4. FAILING THE CRUCIAL TEST
AFTER EXPANDING TESTING LABS ON A WAR FOOTING IN THE FIRST WAVE, THE MOMENTUM WAS LOST EVEN BEFORE THE SECOND HIT
WHEN THE WORLD HEALTH ORGANIZATION declared Covid a global pandemic in early March last year, India had 14 RT-PCR testing labs. By end-March, the country had added 106 Virus Research & Diagnostic Laboratories (VRDLs). Far behind countries such as South Korea and the US initially in terms of the number of tests, India beefed up its testing capacity quickly. By April 2020, we had 166 labs for testing and by July 1,600. The number of daily tests shot up from 1,500 in April to 200,000 in June, and 1 million in October. By the time the first wave subsided in November, India had 2,257 Covid testing labs, the average wait time for a result was 12-24 hours.
These achievements were due to three reasons. For starters, 14 centres of excellence were set up at different medical institutes, under the chairmanship of Indian Council of Medical Research (ICMR) director-general Dr Balram Bhargava and AIIMS director Dr Randeep Guleria. These centres mentored government and private medical colleges and eventually created a molecular virology laboratory network. In the initial phase, around 300 medical colleges across the country were able to scale up Covid testing over a fairly short time span.
Secondly, ICMR, along with CSIR (Council of Scientific and Industrial Research), the Union health ministry, department of biotechnology and DRDO (Defence Research and Development Organisation) mapped remote areas, such as Ladakh, Lakshadweep, and the Andamans, so that even they could scale up testing. Thirty quality control (QC) labs were set up to verify the results of other labs in their respective catchment areas. Labs in each state were instructed to send randomly selected positive and negative samples to the nearest designated QC lab. Thirdly, private labs were added to the fold almost immediately.
To ensure quality, only NABL (National Accreditation Board for Testing and Calibration Laboratories)-accredited labs were picked.
Recognising that labs needed more suppliers of RT-PCR kits and rapid antigen tests, several manufacturers were approved. During the two months of complete lockdown last year, approximately 40 tonnes of testing material was transported around the country. As the lab network expanded, India Post, which has countrywide operations, was also roped in to streamline the delivery of supplies. Eventually, the process of test kit procurement was decentralised in June 2020, allowing states to buy their own kits and handle their own lab resources.
However, these achievements came to an abrupt end with the decline of the first wave. From December 2020 to May 2021, only 249 new Covid testing labs were added. With the alarming spread of the virus in the second wave, the country’s labs no longer have the capacity to give results within the same time frame of 12-24 hours. Labs across Delhi, Mumbai, Noida, Lucknow and Kolkata are taking an average of 3-5 days to give out results. A price cap has also reduced motivation amongst private players to invest in increasing their capacities. Dr Ajay Kushwaha, director of a private path lab in Uttar Pradesh, says, “The government has reduced the Covid investigation fee by Rs 900. It is very low. Many employees and doctors are down with Covid. In such a situation, other doctors and employees have to be roped in, on higher salaries, to get work done. This has increased the cost incurred in Covid testing, which is why private path labs are not interested in Covid investigations.”
LABS ARE ALSO restricted by the number of RT-PCR machines and the number of trained microbiologists who can run them. In Noida, for example, district medical officer Deepak Ohri says that around 6,2006,500 samples are being collected daily, but government labs have the ability to process around 2,000 samples a day, which means a growing backlog. Ramesh Jaiswal, a senior pathologist with the health department in Uttar Pradesh, agrees. “The pressure on pathology [labs] in the government sector has increased due to the rising Covid cases. During the past one month, the sample collection in the state has gone up by three times, but investigation [of samples] has increased by more than one and a half times. This is why it is taking two to three days to get the results of Covid investigations from RTPCR in big cities. In smaller cities, the results of investigation are taking five to six days,” says Jaiswal. The delay in diagnosis is severely affecting treatment as patients cannot get admission in Covid wards or visit a Covid doctor until they have a lab report. Jyoti Roychowdhury, a 32-year-old blog editor in Noida, says she had symptoms for four days but couldn’t get any treatment because her test results hadn’t come. By the time she got her results, she had developed a chest infection and needed immediate hospitalisation. In the US and the UK, patients are able to monitor the waiting time for their results through an online portal. Doctors say this often helps them start some initial treatment. Even in times of high demand, being able to track results helps bring some semblance of order to the chaos. The problem of increased demand is also because anybody can get a Covid test done now. Test lab owners say it is difficult to ascertain who needs a test on priority due to the sheer level of demand. “We get hundreds of bookings in just four or five minutes after we open the website for new requests. I could collect as many samples as I want, but it would take me longer to give out the results. In these times of high demand, the government should help private labs increase services through incentives and support,” says Dr Arjun Dang, CEO of Dr Dangs Labs in Delhi. Recently, ICMR changed its Covid test advisory in the hope of reducing the high volume of test requests—no longer is testing for inter-state travel recommended and a positive patient need not go for a second test after two weeks to confirm if they are negative. Whether this will reduce the pressure on labs remains to be seen.
249 COVID TESTING LABS were added in India between December 2020 and May 2021