Thread by @mahendr46642796

Dr @ARanganathan72 in 2 minutes beautifully tried to imply hightened need of antibody testing in our country . I would just let others with limited knowledge about these tests understand why we need it. But for that we first need to go back in time to Korea(North nahi..south)

-In 2015 South Korea was hit by the MERS epidemic which had started in Saudi Arabia, MERS-CoV,belongs to the same family of coronaviruses as COVID19
- The index case/first case flew in from Bahrain,but S. Korea had not included Bahrain amongst the countries for screening.

-S.Korea was unprepared for MERS, the index case kept jumping hospitals and clinics infecting many till he was finally diagnosed to have it.
- They had 186 confirmed cases, 38 deaths and 16693 quarantined patients.
-Hospitals became the source of infection with the superspreaders

- They were slow in developing & approving testing kits for MERS
-Govt didn't disclose hospital names with infected cases out of fear which spread further infection.
- They lacked adequate no of negative pressure isolation rooms
- The epidemic also hit the Korean economy badly.

MERS epidemic lead to a huge outcry and major reforms in Korea for tackling epidemics in future:
- They made health information system more transparent
- Enacted new laws which allowed labs to use unapproved testing kits in epidemics.
- They also sped up approval of testing kits.

These reforms helped when Zika virus hit S. Korea. Zika infection was mild but caused severe mental retardation & birth anomalies to babies born to infected mothers. Massive screening helped them control the infection.They even Zika proofed the suits of their Rio Olympic athletes

When COVID 19 struck Wuhan, korean health dept sprung into action and activated development of testing kits and started piling up the reagents used in these kits.
- Started robust screening of patients at airports.
- On Jan 20, korea had its first case of COVID 19,same as USA

With massive no of unlicensed testing kits(mainly RT-PCR based) in hands, Korea prepared it's labs & technicians to conduct these tests and authorised its use for screening an extraordinary no of people. By 27 Feb they had tested 66,652 cases while Japan only 1,890 and USA 445..

Apart from using RT PCR kits they used antibody tests in remote areas where RT PCR tests could not be done.They evn made public booths where people could drive in and had their sample taken to decrease burden on hospitals.Positive results helped also in robust tracing of contacts

As more cases and contacts were identified and isolated, no of new cases started dropping and korea flattenned the curve.All without imposing any significant lockdowns. With more no of cases and less no of death, the fatality rate reduced which helped reduced fear in the public.

So why is @ARanganathan72 sir emphasising on increasing antibody testing n India when korea accomplished it with more no of RT PCR tests? The answer lies in our preparation and health infrastructure set-up. So lets see what is the difference between the two tests..

RT PCR is the gold standard test for COVID19, it detects the viral gene which is the first to appear in any case. Testing involves taking swabs from throat and nasal cavity by trained technicians. Results usually take 40-45 minutes but testing is done on a batch of specimen.

Antibodies(Ab)usually develop against COVID19 after day 7 of infection, there are 2main types, IgM which come during early phase, and IgG which appear late and indicate that patient has recovered. These Ab are present in blood so sample is usually serum(blood minus it's cells)

Antibodies based test are easier to conduct,more or less like pregnancy test kits, but the sample here is serum. So high level of expertise and sophisticated labs are not required.They can be done at point of care i e at the same hospital where patient is admitted. T

Thus we must realise that India is not Korea, we did not prepare ourselves unlike them for this outbreak, so if we want to flatten the curve we need to test more number of cases and for that antibody testing kits can be use along with RT PCR for contact tracing.

But we need to speed up the rate at which we are buying or giving clearance to these kits. That will help us immensely particularly during this period of lockdown when most of the contacts are indoors and not spreading the disease. Thank you...🙏🙏🙏

Thank you @ARanganathan72 sir for highlighting the thread...😊🙏🙏🙏

Today, ICMR has included rapid antibody testing guidelines on its website which is a welcome step. More and more such kits should be made rapidly available to speed up the testing procedure. Link to site icmr.nic.in/content/covid-…
Cc. @ARanganathan72