Shashi Tharoor interview: This India-developed, low-cost COVID-19 test will be more effective
The country may soon get a low-cost rapid testing method to detect COVID-19. Thiruvananthapuram-based Sree Chitra Tirunal Institute of Medical Sciences and Technology (SCTIMST) is working on such a testing method that could give conclusive results for COVID-19 in just 15 minutes, at Rs 200 per person. This was disclosed by Shashi Tharoor, MP, a member of the SCTIMST Institute Body, in an interview with TNIE Chief Reporter Sovi Vidyadharan. Excerpts.
Q: You had intervened to get the first batch of real-time RT-PCR testing kits, approved by ICMR, delivered to Thiruvananthapuram. How useful are these kits?
A: RT-PCR (Reverse Transcription – Polymerase Chain Reaction) is the most definite and conclusive test to detect SARS-CoV-2 virus and the gold standard in identifying the COVID-19 disease. We cannot go wrong on testing since one miss would mean grave danger to human lives. I managed to get the first Real-Time RT-PCR kits to Thiruvananthapuram from the only Indian manufacturer validated by ICMR.
It gives rapid results within 1/4th the time taken by existing RT-PCR protocols – whereas such RT-PCR tests normally give results after 9 to 10 hours, the kits we got for Thiruvananthapuram provide results in two to two and a half hours. That meant we could test more samples in less time.
This has helped Thiruvananthapuram to scale up the testing, especially in the Pothencode area, where we suspected community spread after reporting one of the two COVID-19 deaths in the state.
Q: Are there efforts underway to develop even cheaper testing methods for COVID-19?
A: As the local MP and as an Institute Body member of Sree Chitra TirunalInstitute for Medical Sciences & Technology (SCTIMST), I held discussions with Dr. Asha Kishore, its Director, to explore the development of an accurate yet rapid and cheaper diagnosis using the expertise of the institute's highly reputed talent pool.
They came up with the idea of Genomic Viral Diagnostic Tests. These devices are based on Isothermal Reverse Transcriptase Loop-mediated Amplification of Viral Nucleic Acid (RT-LAMP). It is a modification of the highly specific LAMP technique for Mycobacterium tuberculosis by developing a Rapid Test Kit for SARS-CoV-2 specific for N-gene covering three regions of the gene to avoid redundancy due to mutation.
If successful, these tests could give conclusive results in 15 minutes, at the cost of Rs 200 per person. I have allocated one Crore to SCTIMST for this purpose from my MP Funds. They have filed for approval from the Central Drugs Standard Control Organization (CDSCO) under MoHFW and concurrent validation by the National Institute of Virology. After these, there would be the ICMR evaluation and then manufacturing can start.
Q: There is a lot of debate over the efficacy of Rapid Antibody tests vis-à-vis RT-PCR tests. Your thoughts?
A: In the case of Rapid Antibody-based tests, even if IgG and IgM are positive or negative, this would require further confirmation tests. Hence, it is more of a screening process than testing. ICMR has released guidelines for the use of such screening in bigger containment zones, large migration gatherings, evacuee centres etc, and in that specified way it could be useful.
Results from Antibody testing cannot be used as the sole basis for diagnosis or exclusion of SARS-CoV-2 infection.
False-positive results may occur due to cross-reacting antibodies from previous infections, such as from other coronaviruses, or from other causes. Samples with positive results should be confirmed with alternative testing methods like RT-PCR and clinical findings before a diagnosis is confirmed.
Even if a person tests negative for IgM antibody, it does not rule out SARS-CoV-2 infection, especially in case of people with a history of positive contact or travel.
It has to be confirmed or ruled out with RT-PCR. If RT- PCR is not done, the person has to go into quarantine and the Antibody test repeated after 10 days.
Q: The state government is procuring Rapid Antibody test kits from abroad for screening purposes. Should the government have opted the foolproof RT-PCR instead as you had done? Is it the cost factor that makes them opt for the former?
A: These decisions are taken best at the ground zero level after weighing in various factors, best known to the local administration and in consultation with the experts. Rajiv Gandhi Centre for Biotechnology in Thiruvananthapuram, in which I am also a Member of their General Body, has been in the forefront of COVID-19 testing in the state. Under the leadership of Prof. Radhakrishna Pillai, Director of the Centre, they have developed a Rapid Antibody Testing Kit, which I believe is ready for ICMR evaluation. Since it could be mass-produced in Kerala and will obviously be cheaper than imported ones, the State Government could look into that option as well.
Q: Any suggestions you would like to give the state govt or any change in strategy state govt should adopt in its ongoing battle against COVID-19?
A: One: increase test samples. Two: explore pool testing – where a pool of samples can be tested at one go.Three: ensure adequate Personal Protective Equipment (PPE), masks, face shields, and gowns for healthcare workers and Four: create testing booths for medical teams. The WHO mantra is “test, trace, isolate, treat”. Kerala is doing an excellent job on all of these fronts so it is just a question of doing more.