New strategies to expand Covid-19 testing at affordable costs as cases rise

Pvt labs seek approval for protocol on patient sample pooling; faecal testing also considered

As cases continue to surge in India even during the nationwide lockdown, plans are afoot to expand the scope of screening potential Covid-19 patients by reducing expenditure on reagents required to do the tests. An option to do screening using faecal samples is also being considered. 

The idea is to reduce the wastage of reagents by testing Covid-19 negative patients. 

The country's apex health research body the Indian Council of Medical Research (ICMR) has already advised that a new testing strategy be adopted in specific clusters where the positivity rate (percentage of cases turning out to be positive upon testing) is less than 2 per cent or so. This approach will help to ration the number of Real Time PCR kits. It would also help to conduct more tests in lesser time. The idea is to use 'pooled samples' to do the initial screening before one runs RT-PCR tests on individual cases. 

Let's say a cluster has 100 people to be tested. The samples could be broken into groups and a sample containing specimens of multiple people can be run through the PCR system at the same time. If the collective sample tests positive, then individual samples in that group will be taken up for testing. If the collective sample tests negative, then it can be assumed that no one in that group is Covid-19 positive and there is no need to run the individual tests. 

Such a methodology helps to save reagents used for testing and as A Velumani, chairman of Thyrocare said, reagents comprise around 30 per cent of the test cost. He felt that there can savings of 70 per cent of the reagent cost when testing in random population, while when testing in a suspect population, the savings on reagents would be around 20 per cent or so. 

The private diagnostic laboratories have already approached the respective state governments and the municipalties where they are operating to approve protocols for such testing in clusters. Velumani said that Thyrocare and Mumbai's Covid-19 den Kasturba Gandhi Hospital are already working on the same and a protocol is in place. 

He added that in this case, however, the testing methodology and protocol can be different for different clusters. "In hotspots, we cannot take large sample pools as we cannot afford dilution," he said.

Private labs feel that this is one of the best ways to expand testing into the hinterland. "In a village of a few thousand people, the testing can be done on sample pools of 15-20 people or more. This would save time and also cost of testing," said one private diagnostic chain who did not wish to be identified.

The ICMR, on its part, has suggested that pooling of samples of more than five people should be avoided as then there is a posibility that the effect of dilution will lead to false negatives. In simpler terms, positive samples with low viral load can be missed out if the sample pool is more than 5. ICMR has tested this method in its labs in Lucknow. 

Now, another method of screening that the government is considering is faecal screening. Several studies done globally have indicated that testing excrement can help to detect Covid-19 in patients much before they show symptoms. Researchers in Australia and Netherlands, for example, have found that people infected with the virus start excreting traces of Covid-19 almost a week before their flu-like symptoms emerge. 

An industry source said that the government is considering the same as screening tool here too. "Testing from sewage samples of housing colonies can be done. The sewage samples from each building in a housing colony can be tested. Then pooled sample testing can be done for people living in the identified building," explained an industry official. 

In cities like Mumbai which have been badly hit, such a screening is likely to be implemented soon as the government runs dry of test kits and reagents.