The Merits of Bi-directional Screening
9 July 2021
As global research and healthcare assets have been increasingly fixated and diverted towards management of the Covid19 pandemic over more than a year now, much needed attention has been siphoned off from other avenues such as non-communicable diseases, mental health and other ongoing disease control programmes. While there has been some research pointing out the association between these other health conditions and Covid19, most of the new infrastructure and protocols being developed or those in place aim to increase testing for Covid19 alone, thus allowing many undiagnosed or subclinical cases of these other conditions to pass under the radar. This not only interferes with the management of the Covid19 cases, but also leads to setbacks for the respective disease management programmes, and delays attainment of the long term national goals related to the same. Bi-directional screening refers to the testing of cases for multiple conditions during a single visit, thus allowing for diagnosis of multiple health conditions if present, and promoting suitable patient management thus leading to better treatment outcomes.
While in theory the idea of bi-directional screening seems like a very difficult and expensive one, in reality it is not. The infrastructure for mass screening of cases already exists, and trained personnel, if not already available, can be easily trained over a short period of time. The advent of newer, more accurate and more cost effective diagnostic techniques has further eliminated the need for repeated confirmatory tests. In fact, guidelines for bi-directional screening of people with influenza like symptoms for both Covid19 and Tuberculosis already exist, as various studies have pointed out that patients with TB are at a higher risk of contracting Covid19 and are also likely to suffer from more severe symptoms. In addition, such patients may present with similar risk factors, such as a history of exposure, smoking, drug abuse, malnutrition, HIV positive status and so on. This means that on the basis of patient history itself, shortlisting of potential high risk cases can be done, thus eliminating the need and associated cost of testing each and every single person. Similar guidelines can be implemented for other diseases as well, such as diabetes, hypertension, and HIV infection, among others.
Despite these obvious merits, implementation of bi-directional screening as a practice has been relatively slow. This can be attributed to various factors, but for most part the most important one seems to be the lack of integration between private sector diagnostic facilities and national level disease control and surveillance authorities. Lack of any clear directives regarding the same further contributes to the problem, as does the fact that several of the necessary facilities for sample collection, transportation and testing are virtually non-existent in locations other than the largest urban centres, which are inaccessible to the majority of the population. There is lack of proper information management systems and having a way to report and access data digitally, on a national scale, as such systems would allow better oversight over the entire process of surveillance. Lastly, there is absence of demand for such screening due to lack of awareness among the general public.
There is a need for implementation of measures to initiate bi-directional screening, and to allow the transition of testing facilities for Covid19 to testing facilities for other diseases once the pandemic recedes to some extent. This would need a high level of Public-Private Partnership and integration of data systems and information management systems across these. Greater awareness among the masses for the same would generate adequate demand and would further draw investment into the same. Addressing the current pandemic may be the need of the hour, but in doing so, we might be exposing ourselves to another that is creeping up on us silently, and undoing all the gains and progress made by us over the last century.
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