Why do we need COVID19 testing in Private labs?

This is COVID time when the majority of citizens are locked inside their houses but few warriors are fighting hard to save the lives of infected citizens. The most important role is played by doctors and healthcare workers. An equally important role is played by the diagnostic lab by detecting the presence or absence of COVID19 in the patient sample which saves patient's life and of course of many others who might get infected by an undiagnosed patient.

Private Labs are not allowed to test COVID19 in Telangana and many other states in India

The state government of Telangana is not conceding the private laboratories to do COVID 19 testing who are well equipped and do not need the training to execute these tests. The state government decided to use many untrained government research labs as diagnostic labs for such a severe infectious disease and neglected 10 times bigger and highly trained private Diagnostic labs in India. The newly appointed COVID19 testing labs are trying to buy new Real-Time PCR machines and kits to do the tests. When will these new instruments reach Indian labs, get installed and the testing will start? Hundreds of these machines are already available in private labs in India and many in Telangana. Why waste resources when we are certain to face a huge economical slowdown shortly?

Do government labs perform the tests for free? No, they don't.

I support the use of government labs like ICMR, CSIR, DBT and ICAR who are aware of RT PCR tests but what about private labs who are equally capable of performing a similar type of viral diagnostic tests in a qualified lab setup. Let me clarify these Government labs are not testing for free. They use taxpayers money to procure consumables, kits and equipment and also get salary by the institute who are heavily funded by public money. How is this a free test? Asking a small private company to do the COVID19 tests for free is appropriate if similar resources are provided by the government to them too. 

The pressure to test more per day may increase misdiagnosis

The government labs are under tremendous pressure for testing more samples per day. I presume we have thousands of COVID19 patients currently in India undiagnosed and we are unable to reach them so far due to slow speed of testing due to the wretched judgment of testing only in government labs. To increase the number of tests per day and reduce the cost per test, government labs are now suggesting to multiplex 4 to 5 patient samples in a single test which can increase misdiagnosis. The pooling of samples is highly dangerous during Pandemic when imported RT-PCR kits from China are being questioned. There are reports of Chinese companies selling defective and substandard kits which may increase the misdiagnosis further. Government labs need an extremely good vendor network to reach quality manufacturers of the kits which government is lacking so far. The slow speed of testing and misdiagnosis may further enhance the chances of a sudden increase of COVID19 patients in India.

What is at risk? 

Currently, government labs cannot do enough tests per day which could harm India's possibilities of restraining this disease before it turns into a community spread and thousands of lives are lost. This decision of testing COVID19 in only government labs of Telangana is against common people and companies too. The private labs will commence layoff due to no business in the coming months and the government may not have a solution to resolve unemployability in the diagnostic sector. The overall unemployment rate has reached 24%, probably the highest in independent India's history. As per the latest news, 31% of pre-lockdown jobs have vanished. If the lockdown is continued many of these small labs may close their business forever. Government labs do hire but public servant's salary is the government's liability. A company provides permanent employment and reduces GoI's HR burden. When most of the businesses are closed during the lockdown, the government should introduce the funds in the market rather sending funds to untrained government labs who are utilizing the funds to import faulty kits and buying equipment which they will not use after this Pandemic.  

What can be done?

Rs 4500 was the cost of each test reported by the National Institute of Virology to government and the same amount can be paid to every private lab for each test they perform. The labs won't be able to make any profit at this cost but at least they can survive this disaster and help the government by testing more samples per day. The ideal situation should be to do the testing in as many Government+Private labs as possible. The entire world is using private diagnostics labs for COVID19 testing and the Indian government should also shoulder Indian private diagnostic labs by giving them rights to execute the COVID19 tests on a minimal cost basis as given to NIV or any other Indian government laboratory. Sequencing full-length COVID transcriptome and study on the immune response of patients to identify the structural variations in repertoires and HLA genes using highest quality producing long-read genome sequencers like PacBio Sequel 2 should be encouraged. This machine can sequence 500 COVID19 samples in 15 hours. We should also use other tools like Artificial intelligence-based CT scan imaging software for the initial screening of patients along with RT PCR and Antibody-based tests. I hope with the strong public-private partnership we shall come out of this pandemic faster.

About the Author:

Mr Dushyant Singh Baghel is a genomics scientist and MD and CEO of India's top ten Life science solution provider, Nucleome Informatics. His laboratory is working on genome sequencing and analysis of the virus, microbes, plants, animals and human genomes.