Not all heroes take the center stage; some work in the background, in a lab
The crucial work of processing hundreds of samples every day has been essential in saving lives, and the provision of new, additional RT-PCR machines had strengthened these efforts.
PATNA, DIBRUGARH- The enemy was powerful, and while the soldiers had valour within, they were in uncharted waters. Sounds like the plot of a fiction film? This is how the technicians at AIIMS, Patna (Bihar) and ICMR-RMRC, Dibrugarh (Assam), felt during the first wave of the COVID-19 pandemic.
The teams had dual challenges: they worked on such samples for the first time, and the numbers swelled daily. UNICEF came forward with a new RT-PCR machine amidst the crisis that made their work faster and boosted the team morale.
Facing an unfamiliar threat
In the Regional Level Virus Research and Diagnostic Laboratory (VRDL) of All India Institute of Medical Sciences (AIIMS), Patna, Principal Investigator Dr Binod Kumar Pati recalled receiving 300-400 daily samples when the first wave of the pandemic hit.
“These samples came from four to five districts, and our team of 10-12 lab technicians and researchers processed them,” he said, “We were worn out by the end of the day. I started at 7 a.m. and left after midnight. Everyone was working very hard; we knew testing was critical; without testing, we couldn’t detect the virus nor fight the pandemic.”
At that point, two RT-PCR machines were functioning in the lab. There were also three conventional machines with longer processing times. Per the protocol, samples were first labelled and put through a process called Lysis, whereby the virus is killed. Next, the piece goes through the RNA extraction machine. Then RNA sample is placed in the RT-PCR machine for C-19 virus detection.
Suddenly there was a spike in the number of samples received. It was the beginning of the second wave when on average, 4000 samples were obtained daily. “One RT-PCR machine can be used for eight-nine batches of samples daily. One batch had 96 samples, which added up to approximately 800-900 samples. Beyond this posed a risk of wear and tear. We feared that machine could be to break down from the overload,” Dr Pati said.
Nearly 1300 kilometres away, the lab technicians’ and researchers’ team in the Indian Council of Medical Research (ICMR)- Regional Medical Research Centre (RMRC) in Dibrugarh, Assam, testing samples for COVID-19 virus faced a similar challenge.
“The team experienced immense stress during the first wave in 2020,” said Dr Chandrakanta Bhattacharjee, research scientist (non-medical) in the ICMR-RMRC, Northeast, Dibrugarh centre. No private lab was processing samples to test for the COVID-19 virus then. “We also received from the other northeastern states, i.e., Mizoram, Meghalaya and Arunachal Pradesh, in addition to Assam. It was the first time the technicians were testing such samples, and we were testing more than 2500 samples daily. Hence the workload was difficult to manage. ”
The ICMR-RMRC, Dibrugarh centre had three RT-PCR machines at the time, and they would use each device four times a day.
In both places, the increasing workload and overworking of the RT-PCR machines overwhelmed the teams. In ICMR-RMRC Dibrugarh, the team worked day and night, in double shifts, for almost three months.
“During the second peak wave, we spent our nights in the lab, working non-stop. We left at 3 am and returned to the lab by 10 am the following morning,” Dr Bhattacharjee said, “Once during this, I contracted conjunctivitis. I continued to work with itching eyes to complete our work and generate reports within the time.”
Then, reinforcements came in.
Galvanising efforts
In March 2020, during the first pandemic wave, UNICEF sent a new RT-PCR machine to ICMR-RMRC, Dibrugarh. This helped the team test more samples and in increasing efficacy. Then a second machine arrived from UNICEF and further expedited their work.
Similarly, in AIIMS Patna, three new RT-PCR machines from UNICEF in 2021, just in the wake of the second wave in April 2021, helped the team dispense their work faster. Prashant Kumar, the technical assistant at VRDL, AIIMS, Patna, said that more RT-PCR machines, notably when the number of samples soared to 6500 per day during the second wave, proved extremely helpful.
“Before we gave test reports after 24 hours. There was a time when their work shift was extended to 8-72 gruelling hours. The new machines enabled us to reduce the time and give reports in the same day,” Prashant said. Admittedly, he tested positive himself during the second wave and returned to work after a week’s home isolation.
Pumping up confidence
For Dr. Pati, the availability of the new RT-PCR machines ushered in an immediate boost in the team’s morale. “We stopped working in fear (of machine breakdown), and the technicians’ felt confident. We started using the machines for an average of five batches a day, or 500 samples,” he said, “Until now, we have tested more than 1.4 million samples on the RT-PCR machines.” As of June 2022, 70-80 samples were tested daily on these machines at the centre.
In total, UNICEF provided 690 RT-PCR machines and 100 RNA-extraction machines — including one to AIIMS, Patna—across India, strengthening the COVID-19 response.
Going beyond COVID-19
Its impact, however, has gone beyond COVID-19.
RT-PCR is a specific laboratory technique primarily used to measure the amount of particular RNA. Therefore, these multifunctional machines work more comprehensively than testing COVID-19 samples.
“For example, we can use it for serotyping dengue. This can also help us detect the Chikungunya virus, even Encephalitis,” Dr Pati said.
Dr Bhattacharjee added that since ICMR-RMRC is a research centre, samples of other respiratory disease viruses like influenza A and B are also processed in the RT-PCR machines.
The pandemic has slowed down, but the well-equipped, more experienced teams in VRDL, AIIMS, Patna and at ICMR-RMRC, Dibrugarh are better prepared for any eventuality — should it await us in the future.
