NEW DELHI: As the world scrambled to make sense of the Covid-19 outbreak two years ago, doctors found themselves in a particularly-challenging situation catering to a sea of patients with unique symptoms.
Among them was Dr Nivedita Gupta, the Head of Virology at Indian Council of Medical Research (ICMR), who had to take on responsibilities that did not really fit into her “designated work profile”.
“Covid-19 had caught us unawares and we had to play some roles and responsibilities. Since this was a pandemic, and the nation needed many things to be done quickly, we jumped into many roles,” she told The Indian Express.
Dr Gupta was tasked with scaling up the Covid testing process in India. When they started in January 2020, only the National Institute of Virology (NIV), Pune had the bandwidth for Covid-19 testing.
“Fortunately, after the 2009 influenza or swine flu pandemic, I had been religiously involved in scaling up testing for viral pathogens in India. Since 2009, I have been working on a project known as ‘Setting up of Virus Research and Diagnostic Laboratories’.”
Dr Gupta explained that prior to 2009, there were only two laboratories — NIV and National Centre for Disease Control (NCDC), Delhi, that had the capacity to test for viruses. But through the initiative that ICMR took, they could set up 106 viral research and diagnostic laboratories in India by January 2020.
“All of these labs had a molecular testing platform, which was to be used for Covid-19 — RT-PCR, as we know it. I plugged this network with NIV and we scaled up capacity for Covid-19 testing in at least 106 locations in the country.”
But, when cases surged in March 2020, even those 106 labs could not adequately meet testing demands. Dr Gupta said the dilemma led to them doing an “exploratory exercise” with the private sector, careful about maintaining the quality and “correctness” of testing. They also collaborated with the National Accreditation Board for Testing and Calibration Laboratories (NABL).
But, only 75 labs in India at that time were accredited by NABL for molecular testing. States became panicky as sample shipments became increasingly challenging owing to the lockdown. “We were puzzled as to how to get testing done. I, along with my ICMR team, was implementing an initiative and we laid down Standard Operating Procedures to set up an RT-PCR lab in the country,” she said.
Dr Gupta added that they identified and sought help from 14 ‘mentor’ institutes in the country that helped with the initial assessment of these labs “either within the realm of the state government or the Centre, but not within the purview of ICMR”. There was a lot of handholding to do, too, in order to teach these labs how to accurately do RT-PCR testing.
“I, along with my ICMR team, was implementing an initiative and we laid down standard operating procedures to set up an RT-PCR lab in the country,” the doctor said.
The other challenge was that before the pandemic, all testing products were imported. “By March 2020, when the global fear increased, countries like Germany, China and US stopped supplying because they needed to augment their own stockpiles.”
Challenged by the situation, Dr Gupta encouraged indigenous vendors to learn how to make RT-PCR kits, to enable them to start “in-house production”. There were some logistical concerns too, including allowing workers to reach their work units so that the manufacturing could happen. “We also set up 32 validation centres across the country, where these indigenous diagnostic kits could be validated. We were successful, as a result of which, there is a huge availability of testing commodities now,” she said.
The biggest challenge, however, was ensuring the quality of the product. Dr Gupta said “laying down validation protocols” and making people adhere to them was a task. “If you failed people in the validation process, you would receive threatening phone calls and abuses. I had practically stopped taking calls, because otherwise I would start my morning listening to someone shout at me.”
The other challenge was that when the pandemic started, people came up with their own solutions to combat the disease, which had to be countered with logic. They would even send requests for their products to be included in the program. “ICMR has maintained a scientifically-rational stand. We set up expert groups to streamline the process and make people understand why their product cannot be recommended,” Dr Gupta explained.
While the Delta virus upsurge in April-May 2021 was a nightmare for India, it is in a much better position today, she said. “The majority of the population was not vaccinated [last year]. Most of our adult population is vaccinated today, and children are getting vaccinated, too. The government has offered boosters, also. When Covid-19 struck us, the clinicians were not too cognizant of the treatment protocols, either. But now, with two years of experience, the understanding of our doctors has developed considerably.”
She added that waves may continue to happen in the future if the virus mutates, which is why it is important to maintain vaccine rates and public health precautions.
What sets them apart is the route of transmission, Dr Gupta said. Covid is transmitted via the respiratory route, and is hence the fastest. “Zika is transmitted by the bite of an infected mosquito. It is not spreading from one person to another directly. As far as Nipah is concerned, you will see that any virus that has a high mortality rate, by virtue of being infectious, does not have the potential to spread too much; because, the host dies very quickly.”
She concluded by saying that it is advisable to wear a mask still, in a public gathering. “Vaccines protect us from severe infection and death, but not from infection [completely]. They do not reduce the transmission of disease either, or at least not stop it. A vaccinated person can transmit infection to others, especially the elderly and immuno-compromised people. No one has declared that the Covid-19 pandemic is over. We might see a new variant also. So, as a social responsibility, wear a mask to protect vulnerable people in society.”