Mandatory COVID-19 Testing at Delhi's Apollo Hospital Leaves Daycare Patients in a Bind

"My company covers my medical costs, but these days they have refused to pay for any COVID-19 expenses. They say they can’t afford it," said a dialysis patient.

New Delhi: Seventy-one-year-old K.P. Mehta* has been going to Apollo hospital thrice a week for dialysis for his kidney treatment for the last four years. In the first week of this month, the hospital asked him to get tested for COVID-19 once every week before his weekly dialysis sessions.

Mehta, who is a retired man and preferred to go to Apollo for his treatment since it was the hospital closest to his home, paid an additional Rs 4,500 (the price of the RT-PCR COVID-19 test) along with his dialysis fee for the first time. In the following weeks, patients paid Rs 3,500.

At least three patients who frequent Apollo Hospital at Delhi’s Sarita Vihar for day-care treatment services like dialysis and chemotherapy told The Wire that they were being asked to get RT-PCR tests for COVID-19 every week before their procedures.

“We were not told why we need to be tested weekly, we were just told that we need to bring our COVID-19 test reports or our dialysis won’t be done,” Mehta said.

‘No guidelines say all patients must be tested’: health minister

On April 28, in a letter to state chief secretaries, health secretary Preeti Sudan wrote that testing for COVID-19 must be “as per protocols issued by the ICMR”. The letter said, “I would like to draw your attention to certain reports received in this ministry that many hospitals in the private sector are hesitating in providing critical services such as dialysis, blood transfusion, chemotherapy and institutional deliveries. It is also noticed that at many places the hospitals/clinics are insisting on a COVID-19 test before providing services.”

The guidelines issued by the ICMR say that patients who must be admitted to the hospital, asymptomatic health workers who have been exposed, asymptomatic direct contacts of laboratory-confirmed cases and asymptomatic expectant mothers who are nearing delivery dates should be tested for COVID-19.

Also read: Should All Patients Admitted to Hospitals Be Tested for COVID-19?

On April 28, the Union minister of health Harsh Vardhan also echoed this direction. He said that the guidelines issued by the health ministry were very well defined. “Nothing in the guidelines says that you must test all patients, even those seeking daycare admissions,” the minister said.

Mounting bills

“See, my company covers my medical costs, but these days they have refused to pay for any COVID-19 expenses”, he said. “My company has said they can’t afford it,” said Mehta.

“I have seen some patients cry because they can’t pay the extra Rs 3,500 weekly,” said Amit*, a young man in his thirties who takes his 78-year-old grandmother to the same hospital thrice a week. “We can pay the amount, honestly, but there are people who turn back and are not being able to get essential treatments done.”

“Each dialysis session costs us around Rs 4,000 and we have three dialysis sessions in a week. This means we pay around 48,000 per month only on dialysis excluding medicines and our travel cost. With COVID-19 tests, we have to pay 15,000 rupees extra per month,” said Vikas*, who takes his 65-year-old mother to Apollo hospital thrice a week.

A medic collects a swab sample of a man from a new swab testing cabin at Podar hospital in Worli during a nationwide lockdown in the wake of coronavirus pandemic, in Mumbai, Sunday, April 19, 2020. Photo: PTI/Kunal Patil

According to a report in the Economic Times, Max hospital in South Delhi’s Saket was also testing all patients for COVID-19 but stopped after directions were issued by the health secretary Preeti Sudan on April 27 and April 28 directions and the Union health minister’s clarification.

Upon being asked if he would like to shift his mother to another hospital where tests were not being conducted before day procedures, Vikas said that while he could shift his mother, “I will have to go through the entire process. Everyone is scared these days and it will add to our stress.”

Mehta said that Apollo hospital was close to his house and shifting to another hospital would be cumbersome.

Also read: Non-COVID-19 Patients Are Paying the Price of India’s Efforts Against the Coronavirus

Such tests not absolutely necessary, say doctors

Speaking to The Wire, Dr Harjit Singh Bhatti said that according to ICMR guidelines, before admitting any patient into the hospital a COVID-19 test needs to be performed but a test before daycare procedures like dialysis and chemotherapy is not required unless the patient has been showing symptoms.

In some private hospitals, I have seen that COVID-19 tests are being done for people twice even after the person has tested negative once. All this is happening because there are no clear guidelines from either the ministry or the ICMR,” he added.

When asked if the dialysis and chemotherapy machines could become potential carriers of the virus and whether subsequently, it was necessary to test patients, Dr Bhatti said that machines were being sanitised regularly and that he saw no need for these patients to be tested every week.

Apollo Hospital claims its performing tests “as a measure of abundant caution”

In a written reply to queries by The Wire regarding the rationale behind conducting COVID-19 tests and whether the hospital’s staff was being tested as well, the official spokesperson of Apollo Hospital said, “Given the widespread number of hotspots and asymptomatic cases in Delhi NCR, the hospital, as a measure of abundant caution is periodically conducting COVID-19 tests on all its patients undergoing planned procedures as part of its workup. However, emergency treatment is being initiated for any patient needing urgent medical attention, irrespective of their pending COVID-19 status report. Also, no patient is being denied clinical services based on their COVID-19 status. The testing regimen is being undertaken to ensure appropriate clinical management of a patient basis their COVID-19 status. This measure has been necessitated in order to ensure the safety of all our patients, visitors and healthcare workers”

More chances of staff contracting the virus from co-workers, not patients

Another doctor who did not wish to be named said that hospitals were undertaking additional testing because they suspect that members of their staff will test positive. There is no clear communication from the state government or the central government regarding how many doctors have contracted the virus so far. This is creating fear and panic among health care workers and that’s why to protect themselves they are testing patients weekly. In reality, he said, “health care workers are more likely to get infected by fellow co-workers and not from patients”.

Also read: No Food, Water, Toilets: Life After Testing Positive for Delhi Health Care Workers

“They are not testing their staff,” said 71-year-old P.K. Mehta*, who goes to the Apollo hospital for dialysis. “One day, while my sample was being taken, I asked the nurse, out of curiosity, if the hospital was testing them every week too, and she replied by saying, ‘no, we are not being tested.’ I don’t get it,” Mehta said.

“This doesn’t make sense,” said Amit. “Their attendants could be carriers too, why are they not testing them?”

Vikas* said that his mother was being tested in the same room where suspected COVID-19 patients were being tested which was causing a lot of stress.

Dr Bhatti said that keeping patients who were above 60 and were suffering from chronic diseases like a renal problem or cancer along with suspected cases was quite risky. “Keeping an immuno-compromised patient with a suspected COVID-19 patient must definitely be avoided,” he added.

*Note: Names have been changed to protect patients’ identities.