DON'T be SCARED to take a COVID-19 test!

'People are sick at home and think that they might have COVID-19, but will not want to go and get themselves tested.'

Dr Trupti Gilada, an infectious disease specialist at the Prince Aly Khan Hospital, Masina Hospital and the Unison Medicare and Research Centre, Mumbai, debunks the stigma around the coronavirus and the COVID-19 test in a conversation with Vaihayasi Pande Daniel/Rediff.com.

IMAGE: Neighbours look on as Kolkata Municipal Corporation workers transport a COVID-19 victim from his home in Kolkata, July 1, 2020. Photograph: Ashok Bhaumik/PTI Photo

The stigma around COVID-19:

The downstream effects of the stigma have become more and more evident.

There is a lot of stigma and discrimination around COVID-19.

Something that went unnoticed, unaddressed. And we are seeing its effects.

People are sick at home and think that they might have COVID-19, but will not want to go and get themselves tested.

They are afraid that either they will be just lifted up from homes and these are the words that they actually use -- 'ki humko ghar se utha lenge'.

They will be lifted up from homes and put into centres and their entire buildings or their societies will be locked down.

So that fear of treatment by the authorities definitely demotivates them from going and getting themselves tested, which means that they will come to the healthcare system when it's very late.

And in the meantime, they have transmitted the disease to many others.

It is unknowingly, but it's still done -- the disease is transmitted.

That is one aspect where we will have to work together, because it is causing harm.

There are healthcare workers who are afraid of going back to their homes or will be ill-treated when they go back to their homes by their neighbours.

That demotivates a lot of healthcare workers from joining back work (now that transport is available, with more local trains having started), especially at this point when we really need all the healthcare workers to be in the hospitals.

We cannot afford to have people at home, unless they are ill obviously.

The stigma and the discrimination are other unaddressed aspects of the disease, that we will have to tackle.

IMAGE: A healthcare worker at a COVID-19 check-up camp in a Mumbai slum, June 27, 2020. Photograph: Francis Mascarenhas/Reuters

Does this stigma compound the whole COVID-19 problem in various ways, whether it's the death rate or the case numbers?

Yes, because we are probably not seeing all the cases, because people are not testing themselves.

There is also the other side to it, where there will be a lot of mild cases or asymptomatic cases, who might want to get admitted, just out of fear, because once their neighbours come to know they will be shunned from their society.

A lot of times hospital beds are occupied by these milder, asymptomatic cases, when these beds could have been actually put to use for someone who really needs it.

IMAGE: People queue to get tested at a slum in Mumbai, June 29, 2020. Photograph: Francis Mascarenhas/Reuters

One of the ways to reduce mortality from COVID-19 is to make sure a patient gets to the hospital as soon as possible.
But another issue that seems to have arisen is that people who are in lockdown, at home, and start getting symptoms, believe it could not be the disease, because they are in lockdown.
So, they don't test; sometimes because their GP hasn't suggested it either.
They have not realised that lockdown means isolation and not going out or having contact with anyone while at home. And the delay in getting to testing and a hospital can be critical.

At this point, at least in cities like Mumbai, where we are seeing a large number of COVID-19 cases, and over the last two months, we've learned that COVID-19 presents in ways other than fever or (via) the typical presentation.

We've seen COVID-19 present as a stroke at the age of 40.

We've seen COVID-19 present with acute myocardial infarction or heart attacks, without having any previous fever.

Physicians will need to keep that threshold for testing for COVID-19 very low.

It doesn't matter whether the person who is sick has been exposed to someone who had fever or not, because we know that even asymptomatic people are COVID-19 carriers.

There must have been some contact.

We should not go by the history that 'Oh there is no contact, so let's not test for COVID-19'.

This is something the treating physicians will have to keep in mind. They have to keep the threshold for testing much lower.

IMAGE: Health workers prepare before screening residents at a slum in Mumbai, July 1, 2020. Photograph: ANI Photo

And ask the right questions about the patient's case history?

Yes, they need to ask the right questions when nothing explains the clinical scenario and we should just go in for a test for COVID-19.

IMAGE: A healthcare worker checks the temperature of a resident at a slum in Mumbai, July 1, 2020. Photograph: Francis Mascarenhas/Reuters

Maybe the patient himself or his family should insist more strongly on being tested -- that being what an individual needs to do for himself/herself?

We really can't blame the patient or the individual for not being pushy.

That's the general culture in our country, where the patients will believe whatever the doctor says.

A lot of times they actually have fully entrusted their health in the doctor's hands.

Nor would I blame the doctors for not testing.

It's just that we've always read about COVID-19 presenting with fever, cough, breathlessness or sore throat.

When there is any other scenario or clinical scenario, that doesn't fit in, people don't feel it might be COVID-19.

But what I'm trying to say is that since the prevalence of COVID-19 is increasing, we will just have to keep in mind that when we see a clinical scenario that is not fitting into anything that you have ever seen or you cannot explain a certain sign or symptom that you are seeing in a patient, there is no harm in just going in for a COVID-19 test.