As India crosses the 1 lakh tests per day milestone and begins work on the next, a senior government official on Monday underlined that India's testing strategy had evolved to try "remain ahead of the virus" despite the healthcare infrastructure constraints and ensure that the testing facilities were not overwhelmed in any part of the country.
"It has been a tough balancing act… sometimes in the face of criticism from the media," the official said, requesting anonymity because he isn't authorised to speak with the media.
Do remember that the public health system wasn't paralysed this time as it was in 2009 when one of the worst flu pandemics Swine flu reached India. Hundreds died in this pandemic, a government official said. But the 2009 experience led to some attention being paid to strengthen the molecular diagnostic facilities for viruses in India.
That came in handy when Prime Minister Narendra Modi in the early days of the Covid-19 outbreak, told the country's top scientists in and outside the Indian Council of Medical Research to expand testing facilities.
"You have to work day and night to save people's lives. Make every effort. You have my full support," PM Modi told them. And then, he and his office kept following up.
"For this outbreak, we are answerable to the highest level and are being watched by the highest level (officialese for Prime Minister," Dr Nivedita Gupta, the ICMR scientist who executed the effort to set up labs across the country, told Vogue's India website, earlier this month.
The difficult decision of the national lockdown bought them time as it slowed down the spread of the virus and gave the government time to prepare the healthcare infrastructure to trace, track, test, quarantine and treat people.
"We adopted an intelligent testing strategy to remain ahead of the virus. So in the beginning when the infection was entering the country from abroad, we centered our efforts to set up the initial burst of laboratories in cities…. This focus kept on shifting on the basis of our analysis of the likely hotspots of the infection," a government official explained.
Like before the government started allowing the migrants to go back home, testing facilities preceded them in states such as Uttar Pradesh, Bihar, West Bengal and Odisha.
That was the most difficult part since India doesn't have a medical college at the district level, and district-level hospitals don't have the specialised set-up.
"This has been quite challenging as the labs outside the medical college systems have meager experience of handling human infectious material," a health ministry official recalled.
All underserved areas were mapped and Covid-19 molecular diagnostic capacity reached in 'difficult to reach' areas such as Arunachal Pradesh, Nagaland, Sikkim, Ladakh, Goa, Andaman & Nicobar Islands.
In the big picture, India moved from 13 labs in the first week of February to 123 labs on March 24, the day Prime Minister Narendra Modi ordered a nationwide lockdown. Days before the lockdown is formally lifted later this month-end, India has 609 testing labs in all states and UTs.
Jugaad, or a frugal innovation, certainly helped when the imported Chinese testing kits didn't.
TrueNat — a diagnostic machine used for testing drug-resistant tuberculosis — was tested and validated by ICMR to screen people for the Sars-Cov-2 virus (which causes the coronavirus disease) to boost testing capacities.
Since TrueNat platform comes with an inbuilt sample collection in viral lysis buffer, the virus is inactivated and the biosafety requirements are minimal while handling the sample.
There were 367 of these machines in different states for TB diagnosis. These are being used for Covid-19 also . Besides, supplies of 608 additional TrueNAT machines - each has a capacity for 10-12 tests in a day - are also being mobilised to be ready for deployment in June.
With supplies of these machines, it would be possible to have Covid-19 testing capacities in districts with no capacity for carrying out the RT-PCR tests, or reverse transcriptase polymerase chain reaction test that is considered the gold standard for detecting Sars-Cov-2 virus.