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The | New Delhi |
Updated: April 26, 2020 8:12:19 am
The document projects that by May 31, 40 percent of these 100 machines can be used for COVID-19 testing, which can produce 6,748 tests per day in a 24-hour shift. (Express photo by Prashant Nadkar)
As India enters the last week of the 40-day national shutdown, a new research paper from the Indian Council for Medical Research (ICMR) has recommended a multiple strategy to scale up testing: moving from nine-hour shifts to working the 24 hours. government laboratories, relocating test machines from research institutes and using point-of-care (PoC) test equipment from the country’s TB and HIV testing network.
The idea, the newspaper says, is to increase public testing to 1,00,000 daily tests by the end of May. Increasing testing capacity, he says, will reduce delays that lead to the formation of large groups of the disease and an uncontrolled progression of severe cases, and place a large burden of critically ill patients on the health system.
The two pillars of the “potential plan” to expand testing in the public sector are (i) moving to a 24-hour working model and (ii) leveraging machines based on the nucleic acid amplification test (qRT-PCR) and the Nucleic Acid Amplification Test (NAAT) that are available from Multidisciplinary Research Units (MRU), the National AIDS Control Organization (NACO), and the National Program for the Elimination of Tuberculosis (NTEP).
The short-term and long-term strategy, in addition to increasing testing capacity, will expand access to testing to the country’s 736 districts out of the current 114.
As part of the short-term strategy, the document, “Strategic Planning to Increase Test Capacity for COVID-19 in India,” recommends optimizing the existing capacity of qRT-PCR hand machines first.
The 216 machines in approved laboratories can be used in three shifts (24 hours) from the current two (16 hours), he says, thus increasing their capacity from 28,008 to 40,464 tests per day. Furthermore, the document recommends the “redistribution” of the 42 qRT-PCR hand machines in the MRUs to other locations; This is projected to generate 6,048 tests per day in a 24-hour shift on May 3.
Second, the document recommends the use of the “automated high-performance platform” used by research laboratories to conduct thousands of chemical, genetic, or pharmacological tests every day. Such platforms are available from the National Institute of Biologicals (NIB), Noida and the Regional Center for Medical Research (RMRC), Bhubaneswar, and their use can result in 1,493 tests per day in a 24-hour shift, the document projects.
Significantly, the document recommends the use of the high-performance automated platform also available with NACO, in order to take advantage of the available “free capacity” due to “footprint reduction” in blocking. “These platforms carry the Emergency Use Authorization (USA) from the United States Food and Drug Administration (FDA) for COVID-19 testing,” the document says. “These are currently used for early childhood diagnosis and monitoring of HIV viral load. Two thirds of the functional machines have been located in existing ICMR approved laboratories. ”
According to the document, if 15 percent of the NACO qRT-PCR machines are in use by May 15, and the remaining functional machines by June 1, a total of 11,404 tests can be performed daily in one shift. 24 hours.
The third recommendation is to use around 100 automated NAC PoC-based platforms available with the NTEP, which can be used in 725 districts across the country. The PoC test is performed near the location of patient care to reduce therapeutic response time.
Noting that existing ICMR-approved public sector laboratories “cover only 114 of the country’s 736 districts,” the document underscores the need for decentralization to “increase coverage and alleviate concerns about sample transportation.” As such, “about 100 of the PoC NAAT-based operational machines in the 725 districts of the country, used for TB diagnosis, are approved for Biosafety Level 2 (BSL-2) and can be considered to share capacity” , He says.
The document projects that by May 31, 40 percent of these 100 machines can be used for COVID-19 testing, which can produce 6,748 tests per day in a 24-hour shift.
The document also recommends three medium-term interventions to increase testing: (i) acquisition of more automated RNA extraction platforms, (ii) acquisition of 10 additional high-performance automated platforms, and (iii) use of 150 NAAT machines with NTEP .
“Currently, only about 25 percent of laboratories (29 laboratories) have automated RNA extraction capabilities, while the rest carry out cumbersome and slow manual extraction. The installation and / or operationalization of automated RNA extraction platforms supported by the necessary extraction kits in the remaining 75 percent of the laboratories could increase test capacity by 1.5-2 times within the same hours of operation, “the document, written by Dr. Nivedita Gupta and other members of the ICMR COVID team, says.
If short and medium-term interventions are implemented, and if laboratories adopt the aggressive 24-hour work model, testing capacity can be increased from 40,464 to 1,00,085 daily tests, according to the document. Under an aggressive deployment, 28,273 tests can be performed daily on platforms available with NACO and NTEP, while under a 16-hour (moderate) work model, 18,849 tests can be done, the newspaper says.
“In order to utilize expanded testing capacity, increased labor, adequate testing products, and the collection of enough samples / day would be critical … In addition, sample collection and transportation efforts will have to keep up. of the largest testing capacity available in laboratories, “according to the newspaper.
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