Indian Journal of Public Health

COMMENTARY
Year
: 2022  |  Volume : 66  |  Issue : 1  |  Page : 74--76

COVID-19 Pandemic: An Indian radiologist' perspective


Annapurna Srirambhatla1, Abhishek J Arora2,  
1 Associate Professor, Department of Radio Diagnosis, All India Institute of Medical Sciences, Hyderabad, Telangana, India
2 Additional Professor, Department of Radio Diagnosis, All India Institute of Medical Sciences, Hyderabad, Telangana, India

Correspondence Address:
Abhishek J Arora
Department of Radio Diagnosis, All India Institute of Medical Sciences, Bibinagar, Hyderabad - 508 126, Telangana
India

Abstract

During the COVID-19 pandemic, differences in health-care system and policies among countries worldwide meant that each country had to come up with their own strategies for containment, diagnosis, and treatment of the disease − “no one size fits all.” India being the second populous country in the world with modern and traditional systems of health care has its own challenges to face during the pandemic. Among the increased cacophony of information regarding the COVID-19 disease and controversies surrounding the usage of various radiological modalities for its diagnosis, we are trying to present a sane perspective from an Indian radiologist viewpoint. Knowing the strengths and shortcomings of the Indian health-care system, we have suggested plausible solutions which may be the answers to the issues raised by the Indian media.



How to cite this article:
Srirambhatla A, Arora AJ. COVID-19 Pandemic: An Indian radiologist' perspective.Indian J Public Health 2022;66:74-76


How to cite this URL:
Srirambhatla A, Arora AJ. COVID-19 Pandemic: An Indian radiologist' perspective. Indian J Public Health [serial online] 2022 [cited 2022 Jun 28 ];66:74-76
Available from: https://www.ijph.in/text.asp?2022/66/1/74/342590


Full Text



The SARS-CoV 2 infection was declared a pandemic by the WHO on March 11, 2020. In India, the first case of COVID-19 was reported on the January 27, 2020, in the state of Kerala.[1] Since then, India has seen its share of rise and fall in cases as is the expected trend of a pandemic.

Being the second-most populous country in the world with a population of approximately 1.38 billion in 2020,[2] testing, containing and treating the disease posed a gigantic challenge. The Ministry of Health and Family Welfare (MOHFW) and the Indian Council of Medical Research (ICMR) had to garner resources at an unprecedented level to battle the disease. The strategy used by the ICMR was “test-track-treat.”[3]

 Diagnostic Dilemmas and Limitations



Recognition of the viral RNA by reverse transcriptase–polymerase chain reaction (RT-PCR) test was considered as the gold standard for the diagnosis of COVID-19.[4] In the early stages of the pandemic (around March 2020), sample collection was available at 57 Virus Research and Diagnostic Laboratories and testing was conducted by only 51 selected national reference laboratories.[5] The test results took an average of 3 days to be declared. The number of laboratories, however, was later sequentially increased by incorporating recognized private laboratories.[3]

With the rising number of cases and limited laboratory resources; the need to recognize, isolate positive cases and identify asymptomatic carriers requiring elective surgeries, the medical fraternity turned to imaging modalities mostly computed tomography (CT) scan as an alternate screening test for the disease. CT chest imaging fits into the mould of a reliable, quick, and readily available screening tool for COVID-19. Moreover, studies conducted in China showed that CT findings suggestive of COVID pneumonia were seen in 60%–93% of initial RT-PCR negative cases.[6] The sensitivity of CT in diagnosing the disease was reported as 97%.[6]

By November 2020, the major CT scan vendors reported a 40% surge in the demand for CT machines with 60% of machines being sold to first-time buyers in India.[7] CT was being used both to assess the severity of disease and diagnosis of suspicious cases with RT-PCR negative test results irrespective of the disease severity.

 Forming Guidelines for Radiological Investigations



Meanwhile, consensus statements were issued by the Fleischner Society of Thoracic Imaging[8] refuting the role of CT as a primary diagnostic tool in COVID-19 disease. CT scan was recommended only in cases which showed deterioration in symptoms or with a high probability of disease progression. Its use in the triage area was restricted to places with limited resources and confined to moderate-severe cases. The MOHFW[9] and Indian Radiological and Imaging Association (IRIA)[10] had issued the guidelines for the management of COVID-19 cases in June 2020 which recommended that radiological investigations be used only in severe cases.[9],[10]

 Radiology – In the Eye of the Storm



The challenges faced by the government and the medical fraternity in the face of a pandemic depend on the existing health-care system (rural-urban discrepant health-care facilities), organized and efficient use of resources, the ability of the scientific and technological personnel to come up with quick and evidence-based solutions and setting a uniform code of guidelines to be followed across the nation.

With approximately 68% of the Indian population living in the rural areas, shortage of qualified health-care personnel[11] and hospital equipment in the rural areas pose a main hurdle to disease recognition, treatment, and containment.[12] Health-care providers in rural as well as suburban India are diverse ranging from qualified allopathic, AYUSH, and unqualified providers, majority being the last[13] This brings forth a question of the ability to follow a uniform treatment protocol reflecting in the investigations advised and accountability. There was an increase in the number of self-referred CT scans being done by private imaging centers for the detection of COVID-19 pneumonia in lieu of RT-PCR tests.

Soon concerns were being raised regarding the indiscriminate use of CT scan and the potential detrimental effects of radiation exposure it imposed on the patient.[14] The “infodemic” spread as fast as the pandemic through social media posts regarding the treatment and investigations for COVID-19.With heavy workflow and limited resources, concerns were raised regarding regular disinfection of the gantry and personal protection protocols followed by the technicians which spread the fear of CT machines acting as “super spreaders” of infection.[14]

Reacting to the above statements, the IRIA released a press statement citing the negligible radiation dose (0.3–0.55 mSv) incurred by low dose CT indicated for COVID-19 patients.[14]

In a survey conducted by Kalra et al.[15] involving 1633 registrants from 1000 countries, they noted a wide discordance in CT protocols and indications for diagnostic imaging practiced for COVID-19. A balance should be made between the image quality and the radiation exposure to the patient. A foreseeable limitation is ensuring that the guidelines are followed uniformly throughout the country. No estimate is available regarding the number of CT machines in India and their distribution among the public and private sector.

 Plausible Solutions



In this setting, the need of the hour is for the radiology fraternity to shoulder the responsibility of spreading awareness about the role of radiological investigations in COVID-19 pneumonia[10] and curtail the indiscriminate use of CT scans.

Referring physicians should be guided regarding the appropriateness of the investigation and the self-referred radiological investigations curtailedScan protocols tailored to the patient habitus and involving radiation doses as low as reasonably achievable should be diligently enforced and followedEducating the radiology technicians regarding the use of personal protection equipmentHospitals and scan centers should be encouraged to organize efficient workflow and reduce the transit and waiting times of suspected casesHospitals should ensure appropriate sanitization following positive scans.

Advanced technological innovations have made radiological investigations an essential part of diagnosing and treating diseases. With this advancement comes an increase in responsibility. The radiologist needs to be actively involved in not just image interpretation but also in guiding the referring physician and the government in policy decisions. Battling the COVID-19 pandemic requires co-operation and contribution from the government, hospital administration, medical fraternity, and general public.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

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