Attitudes Towards COVID-19 Testing in Pediatric Emergency Department Settings in Pakistan

Background: The COVID-19 global pandemic has shed light on the importance of testing to stop the spread of disease. For a developing country with a large population of over 200 million inhabitants such as Pakistan, widespread testing can be difficult. To date, 957,371 cases have been confirmed and over 14 million tests have been performed in Pakistan, with only 1% of the population vaccinated. In a country already burdened by health disparities with little to no resources, the challenges became ever apparent as case numbers grew.
According to the WHO, complacency among the population in cooperating with public protective measures is a rising challenge. Several violent incidents have occurred in hospital wards in Pakistan, prompting medical staff to fear for their lives and demand extra security not only from the virus, but from volatile patients and families. The incidents are thought to be rooted in a mix of anger at a lack of resources, and mistrust of the medical system.
The objective of this study was to survey Pediatric emergency medicine (PEM) physicians in Pakistan on their ability to test for COVID-19 and their limitations experienced.

Methods: An anonymous prospective survey was performed from February to March 2021 in association with the ChildLife Foundation, a nonprofit organization that operates and manages Pediatric EDs in 10 government teaching hospitals in the province of Sindh. 170 PEM providers were surveyed on their experiences with COVID-19 testing, reasoning for why testing was not performed when infection was suspected and reasoning for patient refusals.

Results: 68% of respondents had COVID-19 on their differential for patients under their care in the week prior to survey. However, 49% of respondents did not order any COVID-19 testing. 37% of those providers had at least one patient in whom COVID-19 was on the differential. 81% of providers claimed to collect COVID-19 testing every time when suspected. When surveying reasoning for not acquiring COVID-19 testing, providers listed patient refusal as the top reason, followed by limited availability and cost, mild presentation of disease, patient leaving AMA, fear of violence against healthcare professionals, social stigma/fear from patients of being labelled as COVID-19 positive and denial of the diagnosis.

Conclusion: According to this survey, PEM providers in Pakistan were not always able to send COVID-19 testing, when indicated, due to a variety of factors. Testing limitations despite suspicion for disease can be a major hurdle in identifying cases and limiting spread in unvaccinated populations.