Zoran Jurić from Sremski Karlovci felt the first symptoms of coronavirus infection on July 3. The next day, his brother Dragan told the Center for Investigative Journalism of Serbia (CINS), Zoran underwent a serology test at a local COVID-19 clinic, but the result was negative.
Despite that result, the symptoms persisted. In those days, Jurić recalls, his brother went back to the clinic five or six more times, where they took X-rays but saw nothing in the lungs. In his words, the doctors determined that the fever did indicate the existence of a hotspot, but pointed out that there was no reason to worry. Whenever his brother asked for a PCR test, he was told they had none. The doctors would, Jurić added, change his therapy, i.e. antibiotic and send him back home.
Nearly ten days after his first visit to the COVID-19 clinic, Zoran’s condition conspicuously deteriorated. Then they took another X-ray of his lungs and once again said that there was nothing wrong with him, his brother told CINS. A few hours later, around 1:30 a.m., Zoran went to the doctor again.
“When he listened to his lungs, the doctor says, ‘this is horrific pneumonia’. So, complete pneumonia in both lungs, which no one noted some ten hours earlier,” Dragan Jurić points out and adds that only then was a PCR test conducted.
Due to pneumonia, Zoran was hospitalized at the Clinical Center of Vojvodina, where he is being given oxygen therapy.
The PCR test showed that Zoran was infected with the coronavirus.
For that reason, Dragan does not believe in the serology tests his brother underwent several times.
“They are constantly conducting that serology test. Nothing comes out of it, it’s a heads or tails kind of thing, you toss and see how it goes, 50 percent possible, but not necessarily.”
In serology tests a blood sample is taken from patients, to look for the antibodies the body creates against viruses. However, that takes time.
“Without at least eight days, preferably more, there is no point in performing those tests at all,” epidemiologist Zoran Radovanović told CINS.
In a written reply to CINS, the World Health Organization (WHO) says that serology tests reveal whether someone was infected recently or in the past, and that they are important for determining how many people in a population were infected. However, the WHO representatives explain that PCR tests are better for discovering whether someone is infected or not, adding that governments must focus on PCR-based testing or any form of testing that detects an active infection.
If serology tests are unreliable, why aren’t PCR tests done for everyone? That is the question our journalist asked at the July 15 press conference of the Crisis Headquarters.
Crisis Headquarters member and deputy director of the Institute of Public Health Dr Milan Jovanović Batut Darija Kisić Tepavčević replied that PCR tests were not conducted in all cases because “that is simply not possible in our country, or in any other.”
She said that the indications for PCR testing were clearly defined – persons with symptoms and signs of the disease were tested after they were examined at COVID-19 clinics.
The president of the Union of Doctors and Pharmacists of Serbia, Rade Panić, recalls that the instruction for the rapid test states that it is not for clinical use, in the sense that one cannot claim whether someone is infected or not solely based on that test. In Panić’s words, rapid tests serve as the best orientation for whether a patient needs to be urgently taken care of:
“So, if you have a patient whom you must get into the operating room in the next 45 minutes, you will conduct that test for them because (the result) can get back very quickly and based on that you will have some kind of orientation – whether you will treat them as a patient who was sick or a patient who wasn’t sick. But it is obligatory to conduct PCR testing after that to be sure.”
The problem is that patients who had a scheduled treatment earlier are now being admitted based on a rapid test, which poses a serious danger, according to Panić. He is familiar with examples from the Kraljevo hospital, when their tests were negative while people actually had the virus.
“That is why we treat those patients like they are not sick, while they are in fact a source of infection and that poses the biggest danger of infection of health care workers, not to mention the patients located in the proximity of those patients,” Panić underscores.
However, epidemiologist Zoran Radovanović says that it is professionally impermissible not to use PCR tests on persons complaining about coronavirus symptoms, whose rapid test was negative.
“That is contrary to logic and the profession, because serology tests cannot be positive
during the first week anyway,” he adds.
On the other hand, anesthesiologist and president of the Union of Doctors and Pharmacists of Serbia Rade Panić says the problem is that antibodies can also be the result of some other diseases."
Kisić and Kon Differ on Official Statistics
Dženeta Agović, a laboratory technician from Tutin, like Zoran Jurić, underwent a serology test for coronavirus symptoms. The result was negative, but the symptoms were there – fever and difficulty breathing. The pain in her muscles and bones was so strong that she felt like “everything inside was breaking apart and crumbling.” She soon lost her senses of taste and smell. A week after the first test, she underwent another rapid test and a chest X-ray.
“It turned out to be negative again, while the image shows this pattern, that’s what the radiologist says, that it’s something typical of coronavirus infection,” says Agović.
In the meantime she tried to get a PCR test done because she wanted to be certain whether she had the virus or not.
“I’m trying to get the PCR test done three times, we at the (Tutin, journalist’s note) hospital either don’t have them or when they arrive, they arrive in small quantities that are used up quickly,” she adds.
That is why three weeks after the onset of symptoms she had a serology test done for the third time. This time, the results showed the presence of coronavirus antibodies, i.e. that she had “gotten over” the virus. Her health card reads that she was positive, and she was treated as such. She says she does not know whether she made it into the official statistics. A few days later she also had a PCR test done, and the result was negative.
According to official statistics, more than 500,000 citizens have been tested for the coronavirus in Serbia so far, while Serbian President Aleksandar Vučić often points out that we are the leaders in the region where the number of tested citizens is concerned.
However, the results of which tests are included in the official statistics – PCR, rapid serology tests or both kinds – that is not absolutely clear. The opposite answers CINS received from the members of the government’s Crisis Headquarters add to the confusion. When CINS asked whether the results of rapid serology tests were part of the official COVID-19 statistics, Kisić Tepavčević replied that only PCR tests were included.
“These are PCR tests which include both testing at personal request and retesting,” she said at the press conference, adding that testing at personal request was oftentimes irrational and created a lower percentage of positivity in the whole picture.
On the other hand, epidemiologist Predrag Kon told CINS that both serology and PCR tests were included in the official number of tested citizens. He added that he did not know why the opposite was being said.
Epidemiologist Zoran Radovanović also believes that both serology and PCR tests are part of the official statistics. He underlines that rapid tests are justified, but not as independent tests.
Anesthesiologist and Union of Doctors and Pharmacists of Serbia leader Rade Panić told CINS that it was highly unlikely that the official statistics did not contain those who had undergone rapid serology tests:
“I am almost sure that the number includes rapid tests, because it’s impossible that they are performing that many PCR tests when we are getting information that, for example, not a single PCR test arrives in Vranje, or 20 are arriving today.”