Nearly 70 percent of Bangladesh’s RT-PCR testing facilities, needed for accurate diagnosis of Covid-19, are based in the Dhaka division — a worrying discovery seeing that the epicentre of the coronavirus outbreak has shifted out of the capital and its surrounding areas.
There are just 39 RT-PCR machines of a total of 128 serving the remaining seven divisions of Bangladesh, with Chattogram accounting for ten of the facilities.
In the absence of widescale testing and implausibility of contact tracing, it would be difficult to break the transmission chain of the more dangerous Delta variant that is engulfing the hinterlands of Bangladesh or even properly diagnose and then treat those with symptoms, according to experts.
“The pandemic was very Dhaka-centric for a while, but now it is all over the country,” said Mushtaque Chowdhury, convenor of Bangladesh Health Watch, a citizens’ platform dedicated to improving the country’s health system through evidence-based policy recommendations.
For instance, Bangladesh recorded the highest number of deaths from Covid-19 in the 24 hours to 8 am on June 30 and 75 percent of the fatalities were outside of the Dhaka division.
Similarly, of the total deaths reported in the 24 hours to 8 am yesterday from Covid-19, about 72 percent were from outside of Dhaka.
Over the past year, 36 new RT-PCR machines were added to Dhaka to go with the 68 already installed, while another 20 were added to the rest of the country.
In Dhaka city, for those who can afford the prohibitively high price of Tk 3,500-3,700 for an RT-PCR test, considered the gold standard for Covid-19 testing, getting one is as easy as picking up the phone and calling for a home appointment from a private hospital.
A medical technologist would arrive, usually within the day, take the patient’s saliva and mucus samples, with the results available in a matter of hours.
Compare that with Khulna city, which is reeling from the outbreak of coronavirus.
The city has two hospitals where a person can get tested: the publicly-owned Khulna Medical College Hospital (KMCH) and the privately-owned Gazi Medical College Hospital.
Our correspondent reported long queues of people waiting for hours at KMCH on Wednesday.
The hospital has two RT-PCR machines that run three times a day and can do 94 tests each time, said Mehedi Newaz, vice-principal of KMCH.
So, around 500 tests can be conducted each day, meaning scores are failing to get tested despite showing up for days on end and the region is failing to identify infections before they spread further.
Take the case of Asma Begum, a resident of Khulna city’s Shonadanga. She had to come to the hospital two days in a row last week to get tested but failed to.
She came back on Wednesday at 7 am but there were at least 30 people in the queue in front of her.
Not too far away from her was Nitish Boiragi, who had arrived from Batiaghati upazila’s Patharighata, which is an hour away from KMCH, on the dot at 7 am.
However, after standing in line for two hours, at around 9:30 am, the flu corner closed shop for the day as the RT-PCR machine was full.
“There were ten people in front of me when they closed the flu corner. Even though I protested, it was no use. I need to come back again tomorrow,” he had said on Wednesday.
He would have most likely failed again as the hospital’s RT-PCR machines had to be taken out of commission.
The lab had gotten contaminated with the SARS Cov-2 virus and needed to be shut down for three days to get a thorough cleaning.
About 2,000 samples would be sent to Dhaka from the lab for testing, according to Shahnaj Parveen, head of KMCH’s microbiology department.
Outside of Khulna city, only Kushtia, Jashore and Satkhira have a lab each.
This leaves the districts of Chuadanga, Magura, Meherpur, Narail, Bagerhat and Jhenaidah to depend on rapid antigen testing, which has more scope for false negatives even if a person is Covid-19 positive.
Should patients need an RT-PCR test, the samples are collected and sent to the districts with the testing facility.
Sylhet has three testing centres with RT-PCR facility, Rajshahi has two, while Rangpur, Barishal and Mymensingh have one each.
Many of the districts that do not have RT-PCR testing facilities are also districts with extremely high positivity rates.
For instance, on July 2, 97 samples from Magura were tested and 46 of them came out positive, showing the astronomical positivity rate of the district.
The district sends its samples to Satkhira for testing and it takes more than a day for the results to come back, according to Shahidullah Dewan, the civil surgeon.
Similarly, on that day, Pirojpur tested 108 samples and 56 of them came out positive, putting the positivity rate of the district at 51 percent.
Thakurgaon tested 276 samples and 125 were positive on July 2, meaning the daily positivity rate of the district was 45 percent.
Rajbari had a positivity rate of 50 percent with 170 people being detected positive.
None of the districts has testing centres and has to send their samples elsewhere.
Even this is a problem as testing in the districts is being restricted to only symptomatic individuals.
A rapid antigen test is carried out first and if the result comes out negative, the sample is sent for RT-PCR to Dhaka, said Nurul Islam, the civil surgeon of Narsingdi.
And asymptomatic individuals do not come for tests but those who have had symptoms for three to seven days, he said.
Over at Chapainawabganj, only those with symptoms can get an antigen test at the district’s 250-bed district hospital, according to Jahid Nazrul Chowdhury, its civil surgeon.
In other words, at a time when testing should be amped up, only a subsection of people are getting tested, making the predictions of future trajectories difficult — and also massively undercounting infections.
“All districts have to have RT-PCR testing capacity,” said Chowdhury, also the vice-chairman of Brac.
Bangladesh has the lowest testing rates in South Asia, but the government is ignoring this, he said, while calling for testing across the country to be ramped up exponentially.
Our Khulna correspondent contributed to this report