In the last one month, Mumbai has witnessed a six-fold rise in Covid-19 cases but the demand for testing in private laboratories is far lower than what was seen in the previous waves, as a large number of patients are opting for unregulated at-home antigen testing (RAT) kits for diagnosis this time. Doctors fear that many Covid-19 cases are going unreported as the reports are not being recorded on the portal of the Indian Council of Medical Research as per protocol.

As of June 16, Mumbai had 13,005 active cases of Covid-19, compared to the 896 cases on May 16. In fact, anticipating a sudden rise in the demand for testa, private laboratories had made additional provisions. But this time, there has been nearly a 50 per cent drop in footfall of patients compared to January this year, when the city had last seen a similar caseload.

Dr Nilesh Shah, president of Metropolis Healthcare Ltd, said, “We haven’t witnessed any rise in demand for testing, although the current positivity rate in our laboratory tests has increased to 30 per cent.”

Dr Manish Dattatreya Karekar, COO-Pathology, Krsnaa Diagnostics, also said that the positivity rate has shot up to 30-40 per cent.

Despite the high positivity rate, testing in private laboratories has remained unusually low. Due to instant result availability, repeatability, and ready accessibility at the nearest chemists, majority of patients are opting for easy-to-use at-home RAT kits, which give the result in just 10 minutes. As of June 12, ICMR had approved 11 at-home antigen testing kits from Mylab CoviSelf, CoviFind, PanBio, among others, demand for which has surged in the last one month.

According to Sujit Jain, director of MyLab Discovery Solutions, the demand for their at-home test kit, CoviSelf, has surged by nearly 30 per cent in the same period. “As most of the patients have mild symptoms, they are opting for the kit for diagnosis. With time, trust about the efficiency of the kits among people has increased, which has also pushed up its usage,” said Jain.

Abhay Pandey, president of All Food And Drug License Holder’s Foundation (AFDLHF), said, “There has been a 20-35 per cent rise in the purchase of kits. Many customers are buying it for the whole family.”

According to experts, an RT-PCR test has 100 per cent accuracy as it uses a molecular technique used in diagnostics. The RAT kits are 70-80 per cent accurate, but when positivity rates are high, they are still very useful because when a rapid test shows that a patient is positive for the infection, there is a high likelihood that the patient is infected.

In fact, the Centre has also instructed the states that 60 per cent of the cumulative tests should be conducted by RT-PCR.

“There are plenty of testing commodities, ranging from gold-standard RT-PCR to rapid antigen tests or ancillary equipment like viral transport medium or RNA extraction kits. Home testing has picked up fast, and some states and districts have recorded a decrease in Covid-19 testing parallelly, possibly as an outcome of the rise in home testing, which is difficult to record officially,” said Dr Sunil Jain, consultant and head of emergency at Jaslok Hospital.

The drop in traditional diagnostic methods is also being reflected in the daily testing of the Brihanmumbai Municipal Corporation.

During last December, which marked the beginning of the third wave, the civic body was conducting over 35,000 daily tests, which has now dropped to around 10,000 despite having a similar caseload. Chandrashekhar Mani, vice president (operations), Thyrocare Laboratory, said as seen in the previous three waves, there hasn’t been any spike in testing from corporate houses.

“We have only witnessed a 20 per cent rise in testing in government set-ups,” he said. Similarly, Dr Karekar said, “Patients are primarily from walk-ins, or residentials and international travellers, but less from corporate companies.”However, doctors fear that due to the surge in the usage of the kits, many Covid-19 cases in Mumbai may be going unreported. As per protocol, each of the easy-to-use testing kits has a unique QR code to ensure traceability and genuineness. An user is instructed to log into the apps of the respective brand through their mobile numbers. Then they have to scan the unique QR code. After running the test, they have to take a photo of the test on the card through the app to confirm the result. However, it is not mandatory for users to upload their results. “But the issue is that positive results are not uploaded and hence they are neither reported nor isolated as per protocol. If the RAT test is positive, they have to inform the nearest government hospital or their doctor, and update the report onto the online ICMR portal,” said Dr Jain.

Dr Shah advised that as a self-test can even give a false negative result, it is advisable for symptomatic patients with negative reports to undergo RT PCR tests in laboratories.

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