. Dengue has very non-specific and vague symptoms, adding to the fear that anyone and everyone who has fever these days, has dengue. Trust me, Mr Chughtai wouldn't have been complaining about the throngs of people panning for a CBC had his lab been allowed to charge their usual rate i.e. Rs. 500. That said, I agree that people need to curb their impulse to get tested unnecessarily. But don't expect the common man, who lacks an education to abide by common sense.

Tayyab Mahmood | 13 years ago | Reply Every one has a valid point, but Mr. Chughtai how can we judge is someone is patient or not ?Mozaam rightly said everyone is feeling feverish now a days. Its responsibility of Govt & media to educate people to dont get panic & rush to hospitals / Test centers. If some you know feel fever ask him to just get panadol / paracetamol and take rest, hopefully he will get relief even-though he might have Dengue Virus, if fever persist for more then 3 days go to doctor. 95% Patients in Lahore have Dengue Fever which is 100% safe. Only 5% have dangerous Dengue Hemorrhage or Dengue Shock Syndrome & that too is 70% safe.

Ameera Ahmed | 13 years ago | Reply @Omair: I really think that the writer is right here. People should stop getting tested unnecessarily. Only patients with the particular symptoms of Dengue Fever should come out and get tested. As far as the price of the test is concerned, Rs. 90 is ok. Even Shaukat Khanum Memorial Hospital is charging Rs. 80 for a CBC.

Omair Shakil | 13 years ago | Reply Does Mr Chughtai, who owns Chughtai Lab Lahore, suggest that we revert the cost of a CBC to Rs 500, as was previously being charged by Chughtai Lab? Everyone has the right to get tested and the testing services are extremely overpriced! Obviously one wouldn't expect the lab owners, such as the author of this article, to warm up to the idea of subsidizing tests, because its not good for business, even if it allows more people to get tested and initiate appropriate treatment. Had this article been written by someone without vested interests in the cost of the test, it would have made more sense.

Moazzam Salim | 13 years ago | Reply Lots of people are feeling feverish these days. With the changing weather the number of people with fever also increases. I think the writer's observation that most of the people getting tested are doing it for fun is an incorrect one. If that was true then there wouldnt be such a high number of people being tested positive every day. In fact this stance is exactly what the majority of Labs have professed. There is an epidemic on our hands and one shouldnt shy away from contributing.

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The problem with a Rs90 dengue test

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