Thread by @nileshjrane

Current testing protocol as per ICMR

- Home Quarantine of 14 days of all Foreign travellers in past 14 days who are asymptomatic. Testing for Virus only if they have symptoms of fever, cough and breathing difficulty. If found positive trearment will start.

#IndiaFightsCorona

- All contacts of Lab confirmed Positive cases to have 14 day home quarantine. Testing if they turn symptomatic as above.

- Health Care workers managing respiratory distress should be tested if they become symptomatic.

#IndiaFightsCorona

Currently, 72 functional labs in the ICMR-Min of Health system for #WuhanVirus testing. The base is being increased.

- Other Govt labs like CSIR, DRDO, DBT Medical Colleges etc - total 49 more labs being brought online by end of this week.

- High Quality Pvt Labs are also being

Operationalised.

- Two labs having high testing rate of 1400/day are being operationalised by end of this week.

- We have unlimited supply of reagents and primers for the testing (likely desi production).

- 1Million probs are ordered already, to be received soon.

- 1Million more probes asked from WHO

- procurement of More High testing rate machines are being looked into.

Note that Roche Cobas 6800 can test 1440/day tests. Recently Roche got emmergency approval for its Cobas 8800 testing machine with capacity of ~4200/day. World over,

Only about 750 of these Cobas machines exist. We seems to have 2x6600 PCR machines for now. These machines must be in a lot of demand and may not be easily available even at high premium price.

In addition, we know that ICMR also has conducted two rounds of random tests for checking Community Transmission. Till now, all such tests have come negative. Likely more rounds will be under taken. These must be from the symptomatic patients outside the current testing protocol.

- Total 8 antibody based kits claimed by various mfg-rers. But no one has submitted kits for validation to NIV Pune so far. 2-3 kits will start validation soon.

- 8 other commercial real time PCR based assays are also under validation at NIV, Pune.

- Test sample process - Patient should not be made to visit labs for giving sample.

- Many pvt labs have approached for testing. But probes are a limiting factor now. All labs who could procure their own probes can join testing efforts. There are 51 NABL accreditated labs.

- ICMR will share testing SOP and positive control with pvt labs as soon as they can procure probes, reagent and primer. They can start testing as per latest ICMR guidelines. Only ICMR approved test kits should be adopted after validation by NIV Pune.

- Pvt labs shud follow all

Safety guidelines and convey test results to appropriate authotrities in real time. It would be the lab's responsibility.

- ICMR appeals pvt labs should conduct Free tests. Currently no plan from Govt to bear cost.

- some of the Pvt labs have offered to test for free. Great.

- Current testing capacity - 90/day/lab which could be doubled. Current capability 8000/day. Samples coming in are 500/day. So the existing capacity is significantly underutilised. And there is significant capacity

Expansion scope available. Theoretical max of 121 labs × 180/day + 2x1400/day = 24580/day Capacity would be operational by next week. Any Pvt labs would be additional to this whenever they can start pitching in.

Enough probes available for all 121 Govt labs.

ICMR's Community Transmission testing protocol is - Testing of 20 Severe Acute Respiratory Illness patients' samples coming to the 51 Labs providing #COVID19 testing to be tested for #COVID19.

Thats 1020 samples total. All tests in Feb were negative. For March 1-15 batch of 1020

Results for 500 have come and are all negative. Rest 500 results are expected soon. So far indications are that there is no Community Transmission happening. Which is a gread news.

#IndiaFightsCorona

The current protocol has a sample size of 20/week x 4week x 51 labs = 4080 samples per month, from the patients who have been admitted in ICU with acute respiratory symptoms similar to those seen in COVID-19, and who are outside the main protocol for COVID-19 testing i.e. they

neither have any travel history, not any contact with known case nor they are Health workers. Now I do not know how many such patients are typically admitted in ICUs Nationwide. So its difficult to say about % of total such cases being captured. But ICMR clearly feels this number

is sufficient for now, as it takes 4-5 days for any COVID-19 patient to develop respiratory symptoms so any potential COVID19 case is likely to end up in ICU within that period. Its anyway not possible to test asymptomatic people as they are most likely be tested negative anyway.

OK, ICMR says, many labs out of the 51, are not even getting the quota of 20 total cases of Severe Acute Respiratory Illness. That probably explains why in 2 weeks (March 1-15) we have received only ~1000 cases instead of 2040 cases. If so, then we are covering quite a big

portion of all SARI cases being admitted nationwide if not all of them. That sounds reassuring.

Why India is yet to join any Clinical trials of drugs - The sample size needed is large. As of now India has too few cases to provide any significant contribution to the clinical trials. Based on transmission level we may join global efforts or conduct our own trials in future.

The random testing of 20/lab/week would be extended to all 121 govt labs as and when possible (51 labs doing it today). These labs are spread across entire Nation. The current protocol should be enough to cover almost entire SARI cases getting admitted in India.

IMP - As per ICMR - If you fall in the current protocol of testing - symptomatic with International travel, or contact with known case, you need not go to Hospital for sample collection and take risk of transmission in the process. Call Helpline published by GOI.

As per an update on ICMR website, as of 17th March, 11263 tests are conducted for #WuhanVirus, out of which 129 are found positive. Total 6 cases are added on 17th March.

@MohalJoshi Data for your model.

ICMR is in process to operationalise 2 high thoughtout PCR machines with 1400/day test capacity. Its proposed to install such 5 facilities with possibility to scale upto 10 total.

To out this no in perspective, Japan, Italy has 2 such facilities. Worldwide only few 00s exist.

This tweet is confusing. Roche got approval from US FDA for its machine Cobas 8800. Did we give the same approval or something else..?? Also, is this same as the 2xPCR machines that were planned to become operational soon..?

https://twitter.com/ANI/status/1240215055431393280?s=19

So all the 842 random samples collected and tested from SARI patients with no travel history and no known contact with known cases have tested Negative. So far we find no evidence of Community Transmission.

m.timesofindia.com/india/results-…

Note that, though the protocol says 20 samples per lab per week, many labs didnt not have even those 20 cases coming up to them in the given time period. Hence the total of samples is less than intended.

This doesn't mean there is absolutely no Community Transmission. What this

Implies is that there is so far no known case of Severe Acute Respiratory symptoms which is caused due to #WuhanVirus, which has no history of Int'l travel.or contact with known positive case.

Had there been significant community Transmission, at least a few of those cases

Should have turned up in hospitals with SARI, and given the large coverage of the total number this protocol is able to get, at least one of them should have been caught in this testing.

This surveillance random testing will continue further. Hopefully we will get to see

Weekly updated on the results. With more labs operationalising, the sample space would also increase hopefully to include all SARI patients, bar none to be tested for #WuhanVirus.