Kolkata, WEST BENGAL — Over four days in March this year, a group of postdoctoral researchers, postgraduate students working towards their PhDs, and medical personnel from elsewhere in Telangana gathered in the quiet laboratories of the Centre for Cellular and Molecular Biology, or CCMB, in Hyderabad.
Their mission: To assist in India’s quest to contain the march of the novel coronavirus by quickly and safely setting up a facility for testing samples gathered from patients suspected of COVID-19, the illness caused by the new virus.
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As India enters the third week of a national lockdown, Chief Ministers from across the country have urged the Union Government to consider extending restrictions until there is clear evidence that the virus has been contained. Public health experts, in the meantime, have stressed the urgent need to test as many people as soon as possible to ensure those infected can be treated and kept from unknowingly infecting those around them.
On the 9th of April, the Indian Council of Medical Research, or ICMR, said that India had tested for the novel coronavirus in samples gathered from 130,792 people — a relatively small number in a country of 1.3 billion people.
Thus far, the biggest hurdle to amping up testing has been a shortage of test kits and laboratories with skilled technicians capable of conducting these tests — which is where an institute like the CCMB comes in.
On March 22, CCMB received the necessary formal clearances to begin processing testing samples for COVID-19 — but first the centre needed to ensure they were ready for the task. This account of how CCMB geared up to this task shows how young researchers in India are throwing themselves into the country’s efforts to contain COVID-19, and reveals the successes, and the challenges, of quickly ramping up testing for a highly contagious virus in a country with an overstretched public health system.
“I wasn’t going to pass up on the chance to be even slightly useful in fighting a pandemic,” said Annapoorna P K, a postgraduate student in CCMB.
“There are about 12 people for RNA isolation and 28 for RT-PCR. There are specialised domains and we have enough back up,” said Dr Rakesh Mishra, CCMB’s director, who has led the team in concert with faculty members Dr Archana Siva, Dr H H Krishnan, biosafety officer Raghunand Tirumalai, and Principal clinical geneticist Karthik Tallapaka.
Testing For Coronavirus
Institutes like CCMB test for the presence of the novel coronavirus, technically called SARS-CoV-2, using a process called a Real Time - Polymerase Chain Reaction, RT-PCR. The test takes between two and three hours to prepare, following which the reaction takes about 1.5 hours. Once set up, each RT-PCR Machine can process 48 samples at a time, significantly speeding up the testing process.
Given how contagious the coronavirus is, each stage of the process — from the isolation of the virus’s genetic material, to running the RT-PCR machines, must be conducted in biosafety environments of varying degrees. So when CCMB’s experts began their training, they started with a day of theoretical lectures followed by hands-on-training the following day.
“On the first day, we gave theoretical lectures on the biosafety measures and the RT-PCR process, following the official two-step protocol given by the ICMR,” said Divya Gupta, a virologist at CCMB currently in the fourth year of her PhD. The ICMR, or Indian Council of Medical Research, is the nodal body for India’s response to the coronavirus.
The next day, Gupta said, everyone was kitted out in Personal Protective Equipment, or PPE, and taken to the labs.
“To avoid panic amongst the trainees, we got negative samples from the Gandhi Hospital,” Gupta said, referring to the Gandhi Medical College, Secunderabad. “Although not everyone was comfortable in wearing PPEs and working, this is a crucial step.”
Training people in just two days was hard, Gupta said, but the researchers tried to maximise the time spent in the lab.
“It was hectic,” said Annapoorna, a postgraduate student in CCMB, after the first day of training, on being asked how it went.
Once the training was complete, the institute had to prepare itself to handle medical samples containing the live virus. Testing for the novel coronavirus requires researchers to isolate the virus RNA — a delicate step that requires great caution. Preparation of the reagents used for testing and running the machines requires coordination and planning. All of this must be done even as researchers follow the protocols of physical distancing.
The students now work in three shifts: morning, day, and night. The samples usually arrive in the afternoon. There is a demand to submit the results quickly, but the students have been extremely careful. All samples that are tested positive, go for a second round of confirmation test.
“I feel taken care of by CCMB,” said Gupta, the virologist. “Sometimes the deadlines are short. For example, yesterday we worked from 5 PM to 11 AM. Till now work has been going on smoothly. At least a 100 samples can be done per day.”
In the first two days of diagnostics, 39 and 80 samples had been tested respectively, and the number had increased to 120 on the third day. In the coming few days, the work may increase.
The demand for test results may sometimes take a toll on the researchers.
“I’ve been doing COVID-19 diagnostics for just 2 nights now, and I’m significantly stressed,” said Annapoorna. “I worked for over 12 hours only to find out we have more positive cases coming up. It’s unsettling. And then there’s news about doctors being abused, patients running away. It’s hard to see light at the end of the tunnel. But I guess we keep trying.”
Waiting For Govt’s Permission
On April 10, ICMR published a request for applications and detailed guidelines for government and private medical colleges setting up COVID-19 testing facilities in their laboratories.
If enough institutes with the right resources and facilities apply, this could allow for significantly more testing.
“Being a young researcher, I feel very disappointed because I am not contributing to the COVID-19 situation. I wish to volunteer for the COVID-19 testing process in Navi Mumbai. I have an experience of required techniques,” Pratik R. Chaudhuri from Tata Institute of Fundamental Research (TIFR), Mumbai, wrote on Twitter.
Others have written to the Union Minister for Health & Family Welfare, Dr Harsh Vardhan, asking for permission to access the laboratories they do all the year, and diagnostic samples be sent to them.
“We are waiting for the permission by the GoI since receiving more than 500 volunteers’ requests from the research scholars who want to work on the COVID-19 situation at their corresponding laboratories, but are stuck at hostels or home,” Research Scholars of India (RSI), a group of research scholars across India, told HuffPost India over email.
The researchers seem to be ready, now it is down to their institutes and the government.