Covid-19: India prepares for massive screening effort after April 14

India, which is under the largest lockdown in the world, is readying to undertake a massive testing programme to identify COVID-19-positive cases after the 21-day period ends in a move that public health experts have been calling for.

The Indian Council of Medical Research (ICMR) sought quotations earlier this week from suppliers for a million antibody kits (for screening through blood tests) and also 700,000 RNA extraction kits (the swab-based test for confirming COVID-19). As on Friday, a total of 157 laboratories were gearing up for testing — of these around 121 are government labs (109 are functioning and 12 are being operationalised) and 36 are private labs.

“India would need screenings on an extensive scale after the 21-day lockdown period is over. The incubation period is about 15 days and the virus manifests by then. So assuming everyone stays put at home, the chances are they would only infect their immediate family members. Assuming they step out to buy groceries, there is a chance of infecting others,” explained K Srinath Reddy, president of the Public Health Foundation of India. Rapid screening tests would then help to identify the people at risk (with high viral load) and they can be isolated.

The ICMR is, thus, working on a war footing to develop the testing ecosystem — especially for the screening blood tests. There are two types of tests — one is an antibody-based test (which is quicker and cheaper) to screen a person with high viral load and then there is the PCR test kit, which is a genetic testing to identify if someone is COVID-19 positive.

In a lockdown, when everyone is isolated, India could be doing fine with lesser amount of testing.

“India has to utilise this period to develop testing infrastructure so that it can screen large numbers of people immediately after the lockdown is relaxed. While it is anybody’s guess now, one can assume that the lockdown would be lifted in stages,” said a senior doctor, who is also working closely with the government on the issue.

Medical staffers wearing protective gear, part of a special unit performing house calls, work in Bergamo, northern Italy, one of the areas worse-affected by coronavirus. Photo: PTI

India has tested 26,798 individuals so far, a low number compared to Western countries, but a complete lockdown may just serve the cause.

However, as ICMR has enquired about production capacity and supply timelines, it was initially looking for kits that were approved by international authorities like the US Food and Drug 

Administration (USFDA). With pressure mounting and time running out, the agency has now relaxed norms to allow test kits with 100 per cent concordance among true positive and true negative samples for commercial use in India.

Private companies have stepped on the gas. Gujarat-based CoSara Diagnostics is ready to supply around 10,000 kits a day from April. It has a partnership with a US-based company. Swiss multinational Roche and others have also been given a licence by the drug regulator to evaluate the quality of kits.

The National Institute of Virology, Pune, is in the process of validating antibody-based screening kits. Sources say ICMR has started receiving test kits from South Korea, Germany and now expects to get a million kits from the World health Organization.

“Locations have been identified where these kits would be stocked. However, given the severity of the outbreak, kits from other countries are taking time to reach. A batch has already come from South Korea,” said a source.

An official measures the temperature of a visitor using an infrared thermometer at the entrance of a bank, following the outbreak of coronavirus in Srinagar. Photo: PTI

Meanwhile, the cost of the PCR test (around Rs 4,500) is deterring individuals from opting for it. About 90 per cent of queries fizzle out after they realise that the cost is not borne by the government.

On the first day of testing, Thyrocare received 3,000 enquiries, of which 30 agreed for the test. Out of this 30, almost 90 per cent requested collection executives to not visit their homes in protective equipment. “They were worried about the neighbours getting to know,” said A Velumani, founder and chairman of Thyrocare.

ICICI Securities said that Metropolis Healthcare management has indicated that they were preparing to ramp up testing capacity to thousands a day. They plan to source kits from multiple vendors to avoid bottlenecks.

“ICMR has been testing 50-60 cases per day per machine despite their capability of 500. This was due to stringent testing profile criteria of travel history. Metropolis believes that with 30 per cent capacity, private companies would be able to support 70 per cent of the requirement,” ICICI Securities noted.

Once the antibody kits (for blood test) are ready, many labs could also offer it for free for the poor, felt government sources. This would expand testing to the hinterland.