Coronavirus: What's holding up rapid tests in India?

Indian Council of Medical Research (ICMR) has issued an advisory to carry out rapid tests on all influenza-like illnesses reported from containment zones, large migration gatherings, or evacuee centres. However, in light of testing on such massive scales, India is staring at a new problem - shortage of rapid test kits. Along with kits, personal protective equipment (PPE), which are the first line of defence for frontline health workers, are also in short supply.

Shortage of rapid testing kits could dent India's fight against coronavirus. Moreover, as health workers demand more PPEs, the shortage of the kits are felt acutely. The government has placed bulk orders for kits and components but that might also fall short in tackling the spread of coronavirus.

Which rapid testing kits have been approved in India?

The ICMR has an approved a list of eight antibody rapid test kits by Mylan, BioMedomics, Zhuhai Livzon Diagnostics, Voxtur Bio, VANGUARD Diagnostics, HLL Lifecare, CPC Diagnostics and LAB-CARE Diagnostics. Voxtur, VANGUARD and HLL are some of the Indian companies in this list.

Has the testing started?

Rapid tests are expected to start soon. What is holding back testing at the moment is that all kits are imported, mostly from China, and supplies are not enough. They are either being imported directly or repackaged locally. Those who can eventually start manufacturing locally also need to import some components, mainly from China. The Government of India has ordered 44 lakh rapid testing kits but these are yet to arrive. Word is that some have just been received. The Ministry of External Affairs is helping in expediting the imports, according to a senior official in the government.

Amid all of this, on April 1, the National Medical Products Administration of China imposed a curb on all exports of testing kits, masks and protective gear unless the exporters prove that they are licensed to sell in the Chinese market too. This is expected to impact some of the testing kits that are to be imported from China.

What is holding us back?

First, Private laboratories have not yet been authorised by the ICMR to conduct rapid tests; it is done only by the government. Second, as for the RT PCR testing which the government and private laboratories do today, there is the challenge of capacity. At best, the Indian private laboratories are able to do about 100 to 150 tests a day, if this is to be increased 10 fold then there is need to augment training, manpower, equipment and more laboratories and testing kits.

Are these rapid testing kits enough for India?

Epidemiologists who have looked at such issues closely believe that even 44 lakh kits may fall short of meeting India's needs. This is despite the official line that India is still on safe ground but is only preparing for the worst.

How does India fare against South Korea's rapid test count?

A paper titled "Pandemic Policy in Developing Countries: Recommendations for India" authored by researchers at the Mercatus Center at George Mason University in the US reveals some figures that are hard to ignore. By March 31, South Korea had tested 300,000 people out of its 50 million population, i.e. 600 tests per 100,000 people. To test at the same per capita level, India would need to conduct 8 million tests. The paper had stated that India would have to conduct 385,000 tests every single day of the 21-day lockdown to reach South Korean level. That is more tests per day than the US is presently conducting.

What is a rapid test?

A rapid test is a test to check the antibody produced in the body after the onset of the disease. It is not a test for virus, which can only be done with the real time (RT) PCR tests that are being conducted by the government and private laboratories. Rapid tests are not for diagnosis but are used as a surveillance tool by the government in hotspots, containment zones and migration gatherings. If done seven days after the onset of symptoms, a rapid test detects the body's immune response to the antibodies.

The body produces two types of antibodies - IgM and IgG. IgM is detected from the seventh day from the onset of symptoms or the entry of the virus in the body. If used with the PCR test, it helps in increasing the detection rate. IgG is detected from the fourteenth day onwards. If IgG comes positive, it indicates immunity or a natural vaccination.

Also, unlike a throat or nasal swab, a rapid test is a blood test and the results can be obtained in a few hours as against two to three days in case of RT PCR tests.