It’s just over a year since India first reported SARS-CoV-2 infection (the virus causing Covid-19) on January 30, 2020, in students returning to Kerala from Wuhan as well as in tourists from Italy visiting Delhi and their contacts in Agra. This was the time which challenged our public health system and forced medical scientists, researchers from other fields, bureaucrats, political leaders and community groups to respond and provide hope to mankind.
In India, the fight against Covid started with enormous challenges, as we had minimal diagnostic capabilities to test the presence of SARS-CoV-2 infection, were dependent on imports for medical equipment and tools and, as in other countries, we did not have any definitive treatment protocol. No public health wins are easy. Though a lot has been achieved within the last 12 months, the battle against Covid is not yet over and there is some more distance to cover.
For India, the successes have made their appearances more in the last few months. Earlier, the daily reporting of cases was in the range of 90,000, the peak being 97,894 on September 16. However, in the last couple of months, the reported number of cases per day has declined without a dip in the number of tests conducted daily. The daily cases are now 12,000-14,000 and that too only in a few States. Covid-related fatality has fallen drastically with less than 200 deaths per day for more than a fortnight now.
The fundamental approach to counter any infectious disease epidemic is to detect, isolate, treat and manage cases early and prevent occurrence of new cases. Scientists at the Indian Council of Medical Research (ICMR) worked relentlessly on the strategy of 5Ts — test, track, trace, treat and technology — to expand and diversify testing capacity and thus enable efforts to effectively mitigate the impact of the pandemic.
India is set to cross a cumulative figure of 20 crore samples tested for SARS-CoV-2. This highlights how innovation, recalibration of testing strategy and collaborative efforts of government at the Centre, States and Union Territories effectively mapped the extent of the epidemic in the country.
Ramping up testing capability
The ICMR exponentially increased Covid testing capability across the country by leveraging technology and facilitating innovation in affordable diagnostics platforms. Apart from RT-PCR testing laboratories, testing outreach was expanded through indigenous point of care test-device, namely TrueNAT, that required minimal training, skills, infrastructures and bio-safety measures.
High throughput testing facilities with Cobas 6800 and 8800 have given a fillip to these efforts and rapid antigen testing in certain specific context has also been initiated. These platforms have accelerated testing rates across the country, particularly in remote areas. Starting with one Covid specific diagnostic lab at ICMR-NIV in Pune in January 2020, there are now almost 2,500 such diagnostic labs.
Labs were set up in remote and inaccessible areas from Leh and Ladakh to Andaman and Nicobar islands. Mobile RT-PCR diagnostic laboratory was developed, which helps in facilitating testing at the source and enables localised containment of the coronavirus. Mobile labs have been particularly effective in Covid hotspots as they can be deployed quickly, and clusters of people can be tested at once. Central and regional depots were set up to ensure uninterrupted supply of kits and reagents to these labs 24x7. Various indigenous kits were tested and validated to handhold domestic players towards Atmanirbharbharat (self-reliant India).
Tracking and tracing were two important aspects of India’s Covid containment plan. ICMR has since conducted three national serological surveys to detect the prevalence of SARS-CoV-2. Community-based survey was conducted in 700 villages and wards, which were selected from 70 districts in 21 States. The survey enrolled 400 adults per district from 10 clusters. Serum samples were tested for Immunoglobulin G (IgG), a type of a long-lasting antibody, using the Covid-19 Kavach ELISA detection kit developed by ICMR.
Based on the results, researchers highlighted the need to continue to implement the context-specific containment measures including the testing of all symptomatic individuals, isolating positive cases and tracing high-risk contacts to slow transmission and to prevent the overburdening of the health system. These findings helped to plan and revise testing strategies and recommend the same to States, so that they can focus on limiting Covid cases in specific areas of their respective States.
Apart from being a very infectious virus, the fatality rate of Covid globally was recognised to be very high. It was therefore necessary to establish an effective patient management strategy and ICMR established a National Task Force towards this goal. Moreover, a National Clinical Registry for Covid was also initiated by ICMR as there was a pressing need for collection of real time systematic data on clinical signs and symptoms, laboratory investigations, management practices followed, clinical course of Covid-19 disease, disease spectrum and outcomes of patients. Such data served as an invaluable tool for formulating strategies, predicting disease severity, patient outcomes and in formulation of guidelines and policy-making.
The scientists of ICMR conducted extensive research to find effective treatment and management of Covid cases. In India and around the world, plasma therapy was deemed as a potential weapon in the fight against the pandemic. However, its usage and effectiveness as a treatment for Covid patients was debated because of lack of any clinical evidence. ICMR carried out a multi-centre randomised controlled trial and based on its results, it was concluded that convalescent plasma played no significant role in preventing deaths or progression to severe Covid disease.
This study helped in guiding the future protocol for treatment of Covid cases. An advisory was also released, which cautioned that indiscriminate use of convalescent plasma therapy in treatment of Covid patients should be avoided. Apart from this, ICMR also participated in the World Health Organization solidarity therapeutics trials, which was the world’s largest global randomised controlled trial in a pandemic situation and provided conclusive evidence on the effectiveness of re-purposed drugs for Covid.
The ICMR has been constantly monitoring the development in other countries and when the case of UK variant was reported, India was the first country to scientifically respond through research. ICMR-NIV, Pune successfully isolated and cultured the UK variant of SARS-CoV-2 from the clinical specimens collected from UK-returnees.
The development of an indigenous vaccine (Covaxin) by ICMR in collaboration with the Bharat Biotech International Ltd, pre-clinical animal studies and overseeing human clinical trials of two vaccines (Covaxin and Covishield) are the final testimony of how ICMR kept its promise to serve the nation amidst all odds and in the time of a pandemic.
The writer is Director-General, ICMR