Paragraph 22: With a positive antigen test, you do not have the right to PCR, it is not PCR, it is not a “case”

The bureaucratic machine continues to create nonsense, so diagnosing people with coronavirus is as complicated as possible and many of those infected do not enter the official statistics. The state does not recognize the results of rapid antigen tests. To confirm a case, a PCR test is mandatory, but current rules do not yet provide people with the opportunity to confirm with public funds.

GPs are prohibited from sending referrals for PCR testing to people who have positive antigen tests because they are believed to have already been diagnosed. Hospitals, on the other hand, are refusing to admit patients with suspected coronavirus without a PCR test. This creates a vicious cycle and many problems related to isolation and quarantine, hospital admission, hospitalization and, last but not least, statistics.

No PCR, no case

Why isn’t the state recognizing antigen test results? “Currently there is a definition of Covid-19 in the country for the entire EU, according to which the laboratory confirmation of Covid-19 is carried out by PCR.. In view of this, all restrictive measures (isolation and quarantine) are in accordance with the officially established order “said the Health Ministry for Mediapool.

“In relation to the application of antigen tests as a diagnostic method for the new coronavirus at EU level, there is active communication between Member States, An amendment to the laboratory confirmation requirements is also under discussion which will be reflected in a new case definition common to all Member States.“They say from the ministry.

In other words, in the EU there is a common definition of what a confirmed case is and requires laboratory confirmation through a PCR test. The definition is published on the website of the European Center for Disease Control (ECDC). The aim is to compare data from individual countries for confirmed cases and not to figuratively compare apples to pears.

Given the lower sensitivity of the rapid antigen tests used to the so-called “gold standard” in the diagnosis of Covid-19 – PCR tests, their use must be precisely specified. applicable to subjects with clinical manifestations of Covid-19 up to 5 days from the start of the complaints or up to 7 days from the date of contact in places and sites in communities with high morbidity. In case of a negative rapid antigen test and Covid-19 is suspected, a PCR test should be performed to rule out / confirm the diagnosis.. “, added by the Ministry of Health.

So far so good. The question is what happens in a positive antigen test and what authorities do to ensure confirmation by PCR. And the answer is: almost nothing. Doctors told Mediapool that from a scientific point of view, PCR confirmation should only be sought for negative antigen tests, and positive ones should be sufficient for diagnosis. However, at the moment, the official authorities do not adopt this approach.

Regarding the availability of PCR tests from the Ministry of Health, they indicate that “PCR tests are free to anyone who has a referral for examination by a doctor., including a GP. The evaluation for the issuance of a referral for PCR is done only by a doctor and then it is free. “. In other words, the authorities do not recommend that people take the test on their own initiative, but they encourage them to always consult a doctor first and possibly decide if they should be tested.

Confirmation is mission impossible

Until now, the possibilities of PCR tests paid for with public funds have been very limited. The patient had to go to the GP, who referred him to the RHI or referred him to a specialist to issue a referral. Starting this week, GPs can also issue referrals for PCR, but the annex to the framework agreement between the Medical Union and the NHIF, signed a few days ago, states that Referral for PCR by GPs is not issued to people with established disease by rapid antigen testing. In other words, the National Health Insurance Fund accepts that people with a positive antigen test have an established disease. For the Ministry of Health, hospitals and official statistics, however, the disease has not been proven.

GPs told Mediapool that because of this ban and because rapid antigen tests are not recognized by the state, they can only prescribe some treatment to their patients with positive antigen tests and issue them regular sick leave for a disease. viral. This leaves patients out of official statistics, out of quarantine and tracking, and then makes it difficult for them to travel if they need hospital treatment.. Almost every day in the media there are stories of patients who have been denied admission by hospitals for lack of a PCR test. A separate issue is that the patient may try to conceal the presence of a positive antigen test if they wish to receive confirmation by PCR.

Ideally, it is assumed that if a person has a positive antigen test and their condition is not severe, they should isolate themselves and begin treatment at home with therapy prescribed by a GP or specialist. If it starts to get worse, seek emergency care and hospitalization.

However, very often in the absence of a CRP test, hospitals refuse admissionbecause they don’t know where to “put” the patient – in the Covid room or not and because not everyone has the call. “buffer zones”. Health authorities say they provide PCR capabilities to confirm positive cases of vans in front of hospitals, but many people refused PCR to avoid quarantine. This also questions the extent to which the authorities control the epidemic. However, it is debatable whether all those tested in the trucks received such an opportunity for PCR confirmation. and the practice is rather to do PCR tests on people who will be admitted to hospital and those who will be referred for home treatment – no. If the patient has a positive antigen test for any of the Covid structures detected in the clinics, it is also debatable whether they will receive a referral from a specialist in PCR testing. yes its confirmation as a case is left to the good will and economic capacity of the patient to withdraw 120 BGN for private confirmation. Or it lasted until his hospitalization became absolutely inevitable.

Distorted statistics

As a result, official statistics show a decrease in the number of CRP tests in the context of a rapid increase in morbidity. Currently, around 6000-8000 tests are performed daily, while a month ago the system reported 10,000 – 11,000 tests per day. The reduction also has its objective explanation. For example the mandatory negative PCR quarantine clearance test, which was abandoned in October. Now the quarantine is removed directly after day 14 for the sick and after day 10 for their contacts. At the current level of approximately 1500-2000 cures per day, this automatically does the same number of fewer tests per day compared to when people were tested before declaring themselves cured. The massive influx of antigen tests is also reducing the number of PCR tests, because the former are faster and cheaper, respectively, more affordable and people prefer them. Some of the positive antigen tests are still confirmed by PCR, which in turn raises the percentage of PCR positive samples, due to the focused tests among those already shown as infected cases.

However, in general, the requirement to confirm any positive PCR antigen test complicates and complicates the overall process, therefore a serious gray part of the epidemic is forming. Polyclinics, for example, reported 30% positive antigen tests, which roughly corresponds to the level of positive PCR tests in official statistics. However, how many of these positive antigen tests are confirmed by PCR?.

Health authorities speak of 10-15% “hidden morbidity”, but how objective this picture is and if the “hidden” morbidity means that people who do not undergo the test at all or those who are ignored by the official testing system still shrouded in fog.