Working with shortage of testing kit supply

Protocols for working with a shortage of test kits

From what we have seen happen in other countries we know that we need to perform atleast one test for minimum 1.2% of the total population (requiring 1.5 crore tests) and perform multiple tests (at least 3) for vectors (such as health-workers, delivery agents, truck drivers, police forces and essential service providers) requiring another 7 crore tests. Even if we ramp up our testing facilities to 1,00,000 tests a day we will require at least another 2.5 years of testing given isolation and quarantine strategies are very well implemented!

As we are aware, this isn't our current testing capacity; not even close. To give you a reference, India has done a total of ~50,000 tests till now (in entire month of March).

The availability of timely and accurate results will also be threatened as testing demands grow and outstrip capacity, such as when:

• There is a backlog for testing and it is no longer possible to turn around results within 24 to 48 hours. This will require identification and approval of more government and private testing laboratories along with labs at academic and research institutions.

• The demand for laboratory reagents exceeds the capacity for supply. A thorough centralized inventory management system that is capable of identifying reagent shortages and reallocating reagents to approved labs may help us solve this issue.

• Laboratory staff is exhausted and working hours need to be reduced. Training of more lab technicians for carrying out tests and automation of some basic sample processing steps might help in reduction of fatigue of laboratory staff.

• The number of incoming samples exceeds the capacity for safe pretesting storage. Sample storage can be done at the collection centers and transferred to labs in time for processing. The logistics industry already has multiple Just-in-time algorithms for achieving this.

• Critical staff become infected or are otherwise unable to perform their duties (e.g. being in quarantine). PPEs and effective training are a must. Creating negative pressure environments at sample collection and processing rooms will also help in avoiding infection risk to the lab technicians.

• Laboratory instruments can no longer be serviced or properly maintained. A centralized inventory management system can also help here.

If you are a senior official who can help resolve any of the above-mentioned challenges then this should be your first priority!

Advocating for ramp-up of testing facilities and approving more laboratories is certainly going to help with the situation but what do we do till the testing supply chain picks up?

How can we proceed in lack of testing? How can we bridge the gap?

There are multiple modes of testing for COVID-19; however the recommended method or gold standard as per WHO is RT-PCR (real-time polymerase chain reaction) method which can currently be done only at certain ICMR approved govt labs or ICMR approved private testing labs.

During a supply shortage of testing, well-informed decisions on where and who to test may help districts better ration the tests.

What can be done during a supply shortage of testing kits?

Situation

Red Zone

Yellow Zone

Green Zone

Asymptomatic case who had come in contact with a positive case

Home isolate for 14 days. Manage through a symptom reporting tool. Ask the patient to report temperature and respiratory rate regularly.

Home isolate for 14 days. Manage through a symptom reporting tool. Ask the patient to report temperature and respiratory rate regularly.

Test using the RT-PCR method!

Asymptomatic case who had come in contact with a positive case, with preexisting conditions

Test using the RT-PCR method as the individual may require medical attention

Test using the RT-PCR method as the individual may require medical attention

Test using the RT-PCR method!

Asymptomatic health care worker with history of contact with a positive patient or fellow health worker

Home isolate for 14 days. Manage through a symptom reporting tool. Ask the patient to report temperature and respiratory rate regularly. Redo health and safety training for all other health workers at that hospital.

Home isolate for 14 days. Manage through a symptom reporting tool. Ask the patient to report temperature and respiratory rate regularly. Redo health and safety training for all other health workers at that hospital.

Test using the RT-PCR method! Redo health and safety training for all other health workers at that hospital.

Symptomatic health care worker with history of contact with a positive patient or fellow health workers

Test using the RT-PCR method! Redo health and safety training for all other health workers at that hospital.

Test using the RT-PCR method! Redo health and safety training for all other health workers at that hospital.

Test using the RT-PCR method! Redo health and safety training for all other health workers at that hospital.

Symptomatic individuals from a cluster such as night shelter; a religious event; a political event or from another zone

Rapid serological tests can be used followed by a mandatory 14 day quarantine.

Rapid serological tests can be used followed by a mandatory 14 day quarantine.

Test using the RT-PCR method!

Recovering patient for monitoring

Rapid serological tests followed by radiology to ascertain progress of the patient.

Rapid serological tests followed by radiology to ascertain progress of the patient.

Radiology to ascertain the progress of the patient

Recovering patient prior to discharge

Conduct two RT-PCR tests on two different dates. Patient can only be discharged after 2 negative tests.

Conduct two RT-PCR tests on two different dates. Patient can only be discharged after 2 negative tests.

Conduct two RT-PCR tests on two different dates. Patient can only be discharged after 2 negative tests.

For contact tracing after identifying a positive case

Rapid serological tests can be used followed by a mandatory 14 day quarantine in found positive. If the test is negative, home isolate and test again after 10 days.

Rapid serological tests can be used followed by a mandatory 14 day quarantine in found positive. If the test is negative, home isolate and test again after 10 days.

Rapid serological tests can be used followed by a mandatory 14 day quarantine in found positive. If the test is negative, home isolate and test again after 10 days.

Entry-point surveillance for people coming in from other clusters

Rapid serological tests can be used followed by a mandatory 14 day quarantine in found positive. If the test is negative, home isolate and test again after 10 days.

Rapid serological tests can be used followed by a mandatory 14 day quarantine in found positive. If the test is negative, home isolate and test again after 10 days.

Rapid serological tests can be used followed by a mandatory 14 day quarantine in found positive. If the test is negative, home isolate and test again after 10 days.

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