As H1N1 cases rise in Kolkata, hospitals run out of test kits

KOLKATA: Amid an outbreak of swine flu across the city and Salt Lake, which has claimed at least seven lives since January, several private hospitals have run out of test kits to detect the H1N1 virus that triggers the infectious disease.
Patients desperately seeking to get the H1N1 test done are being told by the hospitals that as per “government instruction”, the test will be done only if they get themselves admitted.The government, however, has denied issuing any such instruction. The facility to conduct the Xpert flu test—which detects the presence of the H1N1 virus — is currently available only at two government hospitals, four private hospitals and one private diagnostic centre.
Scores of patients were turned away by AMRI Hospital in Salt Lake, Peerless Hospital and CMRI Hospital this week. The hospitals said they are frequently running out of kits and have been asked by the health department to desist from conducting the Xpert flu test without admitting patients.

“We had run out of the kit but fresh supplies have arrived. As per the health department’s instruction, we are not conducting the test on outdoor patients. We have been asked to follow the direction to ensure that the test is not done indiscriminately without enough reason,” said Peerless Hospital medical superintendent Sudipto Mitra.
However, the health department has denied this. “There’s no such instruction,” health secretary Rajiva Sinha said.
While AMRI, Dhakuria has received a fresh batch of kits, its Salt Lake unit ran out of them over a week ago. AMRI, too, is conducting the test only on those who have been admitted.
‘Kin of swine flu patients must undergo test’
An AMRI spokesperson said: “The kits have been trickling in since supply turned slow a few weeks ago. We are conducting the test only on admitted patients as per a NICED instruction.” CMRI, too, has run out of kits.
While patients have been left in the lurch, doctors are often being forced to prescribe swine flu drugs on assumption. Ideally, once the virus affects one, the rest in the family should undergo an Xpert test to check if they have H1N1, said AMRI Hospital consultant Debashish Saha.

“All close contacts have to be clinically examined through the flu test that uses the PCR method. A throat or nasal swab is taken to detect the presence of H1N1. If the test result is positive, then immediate isolation and treatment are necessary. All family members should immediately start taking Tamiflu – the principal H1N1drug,” said Saha.
“There’s a clear WHO guideline that swine flu can be treated at home and patients should be tested without admission. The government should make the test kit widely available so that patients and doctors know for sure if the disease has indeed struck. Prescribing Tamiflu on assumption could be dangerous since it will invariably lead to resistance to the drug,” said consultant Arindam Biswas.
Others, however, differed on the use of Tamiflu. Since Xpert test is expensive and has now become difficult to avail, family members of an affected should rely more on precautions, according to Fortis Hospital internal medicine consultant Joydeep Ghosh.
“Since hospitals are refusing to do the test without admission, it is safe to start taking Tamiflu if one has flu-like symptoms. The elderly and those suffering from blood sugar, cardiac ailments, renal diseases should have the medicine since they have lower immunity which makes them vulnerable,” said Ghosh.
National Institute of Cholera and Enteric Diseases (NICED) director Shanta Dutta pointed out that according to a government of India guideline, the Xpert flu test can only be conducted if a physician recommends admission. “The patient must have grade III flu symptoms including respiratory distress that indicates swine flu. It’s an expensive test and can’t be conducted by us indiscriminately,” said Dutta.
It is difficult to distinguish between an ordinary flu and H1N1 since the symptoms are similar. “The most common swine flu symptoms are fever, cough and breathing difficulty. But the intensity of the symptoms could vary. Often, swine flu triggers vomiting diarrhoea, too,’ said Saha.