NEWS
01/07/2020 7:47 AM IST | Updated 01/07/2020 7:50 AM IST

Punjab Shows How Easily COVID-19 Test Reports Can be Forged In India

A police investigation into an alleged conspiracy in which a privately-owned diagnostic lab and a COVID-19 hospital in Amritsar stand accused of colluding to declare healthy people coronavirus-positive has cast an uncomfortable light on the vagaries of India’s testing infrastructure for the novel coronavirus.

HuffPost India
The recent controversy of Tuli Diagnostic centre at Amritsar district in Punjab has cast an uncomfortable light on the vagaries of India’s testing infrastructure for the novel coronavirus.

CHANDIGARH — A police investigation into an alleged conspiracy in which a privately-owned diagnostic lab and a COVID-19 hospital in Amritsar stand accused of colluding to declare healthy people coronavirus-positive, hospitalize them, and charge them very high medical costs, has cast an uncomfortable light on the vagaries of India’s testing infrastructure for the novel coronavirus.

Those affected, who include a pregnant doctor, say that their hospitalization in a facility full of coronavirus-positive patients meant that they ended up catching illness at the hospital itself. 

Punjab’s enforcement agencies say the owners of Tuli Diagnostics Laboratories connived with the proprietors of EMC hospital and endangered lives by faking test results to fraudulently admit healthy people in their COVID-19 isolation wards.

The First Information Report (FIR) filed by the police includes several serious charges including an attempt to murder, fraud, and participating in a criminal conspiracy.

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Tuli Diagnostics, the lab in question, said they are being harassed for simply doing their jobs and declaring results in line with guidelines laid out by the Indian Council of Medical Research, India’s nodal agency for COVID-19 testing. ICMR has called for strict adherence to established protocols for collecting, transporting and testing samples.

This testing scandal, at present limited to only one private hospital and testing centre, comes as over 550,000 Indians have tested positive for the novel coronavirus, the fourth highest in the world after the US, Brazil, and Russia.

HuffPost India spoke to the affected patients who filed police complaints to untangle a curious and unsettling tale.

Hindustan Times via Getty Images
Photo by Sameer Sehgal/Hindustan Times via Getty Images

False Positives

On June 10, Amritsar resident Varinder Dutta’s father-in-law was admitted in the privately-owned EMC Hospital, a medical facility intended exclusively for COVID-19 patients, after testing positive for the novel coronavirus.

At EMC Hospital,  Dutt’s wife Preeti and three relatives were asked to submit blood samples to check if they had caught the virus as well. The three relatives gave their samples at EMC, who transported the samples to Tuli Laboratories — a private diagnostics facility that handles EMC’s COVID tests. Preeti dropped off her sample at another collection facility run by Tuli Labs. 

When the test results for Preeti and her relatives turned out to be positive on the same day, Dutt said EMC hospital put pressure on them to admit themselves in the hospital’s COVID-19 isolation ward.

“The hospital gave us 45 minutes to either get admitted in their isolation ward quietly or else they would inform the government authorities who would drag us out of our homes in front of our neighbours and take them away in COVID-19 ambulances,” Dutta who runs an NGO told HuffPost India. “They even assured us to keep our COVID-19 positive status as a closely guarded secret.”

Dutta said his family decided to admit themselves on June 10 at EMC to avoid harassment from government authorities.

As per ICMR guidelines, a COVID test is conducted in 2 parts — if the initial test is positive, ICMR requires a second confirmatory test after 24 hrs. (If the initial test is negative, there is no need for a second test). Dutta claims he insisted that his family’s second, confirmatory, test be submitted at the state-run Government Medical College at Amritsar, and insisted on a third test on June 13, from the same government-run lab.

Dutta says EMC did not inform his family that the results of their second confirmatory tests were negative; implying that they didn’t have the coronavirus. But the family’s third and final test the three relatives tested positive, while Dutt’s wife Preeti turned out to be negative, Dutt claims.

“The hospital authorities gave us 45 minutes to either get admitted in their isolation ward quietly or else they would inform the government authorities who would drag us out of our homes in front of our neighbours and take them away in COVID-19 ambulances. They even assured us to keep our COVID-19 positive status as a closely guarded secret.”Varinder Dutta, Complainant

Dutt has interpreted these conflicting testing to mean that EMC deliberately withheld the negative test results when his family did not have the virus and shifted his family to a coronavirus ward where they caught the virus.

“EMC did not inform us about the test results conducted on June 11 and shifted us in the isolation ward amidst COVID 19 patients,” Dutta told HuffPost India over the phone. “While my wife took precautions and managed to keep the infection away in the isolation ward, her family members came positive in the third test.”

Dutta isn’t the only person to have complained against EMC and Tuli Labs.

In another case, being probed by the police, Tuli lab was accused of issuing a false ‘positive’ report of a nine months pregnant doctor Dr. Anum Khullar. According to her father-in-law, Raj Khullar, when Dr. Anum went to Apollo hospital two days before her delivery date, the hospital authorities asked her to take a covid test before admitting her in the maternity ward. 

She gave a sample to Tuli Labs on the same day in which she was found positive. Tuli Labs then directed Dr. Anum to EMC hospital, where she was asked to pay Rs. 4,00,000 for admission to the hospital.

Dr. Anum says she also gave her samples at the Government Medical College at Amritsar, where her results were negative. 

Maninder Singh manna, an Amritsar based local Congress leader has claimed to have exposed the alleged nexus between the private labs and the hospitals in Punjab. 

Hospital Responds

Neeta Tuli, Director of the Tuli diagnostics refuted the charges levied against her laboratory and said that the results were declared as per ICMR guidelines. A private lab like Tuli Diagnostics, she added, offers more accurate results than government labs as the latter conduct pool testing of upto five samples at a time. It was only after a  sample comes positive, a government lab conducts tests on all the pool samples separately. 

The test results of the Dutta family, Tuli said, were initially inconclusive, and — as per ICMR guidelines — must be declared positive and sent for further testing.

“Since the machine also stores these results and real-time graphs in its internal storage, the enforcement agencies can verify the results by assessing the internal storage with the help of the manufacturer,” Tuli said while speaking to HuffPost India over the phone. 

As per ICMR guidelines, Tuli said, the second confirmatory tests had to be done at least 24 hrs after the first test, and the third test after 10 days.

“In all the cases mentioned against us, the tests were done in less than 24 hours,” said Tuli. 

ICMR’s Response

Dr. Nivedita Gupta, Division of Epidemiology & Communicable Diseases, ICMR, New Delhi, said ICMR was still in the process of understanding why RT-PCR tests, considered the gold standard for COVID testing, sometimes gave contradictory results.

“We are getting similar reports wherein a person tested positive through RT-PCR turns out to be negative in the second test taken within 24 hours,” said Dr.  Gupta. “We wanted to conduct a study  on  such patients but finding it difficult as the factors responsible for such variability of results are yet to be identified.”

“Normally, repeat testing is not recommended before 24 hours. The private labs are under a lot of scrutinies as they even declare borderline cases as positive ones. The state government should give liberty to private players but should hold the baton tight,” said Dr. Gupta. 

Dr. Gupta said it was difficult to comment on the Amritsar cases without going into the nitty-gritty of the case.

“We have time and again highlighted the need of state governments to conduct random testing of samples by a third party lab to keep a check on quality by the authorised labs,” said Dr Sharma.

“The samples should be packed and given random numbers so as to hide their identity from the third party. Then the state government should compare the results of both the labs and take necessary action if they find something suspicious.”