The fast spread of Covid-19 infection seems to have overwhelmed the virus testing capability in the country’s most populous province, the Punjab, in the aftermath of lockdown relaxation across the country.

The Covid-19 curve is on a sharp upward trajectory in the province which had recorded 43,460 confirmed cases of coronavirus, including 807 mortalities, till June 10. According to Covid-19 National Database, the Punjab has acquired a capacity 8,810 tests per day including 5,710 in the public sector. The PCR labs are working overtime in three shifts as the rate of infection has dwarfed the province’s capability.

Having recommended intermittent lockdown for two weeks a month, the World Health Organisation (WHO) emphasised the importance of developing testing capacity in the country and taking it beyond 50,000 tests per day.

“The [documented] Covid-19 figures are just the tip of the iceberg,” says Prof Dr Saeed Ahmad, head of the Pathology Department at the King Edward Medical University (KEMU). Declaring Punjab’s existing testing capacity insufficient, he stresses the need for testing on a massive scale to determine the scale of the spread of the virus.

After easing of the lockdown and the irresponsible behaviour of many people vis-à-vis the standard operating procedures (SOPs) recommended by the government, he says, the coronavirus transmission has reached an alarming level and it is now a threat to almost every other household. “A strict lockdown for 15 days is absolutely vital to bring down the rate of transmission,” he says while also suggesting a strict implementation of the SOPs. He says no one should be allowed outdoors without a mask.

To a question regarding erratic diagnostic results, Dr Ahmad says that although cases of a false positive are rare, approximately 30 percent false negative results have been noticed globally with PCR tests conducted using the correct technique. “Poor technique and other factors may further increase the ratio of false negatives,” he says. He, however, maintains that even if a PCR result is a false negative, other diagnostic parameters such as X-rays, inflammatory markers, low oxygen saturation indication etc, help determine provision of treatment to a patient as a Covid-19 case. “Moreover, in case of a false negative diagnosis, if a patient betrays subclinical, mild symptoms, observes social distancing and lockdown SOPs and wears a mask, the risk of further transmission declines considerably,” he says.

According to official data on testing capacity in Lahore, the Punjab Public Health Reference Lab has a capacity of 2,000 tests daily; a facility of 200 tests per day is available at the Punjab Forensic Science Authority Lab; 800 tests per day at the Pakistan Kidney and Liver Institute; 500 tests per day at the Jinnah Hospital; 100 tests per day at the Lahore General Hospital; 200 tests per day at the Centre for Applied Molecular Biology (CAMB); 190 tests per day at the Lahore TB Programme (BSL-3); 190 tests per day at the Institute of Public Health; and 200 tests per day at the University of Veterinary and Animal Sciences (BSL-3) in the public sector and 1,000 tests per day at the Shaukat Khanum Memorial Hospital; 1,000 tests per day at Chughtai Lab; 100 tests per day each at Zeenat Lab; University of Lahore and Bahria International Hospital in the private sector.

In Rawalpindi, there’s a capacity for conducting 190 tests per day each at the Holy Family Hospital and the Benazir Bhutto Hospital in the public sector, 200 tests per day at Citi Lab, and 100 tests per day each at the Bahria International Hospital and Al-Khidmat Foundation Lab in the private sector.

In Multan, there’s a capacity for conducting 200 tests per day at Nishtar Medical College and 190 tests per day at the Multan TB Programme (BSL-3).

In Faisalabad, there’s a capacity for conducting 190 tests per day at Allied Hospital in the public sector and 300 tests per day at the Abwa Hospital and Research Centre in the private sector.

There’s a capacity for 190 tests per day each at the Trauma Centre THQ (BSL-3) in Wazirabad and the Civil Hospital, Bahawalpur, and 90 tests per day at the DHQ Hospital in Dera Ghazi Khan.

The patients, who are getting their diagnostic investigation at private labs, are complaining about exorbitant rates varying from Rs 8,000 to Rs 11,000 per test.

An official of the Primary and Secondary Health Department says that the Punjab government is conducting free tests at all its designated labs. “The department has also established a walk-in testing facility at the Expo Centre, which collects swabs and sends these to government laboratories for testing,” he says adding that reports are usually delivered after 48 hours. On the question of the government conducting tests for asymptomatic patients, the official, requesting anonymity since he is not allowed to share the information, responds in the negative. He says that the government has attached priority to testing of symptomatic patients, and is already struggling to cope with the number of patients.

In all public sector labs, he says, a doctor examines the patients for symptoms with a set of questions regarding their history and close contacts. If there are no signs of coronavirus, the patient is immediately sent back. But if a patient manifests signs and symptoms of coronavirus, a nasal swab or throat saliva is taken and sent to one of the designated facilities for Covid-19 testing, free of cost.

In the private sector, he says, the Chughtai Lab has agreed to provide 50 percent discount to those over the age of 50 among the first 100 patients reaching the lab daily.

However, patients carrying symptoms suspected of coronavirus face multiple challenges. In public sector hospitals, the patients have to cope with excruciatingly long delays in delivery of reports, while those who can afford diagnosis from private labs are being fleeced.

According to official documents, out of 386 Covid-19 mortalities in Mayo Hospital till June 8, the test reports of as many as 178 patients, who supposedly died of coronavirus, were still awaited. “Nobody knows the cause of death of 178 patients,” says a doctor at Mayo Hospital adding that some of the admitted patients also had been made to wait for their reports for several days.

The patients, who are getting their diagnostic investigation at private labs, are complaining about exorbitant rates (varying from Rs 8,000 to Rs 11,000 per test). According to an official of the Primary and Secondary Health Department, a single test for the virus costs about $18 (approximately Rs 2,962).

Dr Salman Kazmi, general secretary of Young Doctors’ Association (YDA)-Pakistan, says that private labs are making hay in the midst of a health crisis. He says the labs in the public sector have been overwhelmed by the load of symptomatic patients. “Even private labs are now delaying collection of samples by two to three days. In the absence of government control, fleecing has become a norm.”

Dr Shahid Shaukat Malik, general secretary of the Lahore chapter of Pakistan Medical Association (PMA), says that the Punjab government is staring at a public health emergency beyond the capacity of its health system. In view of WHO’s recommendation for conducting 50,000 tests per day in Pakistan, he urges the Punjab government to enhance its capacity to at least 25,000 tests daily. He also doubts the government’s claim of conducting 9,000 tests daily saying that probably between 5,000 and 6,000 tests were being conducted per day. “The tests reports are being delayed in government labs for up to 15 days.”

Prof Dr Yasmin Rashid, the provincial health minister, in a press conference the other day, claimed that the government had scaled up the testing capacity from 1,200 in March to 9,000 per day to date.

The co-chairman of the Corona Experts Advisory Group (CEAG), Prof Dr Asad Aslam Khan, says that the Punjab government is ensuring that the testing facility is available for all symptomatic patients. However, with the prevalence curve moving upward, and in line with the recommendations of the WHO, he believes that a capacity enhancement of 5,000 tests per day is required.