Varied results for Covid-19 diagnostic tests in private and government labs can leave patients in the lurch. In an interview with Businessline , Arvind Lal, Executive Chairman of Delhi-based Dr Lal PathLabs and and Advisor, FICCI Health Services Committee, explained how the industry is working towards addressing this issue. Excerpts:
People get confused when private and government labs throw up different test results for Covid-19 at the same time. How do we understand this issue?
If the private lab says the test is positive, and say, after four days, the government lab retests it to declare it is negative, this is bound to occur. The levels of virus would have gone down in the person’s body by then. If we take out four swabs at the same time, and test them in both private and government set-ups and there is a discrepancy, then there is a problem with one of them. But testing the sample after four days, after the private lab has already said it is positive, and after virus load in the nose and throat may have gone down, is like comparing apples to oranges.
Also, the technique of taking out the samples may vary. The government is using its own primers and probes, whereas private labs are using ready-to-use kits. We brought this ‘dispute’ to the notice of the Indian Council of Medical Research (ICMR) nearly two months back, and we seek resolution.
Why can’t you use the primers and probes that the government labs are using? Also, is the government reluctant to share positive controls of the virus sample to ease research and testing?
We had asked the government if we can use the method that they are using, which is a primer and probe lab-developed test. However, the permission given to private labs is to buy ready-to-use kits, in which all the components are present. The assay becomes slightly cheaper if we also do tests using primers and probes. Also, now we have reported thousands of cases so we already have our own positive controls.
How do we resolve the discrepancy in testing then?
In rare cases, we tell the patient that their result is indeterminate. And the sample can be tested by another accredited lab, preferably using the same reagent, which follows our methodology. This is called inter-lab comparison. There are SOPs (standard operating procedure) that need to be followed to this effect and we have already brought this to the notice of ICMR.
How difficult is it for patients to access the Covid-19 test?
We can test them only after a doctor’s prescription is obtained. Government regulations are fairly strict, so we are telling the patients — if you don't fit into the government’s category please don't come to us.
How has the lockdown affected the economy of path labs?
Business was down by 70 per cent when all this hit us, plus Covid-19 is not our main line of business. Here, margins are very small, the business may come today not tomorrow, depending on the number of people who require testing. We expect that business will be normal after six months. The (March) quarterly results are down as compared to last year. Though the lockdown was in the third week of March, the business started tapering by mid-March. Tests for all lifestyle diseases like diabetes, haemoglobin, urine tests like urea, cardiac tests like lipid profile, liver function tests, kidney function tests, so also cases of dengue, malaria took a hit.
Only 20 per cent of all tests are being done in private labs. Why so?
We can do up to about 4,000 tests per day for Covid-19 through the RT-PCR method in Delhi. We are currently doing 1,000-1,500 tests in Delhi. We can scale up much more, but most people go to government set-ups here. The Delhi government has to exhaust its capacity and then give us the overflow after that. This was told to us before we started testing. Only in case the government exceeds its capacity will it give samples to the private labs.
We also have reference labs in Kolkata which process 500 samples a day and in Indore which process 150 samples a day. They are pretty much packed.
The Delhi government has said it will not conduct tests on those brought dead. How do you view this decision?
If anybody is suspected of having died of Covid-19, before their bodies are packed, the hospital can just take a sample and give it to the labs for testing. We as a private lab will never get these samples because we have no access to places where people are dying in hospitals. We will only get live patients, so no samples of dead patients come to us. But I see no problem in collecting samples from suspected Covid-19 patients who have died.