india

Updated: Apr 13, 2020 13:59 IST

As the number of coronavirus disease (Covid-19) cases in India nears 10,000, the Indian Council of Medical Research (ICMR) is considering pooled testing of people with symptoms in areas from where no SARS-Cov-2 (the virus that causes Covid-19) infections have been reported, in a move that will widen testing significantly and highlight the actual spread of the disease in India.

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Pooling of samples involves testing them in batches. When a pooled sample tests positive, then individual samples are assessed. Research shows that this method can be used to do up to three times as many tests with the same number of kits — an important consideration given India’s population.

There are around 450 districts (out of a total of around 730) which have not reported any Covid-19 cases. The plan is to test people with symptoms (cough, fever) using both RT-PCR and rapid antibody testing. The regions will be selected on the basis of data available through their integrated disease surveillance programme network, and also the new mobile application, ArogyaSetu, which has started generating relevant data on the disease pattern, according to a health ministry official.

“Pooled testing is a good surveillance tool and can be used to test symptomatic people in non-Covid areas to confirm if the areas are actually Covid-19 free. It has not happened yet but is being considered as one of the options to get an idea on the disease spread. The idea is already there, testing will only confirm it,” this person added on condition of anonymity.

India is yet to get the rapid test kits it ordered from China, so the plan will be put into effect with RT-PCR tests.

Once the rapid test kits arrive -- these antibody test results are available in 30 minutes as opposed to the RT-PCR tests which take about five hours -- they will be used.

In addition to the order for 500,000 kits that has already been placed, ICMR has raised a tender on April 11 for 4.5 million more rapid testing kits to be delivered in batches. The plan is to have the first batch in by May 1 and the final batch latest by May 31.

The major issue that India is facing with rapid test kits is their quality as most come from China; after many kits failed quality tests, the Chinese government restricted exports, allowing only five to six companies to sell them.

“Quality control is important as there is no point in getting a product and then realising it is of no use. The products from China have to be cleared by their local regulator and we will also conduct tests on batches to check their accuracy on a random basis,” said an ICMR official who asked not to be named.

In addition, local manufacturer HLL Lifecare has also started manufacturing the rapid test kits. It is making 20,000 a day at its Manesar facility starting Monday.

The ICMR tender, which HT has reviewed, says, “If the item is proposed to be imported from China, NMPA (National Medical Product Administration), China, approval for the said item/company is mandatory… ICMR reserves the right to ensure random “Lot-testing” or “Pre-shipment testing” of supplied items for quality. On negative findings, the consignment will be rejected outrightly. Any supply not found acceptable shall be returned...”

Experts in the field, however, say that ICMR is already late.

“They should have started at least a month ago; even if they didn’t have rapid test kits, they should have gone ahead with the RT-PCR tests. We had to test more to know better,” said a senior epidemiologist, who asked not to be identified.

Meanwhile, ICMR is also working on increasing the number of laboratories that can test, and is in the process of upgrading laboratories of both private and government medical colleges so that these can also be utilized for Covid-19 testing. It is currently in the process of identifying college laboratories that can be upgraded with the help of some mentoring by advanced labs already doing Covid-19 testing.

“ICMR has taken cognizance of the need to expeditiously expand COVID-19 testing facilities in all parts of the country… efforts are being made for proactive search of potential laboratories which could be enabled for COVID-19 testing…,” says an ICMR document seen by HT .

ICMR has identified 14 institutes of national eminence, such as All India Institutes of Medical Sciences; Armed Forces Medical College, Pune; National Institute of Mental Health and Neuro Sciences, Bengaluru; JIPMER in Puducherry; King Goerge Medical University, Lucknow; and Nizam’s Institute of Medical Sciences to mentor colleges.

The mentor labs will form teams to conduct a comprehensive review of the college laboratories. The mentors will see what facilities these laboratories have and what they need to be able to do Covid-19 testing. At least 400 such laboratories have been identified by the government for assessment.

“It is a good idea as there are some states with good infrastructure, and their labs can be taken up almost immediately. For those states that don’t have good medical colleges, the government can help set up/upgrade lab based on Covid-19 testing requirement. The good thing is labs can be created or upgraded in a short span of time, so we can increase the capabilities of the testing labs,” said Dr Jugal Kishore, community medicine expert, Safdarjung Hospital.