Fast-tracked and extensive testing key to coronavirus containment

India’s capacity of testing 100,000 samples for Covid-19 can be increased further by adding ICMR’s network of 106 virus research and diagnostic laboratories (VRDLS) within days.

Speedy and widespread testing will prove to be one of the make-or-mar measures in stopping the coronavirus disease (Covid-19) transmission from turning into an acute community transmission.

The Indian Council of Medical Research (ICMR), the country’s apex health research body, has increased testing capacity from 51 to 65 not just for preliminary testing, but also for confirmatory testing. The improved strength will cut the lag time by 24-48 hours for test results.

“The secondary test for reconfirmation of the virus, which was earlier conducted only at the National Institute of Virology [NIV] in Pune, have also been expanded to 31 laboratories. These steps will enable India to expedite detection of the virus and will help in effective management,” said Dr Balram Bhargava, director general, ICMR.

India’s capacity of testing 100,000 samples for Covid-19 can be increased further by adding ICMR’s network of 106 virus research and diagnostic laboratories (VRDLS) within days.

 

ICMR is also negotiating with the private sector for rapid-testing kits that can cut the testing time from five-six hours to 15-20 minutes. “Given that the symptoms of Covid-19 and the common flu could be similar, effective screening and diagnostics is key to prevent undue anxiety and focus on providing care to those infected, and containing further spread of the infection in the vicinity of those infected,” said Dr Shravan Subramanyam, managing director, India and Neighbouring Markets, Roche Diagnostics India Private Limited.

“The reported increase in the number of cases across India calls for rapid scaling up of the availability of screening and diagnostic tests in more centres across India. We have the potential to offer three types of test kits that can be used to screen and further diagnose Covid-19 infections in our existing systems that run other infectious disease panels. These systems are installed across the country’s 15 major cities,” said Subramanyam.

“We are evaluating some rapid testing kits; a couple of tests have shown promise but we are evaluating further before allowing them as there is always a risk of getting false positives. For any diagnostic test, its sensitivity and specificity that are of utmost importance,” said Dr Priya Abraham, director, NIV, Pune.

 

There are plans to involve the private sector in diagnostics, quarantine or isolation of cases once there is an increase in cases. Dr Harsh Mahajan, founder, Mahajan Imaging, agreed that the private sector is willing and capable, and should be engaged if not in testing then at least for sample collection.

“There was a meeting between the health ministry and the private sector a week ago. The private sector expressed its willingness about being a part of the diagnostic process as it has both the capacity and capability. All the laboratory that can do swine flu testing can also do Covid-19 testing. There are at least a few hundreds across India. The government may be managing well for now, but if the numbers rise exponentially then it will have no choice but to involve the private sector,” he said.

At this stage of the pandemic in India, the government testing infrastructure is still hugely underutilised. “We have also placed an order for more testing reagents from Germany that will help us perform at least 200,000 more tests. We are adequately prepared but as compared to the capacity of performing 90 tests per day in all our laboratories, we are getting about 60-70 samples daily,” said Dr Bhargava.

Not everyone needs testing, according to the experts.

“Only symptomatic people, especially those with a travel history or contact of a laboratory positive case, need to get tested as there is a risk of getting false negative results in the early stages of disease. When there are no symptoms that means viral load in the body is very low and it may not show up. The person may think he is Covid-19 negative when he is not. Home quarantine for 14 days is the most effective way to break the transmission cycle if there’s any kind of suspicion,” said Dr Lalit Dar, professor, microbiology, All India Institute of Medical Sciences.

The government is pulling out all the stops to contain the spread of infection, and to prepare for a surge in cases, including suspending almost all types of visas till April 15, and invoking the Epidemic Disease Act, 1897, and Disaster Management Act, 2005, even though it maintains that the disease in India had not reached epidemic proportions yet.

“Invoking these acts does not mean there is Covid-19 epidemic in India. It means the government is working proactively to ensure the situation does not reach epidemic proportions,” said Lav Aggarwal, joint secretary, health ministry.

“The government has taken several pre-emptive, timely and proactive measures for prevention, containment and management of Covid-19 that includes strict screening of passengers at entry points, strengthening our quarantine and isolation facilities and scaling up our testing capacity by adding more laboratories to the network,” he added.

All essential facilities such as community surveillance, quarantine, isolation wards, adequate personal protection equipment, trained manpower, rapid response teams are being strengthened further in all the states and union territories to prevent more people from contracting the infection.