India’s fight against COVID-19 has now reached a critical phase. We have gone through three successive lockdowns of decreasing intensity and now are well into the unlocking phase. Prime Minister (PM) Narendra Modi’s vision has expanded from “preventing loss of life” to “saving lives and protecting livelihoods”. Despite this, there is a certain amount of fatigue among people who have seen their lives and livelihoods put on hold. The daily news and updates on COVID-19 have left the public exhausted even as the number of recoveries has exceeded the number of active cases across the country.
On April 6, the PM warned that India’s battle against COVID-19 would be a long one and that the nation would have to come together in a tireless effort to emerge victorious. Even in the first 10 days of the lockdown, the PM was well aware of the scale of pandemic and economic cost to the nation. India’s early recognition of the seriousness of the pandemic allowed the government to prepare the health care infrastructure to deal with the rising number of cases. Therefore, it was imperative for the Indian Council of Medical Research (ICMR) to step up and build the foundation, protocol and infrastructure to test, track and treat cases.
Countries across the world have had their methods of responding to the pandemic with varying degrees of success. However, the mantra of test, test, test has been a common denominator for all who have flattened the curve. ICMR too has worked towards this and steadily ramped up the country’s testing capacities to meet the requirements of its huge population. The rapid progress in ramping up testing capacities has been in sync with the vision of “saving lives and protecting livelihoods”.
We are now testing more than 200,000 samples every day since we validated in excess of 1,000 laboratories covering every district. Just over a month ago, India’s daily testing capacity was 100,000 in 555 laboratories.
In order to have inclusive and equitable access to testing, the strategy underwent iterative calibration to keep pace with the changing epidemiology and extent of infection. Keeping in mind the thousands of economic migrants returning to rural areas, ICMR worked with state governments to build more testing laboratories along with framing a strategy to monitor, investigate and treat new cases. While several union ministries developed an economic stimulus and an unlocking plan to prevent the loss of livelihoods in the quest for an Atmanirbhar Bharat (making India a self-reliant state, ICMR was ensuring that the expertise, materials, staff and capacity to carry out testing safely, successfully and reliably were being put in place.
ICMR’s COVID-19 programme has proved to be a flag-bearer of Atmanirbhar Bharat as the government has worked in close coordination with the domestic healthcare industry to make India self-sufficient in testing. Because of the nationwide lockdown, industries have faced severe operational challenges related to the movement of human resources and procurement of material and machinery. A task force was set up principally to deal with these challenges and help the industry to accelerate production. A case in point is the development of swabs for COVID-19, which was initiated within six days locally. Three companies can now manufacture up to 200,000 swabs per day. Despite the lockdown, the production of viral transport medium (VTM) kits was increased from 500,000 units per year to 500,000 units per day. After expedited approval from the Central Drug Standard Control Organisation, a private company has developed 10 million polymerase chain reaction (PCR) tests and 5 million viral extraction kits.
In order to ensure that the supplies reached every laboratory in time, the services of the ministry of civil aviation and their airline partners in the government and private sector under “Mission Lifeline Udan” were called upon. They carried ICMR consignments of diagnostic material across the country. In the last two months, approximately 40 tonnes of testing material were transported in more than 150 flight operations, reaching out to the remotest corners. Doorstep deliveries were coordinated with several courier companies and state governments. As the lab network expanded, India Post, which has countrywide operations, was roped in. To cut down transit times, logistical complications and risks of stocks running out, decentralised storage of these supplies has been carried out by building a network of 16 storage depots in a phased manner.
Along with the internationally accepted reverse transcription (RT)-PCR test kits, ICMR has also encouraged the use of indigenously developed TrueNAT and CBNAAT testing protocols, which are more cost-effective and can be more easily used in rural areas where migrants are returning.
These efforts by ICMR, in collaboration with various state and central government ministries, have facilitated the construction of testing laboratories even in the remotest parts of the country, from Ladakh in the north to all the seven states of the Northeast, as well as the Andaman and Nicobar Islands and Lakshadweep Islands down south.
The construction of 1,000 laboratories capable of conducting 200,000 tests per day within three months has also ensured that the economic activity associated with the construction, procurement and staff for these has built an ecosystem that protects and provides livelihoods.
More important, the scientific- and data-driven inputs from the country’s leading epidemiologists and scientists at ICMR have been also been instrumental in formulating the protocols for Unlock 1.0 to restart the economic engine. While our soldiers are securing the territorial integrity of the nation at the China-India border, the warriors at ICMR are saving the lives and protecting the livelihoods of those living in this territory.
Dr Balram Bhargava is director-general, Indian Council of Medical Research.
The views expressed are personal. HINDUSTAN TIMES