The Covid-19 outbreak has had a major impact on Pathology laboratories since the past year. Early and accurate diagnosis of Covid-19 is critical to curbing its spread and improving health outcomes. Medicircle is honored to have a conversation with specialists on this topic. Through this series we aim to create awareness about the role of Diagnosis in COVID-19 and get many doubts clarified directly from the experts.

Dr. Sanjay Arora is a Pathologist. He is Founder and MD of Suburban Diagnostics. Suburban Diagnostics has led the way in this fight against COVID by performing over 1.3 million tests (RT PCR, antigen, and antibody). Dr. Sanjay Arora is known to be the leader in the diagnostics and healthcare industry. He graduated from Grant Medical College and JJ Hospital, with a special interest in Cytopathology. He has trained at esteemed Tata Hospital, Johns Hopkins Hospital, and Henry Ford Hospital, USA. His visionary approach towards women’s health has helped bring a change and improve the health outcomes and health indices in the country. 

Why is second wave of COVID-19 more powerful?

Dr. Arora mentions, “There are 3 variants of COVID-19 – UK variant, Brazilian variant, and South African variant. Variants are based on the change or alteration in the gene structure of the virus. Genetic sequence technology is the means through which 1 % of the virus is being studied in the UK to ascertain the exact variant. In India, we are starting the use of this technology too. In the initial phase, we found that instead of 1 change in the Covid variant that is generally occurring in the entire world, there are 2 changes in the variant which is predominant in India and that is why the 2nd wave of the pandemic here have had a more powerful impact.”

Significance of RT PCR

Dr. Arora points out, “RT PCR test is considered to be the gold standard test in the entire world. It helps in detecting the genes of the virus and also its variants or mutations. Fever is a common symptom of Covid. There are other symptoms like loose motion, sore throat, body ache, fatigue, etc. RT PCR test irrespective of what the symptom is should be done immediately. Also, if one is coming in contact with someone who has been diagnosed positive, then after isolation of 5 days, even if the symptoms do not get evident, an RT PCR test is advisable.”

Why more youngsters got affected in the second wave?

Dr. Arora says, “We are analysing data and have found that the younger population is more affected in the 2nd wave. Data analysis is being done to find the exact reason for the same. One reason could be that the youngsters have lost the patience of staying indoors for so many months at a stretch. However, full data analysis would help in ascertaining the reason more definitively.”

Why is repeat RT PCR recommended?

Dr. Arora points out, “In RT PCR test, multiple steps are involved. Something or the other might go wrong in about 30% of the cases. Thus, if there are 100 positive RT PCRs, 70% would get recorded with accuracy while there could be 30% chances of the test report being negative even when it's positive. If the symptoms persist, then after 48 hours, a repeat RT PCR can be done. Repeat tests have captured the right condition in many of the cases.”

Emergency tests to diagnose COVID-19

Dr. Arora informs, “Waiting for 24-36 hours for the COVID-19 RT PCR report may not always be possible There are 2 tests that provide almost instant Covid report which proves helpful in an emergency. One is the rapid antigen test that can detect, Covid in 15-20 mins so that doctors can take action accordingly. It’s not as accurate as RT PCR but can provide instant information. 

There is another test called Rapid RT PCR developed by Abbott. We get the result from that in 30 mins. These two are good options to ascertain Covid in an event where the patient’s health is deteriorating speedily and the hospitals need a COVID-19 positive report to admit and treat the patient.”

The right way of using the mask

Dr. Arora advises, “People should wear the mask properly instead of using it on the chin or covering just the mouth with it instead of both mouth and nose. The N95 mask is most effective. It's more for the use of medical professionals but others can use it too. If one is using that mask then double masking is not required.

The other option is the 3 ply surgical mask which has a special way of wearing it that people should follow. People can wear double masks as well, first the 3 ply surgical mask and then the cloth mask above it. People find it difficult to always use the mask but getting into the habit is required. The best way is to avoid going out of home and if you are going out in an emergency, then go either with a double mask or N95 mask,” suggests Dr. Arora.

Important instruments to be kept at home

Dr. Arora says, “Pulse oximeter and thermometer are 2 instruments that should be at every home. If oxygen saturation is 95 and above then there is no problem. If oxygen saturation is dropping by 3-5 percent, then it’s a matter of concern. Proning helps in increasing our oxygen level to up to 98 if it's 92-93. If the oxygen saturation is lower than 94 then it’s better to get hospitalized.”

How effective is an oxygen concentrator?

Dr. Arora informs, “Oxygen concentrators are of 2 types. One is up to 5 litres per minute capacity and commonly available and the second is up to 10 litres per minute capacity. If there is an elderly person at home who already has problems like lung issues or weakness and has oxygen saturation at borderline, then an oxygen concentrator helps in the interim gap between home and hospital. But if oxygen is required at the rate of more than 10 litres per minute, then hospitalization is the solution. Oxygen concentrator helps up to the requirement of 10 liters per minute,” says he.

How to monitor the after-effects of COVID-19 in one’s body?

Dr. Arora advises, “Covid affects lungs, heart and diabetic conditions. For people with lung issues, oxygen saturation, lung function test, and CT scan can ensure lung health. For people with heart ailments regular ECG and sonography of the heart is good. Other than that, routine tests like CBC, haemoglobin, blood sugar levels are basic health parameters to monitor. Not much other than this is required for people who have already got affected by Covid and recuperating.

Efficacy of vaccine – comparative analysis not required

Dr. Arora advises, “There is no need to do a comparative analysis of which vaccine is better. The objective of the vaccine is to prevent severe conditions arising out of Covid and to help escape death. Covishield, Covaxine, and Sputnik -V are all effective in that direction. All age groups above 18 are recommended to take the vaccine without doing an unnecessary comparative analysis of efficacy.” 

Don’t let down your guard after taking the vaccine

Dr. Arora further points out, “If you have taken the vaccine, it does not mean that you can get casual with precautions. You can still get infected. The vaccine ensures that the severity of the effects of the virus is much lower, that’s all, but you can still get Covid-positive. The other thing is that maybe the symptoms might not get aggravated in you post-vaccine but you might infect others. So, you need to follow precautions for others too. Vaccination should spread, not the infection,” says Dr. Arora.

Antibody test is not required

Dr. Arora informs, “Antibody test is of two types. The first type helps us to understand whether antibodies have been produced or not after one got affected by Covid. The other test is done to ascertain whether antibodies in the body have increased after the vaccine or not. However, these tests are not really required.

(Edited by Amrita Priya)