False Negative Results in RT-PCR test: What you should do?

Arjun Sharma (name changed on request) from Delhi visited three hospitals for an oxygen bed for his father as he was having covid-19 symptoms. The oxygen level was steadily decreasing, and the CT scan was also showing infection and pneumonia in the lung. But, he did not get admission to any hospital because his father’s covid-19 RT-PCR test report was negative. It was a case of False negative results.

false negative results and RT-PCR tests
RT-PCR test, image: Hindustan Times

The doctors with whom Arjun Sharma spoke said that his father could be covid-19 positive. And, they may also need to be admitted to the hospital, but due to negative Covid report, they are facing difficulty in getting admission to the hospitals. However, later his father was admitted to the Government Hospital with the help of some civil society volunteers. But, the increasing cases boost the demand for RT-PCR tests, which also increases the false-negative results in RT-PCR tests.

Increasing False-Negative Results will increase the chances of people who need serious care not getting admission to hospitals. And people who are covid positive and not showing symptoms can spread the virus.

The RT-PCR test is a precise test for the diagnosis of covid-19. But now it also giving false-negative results. So, it is essential to know what you should do if you have Covid symptoms and the RT-PCR test comes negative. Because, On April 23, the Delhi government declared that people with RT-PCR negative tests for Covid-19 were being refused admission in Delhi hospitals, despite having symptoms. “No patient requiring medical aid should be denied treatment,” said the order. 

ICMR on False Negative Results

According to the Indian Council of Medical Research (ICMR), the minimum sensitivity or ability to detect positivity for validating RT-PCR tests is 95%. It means that council accepting up to 5% of false-negative results. But, the disturbing thing is that the percentage of false negative results is increasing, and according to some reports, it has reached 20% (The Indian EXPRESS). 

So, let’s dive into the reasons and solutions if you are getting false negative results in the RT-PCR test. 

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Reasons behind False-Negative result

Viral Load

Usually, the covid-19 infection effects on the 5th day of the cycle, and due to early testing, the infected person’s test also becomes negative. Many doctors believe that this will not be the major factor behind false-negative results in India because recent covid-19 mutants in India are showing early symptoms.

Some symptomatic patients whose RT-PCR test results were False negative have verified that they have been reported positive in the Bronchoalveolar Lavage (BAL) test. In the BAL test, samples are collected from the Lower Respiratory through a bronchoscope. This also indicates that there are one or a few mutants which bypass the upper respiratory tract and directly target the lungs.

Capacity explosion

In the last year, the number of Covid test labs has grown very fast in India. On February 14, 2020 there were only 14 Covid test labs in India, which increased to 2400 in April 2021. For this expansion, it is vital to approve labs and train thousands of technicians.

To check the quality of Covid Labs, ICMR listed around 30 quality control labs in July 2020. After that total 8 quality control labs were added by ICMR. But, sources of ‘the Indian Express’ in 3 states said that “only a few inspections of facilities and instruments took place.” One scientist with an ICMR institute also said that “Ideally, a mix of positive and negative samples should be picked up at random from every lab periodically for re-testing. Was that ever done? Yes. Was that done consistently? No”. And,, periodic lab monitoring and quality compliance data were also not received from July 2020.

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Human Element

According to some doctors, this may be the third reason for the false-negative results. The RT-PCR test is entirely related to human work, and there are chances of faulting on various stages like from sample collection to storage and amplification. 

Viral Mutation

An RT-PCR test targets particular area/s of one or more viral genes to identify its presence. A test may return false-negative results if a mutation happens in the segment of the genome assessed. Tests that use various genetic targets, like in India, are less likely to be misled by mutations. The government also denied that the presence of false negatives is not linked to the new SARS-CoV-2 variants. 

What to do when: symptoms +ve, test -ve;

Kamna Kakkar is a senior resident at Pandit Bhagwat Dayal Sharma Post Graduate Institute of Medical Sciences in Haryana. She said that “doctors are trained to recognize disease by their symptoms and not only by lab reports, and it helps them to understand the disease.” She also said that doctors could use CT scans and X-rays for diagnosing Covid-19.

If you show covid symptoms and hospitals are not admitting you, then do social distancing and quarantine yourself. And stay in contact with doctors. Apart from this, if you feel a lack of oxygen, follow these instructions given by the news anchor of NDTV.

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