5 things India can do to scale up Covid Testing

By Anu Acharya, CEO, MapmyGenome India Limited
Originally written for ABLE (Association of Biotech Led Enterprises) and published at ableindia.in

COVID-19 is a pandemic like never before in our lifetimes. By any conservative estimate, we need to test 1–2% of the population (15–30 million tests) at a minimum before a vaccine or cure is discovered. Even though private companies can step in, we suggest a strategy to acquire individual elements in bulk, assemble, and distribute to private and public labs for the next 3–4 months.

The Two Types of Testing

Many countries have used rapid diagnostics using IgG and IgM antibodies for wide-scale screening, followed by RT-PCR for confirmation. As of now, ICMR has only allowed RT-PCR testing. Scaling RT-PCR is not as simple as many people think, especially when supply chains are broken.

The Key Components of RT-PCR Testing

• Bioinformatics team: We can use primers and probes designed by the CDC. However, we need to keep running analysis on genome sequences of viral samples being published — especially Indian samples — as the virus mutates and could interfere with primers and probes

• Primers and probes: These are the unique part of every RT-PCR test. Manufacturing oligos for primers and probes is important — very few companies do it in India. These do not cost more than ₹30 per test at low volumes

• Mastermix: The most expensive reagent in the process. Very few are approved by the USFDA and are likely to become a bottleneck. Government needs to order this at large scale for use by all certified labs. These can cost ₹300 per reaction and can reduce further at scale

• Isolation kits: For an RNA virus like SARS-CoV-2, RNA isolation kits are needed. This is a major bottleneck worldwide — very few companies make these kits. These will cost around ₹200 per reaction or lower at scale

• Collection swabs and PPEs: Another area where many countries fell short. These should cost around ₹200 if safety measures are taken, plus ₹100 for PPE

5 Things We Need to Do Immediately

1. Acquire primers and probes in bulk

2. Acquire RNA isolation kits and mastermix in bulk

3. Procure swab and collection kits

4. Add more equipment and calibrate existing machines as we scale up testing

5. Buy PPEs in bulk or manufacture at scale

Looking to the Future

• Automation: When sample numbers increase, sharp automation is needed — we cannot suddenly increase the number of technicians

• Multiple labs: Each city should have multiple centres that can test simultaneously and upload data in real time

• Home sampling: Safe home testing where patients don’t have to come to a hospital would change the dynamics and enable safe scaling

• Software: Sample tracking with barcoding will be essential for real-time tracking across the country