Maharashtra directs high-res CT scan centres to share contact details of Covid cases

MUMBAI: The state has finally woken up to the surreptitious practice of using the HRCT scan for Covid-19 diagnosis by skipping the gold standard RT-PCR test altogether. Worried that scores of such cases were going under the radar, the state issued an order on Wednesday asking diagnostic centres and hospitals to share the contact details of suspected or confirmed Covid cases with local authorities. The BMC has taken the order a step ahead and put the onus on such centres to pursue patients to get an RT-PCR done.

Principal health secretary Dr Pradeep Vyas stated in the order that some hospitals were using the high-resolution computerized tomography (HRCT) test to diagnose Covid-19 and initiating treatment based on the scan findings without getting the confirmatory RT-PCR or antigen tests done. He said in the absence of an RT-PCR report, the local authorities stay in the dark about these cases and cannot carry out contact tracing and other infection-control measures. Emphasising that RT-PCR or rapid antigen tests were the only approved methods for a confirmed Covid diagnosis, Dr Vyas said skipping these tests could increase chances of infection spread in the community.

The order states the hospital or centre will have to share the name, contact number and address of the patient suspected or diagnosed with HRCT and share these with a cell that local administrations have been asked to set up. As soon as any facility gets a Covid diagnosis through HRCT, it will be mandatory for the patient to undergo an RT-PCR test within 24 hours, the order added. The local authorities will also have to spring into action and check that RT-PCR is done and initiate contact tracing.

For Mumbai, additional municipal commissioner Suresh Kakani said patients who are being picked up using HRCT are not on the BMC's tracking list. "Hence, we cannot do contact tracing or monitor their health condition," he said, adding the diagnostic centres can prescribe RT-PCR to such patients.

While doctors have welcomed the move, they say it has come a tad too late. "HRCT was a rage in April and May when RT-PCR was not too accessible. Several centres were doing up to 40 scans a day and finding 30 positive reports," said Dr Bhavin Jankharia, radiologist and former president of Indian Radiological and Imaging Association (IRIA). It's not the case any longer as RT-PCR is widely available, he said. Dr Jankharia said his centre now carries out five scans in a day and finds one positive case in two days.

Physician Dr Hemant Thacker said HRCT scans help pick up classic ground glass presentations seen in Covid. "However, not all ground glass appearance on CT scan is Covid, and one has to correlate it with the clinical picture," he said.

He called the state decision a good move in terms of "epidemiology". Incidentally, Maharashtra was also one of the first states to cap HRCT rates because of rampant profiteering.

Radiologist Dr Jignesh Thakker said a positive RT-PCR report initiates a chain of events starting from local authorities coming home to quarantining a floor, which many try to avoid by getting an HRCT. Much before the state notification, Thane authorities had introduced a rule to inform them about HRCT cases through WhatsApp, he said.