COVID-19 Testing: Why Private Labs in India Are Struggling

COVID-19 Testing: Why Private Labs in India Are Struggling

Experts around the world seem to have an unequivocal word of advice for containing the COVID-19 pandemic: Tests, tests and more tests.

In India, as a move to expand testing, the government allowed private players to test for COVID-19. As on 2 April, over 50 private labs have been approved to test for the disease caused by the novel coronavirus.

The Indian Council of Medical Research (ICMR) has laid down guidelines for the concerned private labs - which can only offer tests when the enlisted criteria are met.

While involving the private labs has been a welcome step, the roadblocks are far from over. From a shortage of supply kits to the lockdown obstructing movement, private labs are struggling to keep up with the testing requests.

FIT spoke to some leading private labs from around the country to understand how prepared they are, where they are struggling and what challenges they continue to face: Dr Dangs Lab in Delhi, SRL Diagnostics in Mumbai, Neuberg Diagnostics in Ahmedabad (Neuberg Supratech), Bengaluru (Neuberg Anand), Chennai (Neuberg Ehrlich) and Pune (Neuberg AG) and Vijaya Labs in Hyderabad.

Shortage of Test Kits & PPEs

Private labs need to buy the testing kits from diagnostic firms that are either certified by the US FDA, the European CE (after due intimation to the DCGI and the health ministry), or by any of the four designated evaluation centres in India. The details of the internationally approved companies are not yet available in the public domain. The only publicly known options are the five manufacturers (as on 2 April) who have been approved by the NIV to supply the kits to these labs.

Most private labs, however, are scared that they may run out of the testing kits and supplies.

Dr Arjun Dang, CEO of Dr Dangs Lab: “Only five companies are authorised to supply kits to private labs. It has been fine so far, but a short supply of kits is a major concern. There is also no clarity regarding bulk orders. The availability of kits has been promised, but we are only getting a limited supply daily. We have been conducting many tests every day, and can ramp it up based on the number of kits we get. The shortage of PPEs has also led to a surge in pricing. We have reached out to the government who is helping us and we are hoping for a good response.”

Aishwarya Vasudevan, Group COO of Neuberg Diagnostics: “Right now, our labs are testing around 3000 samples a day. There can definitely be a shortage of kits and PPEs in the future. A major reason for this is the lockdown because it is difficult to get supplies from even within the country. There is a limited number of PPEs available per person, but the people coming in for tests are not limited. It is definitely a pull and push right now. India needs to behave like one unit for us to help each other out right now.”

Arindam Haldar, CEO, SRL Diagnostics: “We have a high number of RT PCR machines installed across our systems. Our immediate capacity is to do about 1000 tests a day which can be significantly scaled up 2 to 3 fold if the need arises. The demand for testing kits and PPEs far outweigh supply at this stage – though I believe the same will get normalized in coming weeks. We are not been able to extend our home collection services effectively due to shortage in PPE.”

Dr. A. Velumani, Managing Director at Thyrocare, another private lab approved by ICMR, tweeted on 31 March, “Absolute paucity of PCR #COVID kits. Scarcity for PPE too. Daily Limited quantities rationed. All do not get daily.”

Also Read: What Does It Take to Get a COVID-19 Test Kit Approved in India?  

Miscommunication & Lack of Clarity

The labs are also struggling to keep up with the state and central guidelines, that often go in different directions. For instance, even though ICMR has approved certain private labs in the state to carry out testing, Telangana Chief Minister K Chandrashekar Rao has not yet given the nod for private players to enter the field.

Srinivas T, Sr. Manager Operations at Vijaya Diagnostic Centre in Hyderabad told FIT, “We are good to go but we are waiting for the state government to allow us to start operating. For now, our CM believes the government has enough labs and equipment to manage testing. If the need arises, we will be involved. But from our end, everything is ready.”

Mr. Pradeep Dogra, General Manager Marketing from Vijaya also added,

Mr. Pradeep Dogra“We have a stock for a week or so, not for bulk. In the beginning, it was a challenge to get supplies. Transportation was a big concern because of the lockdown. But things have been improving in the past week. For now, we are only waiting for permission to start.”

While Telangana is yet to allow private labs to test, states such as Karnataka, Gujarat and Tamil Nadu are not allowing home collection of samples, even though it is recommended by the ICMR. Vasudevan from Neuberg confirms this by telling us that the company is not collecting home samples in Ahmedabad and Chennai, as per the government rules.

She adds, “In general, there is a lot of panic everywhere, coupled with a lack of clarity on who needs to be tested and who doesn't, because the rules and guidelines have been changing constantly. There is also some miscommunication between the central and state government. We have been told to put our operations on hold in a few cities.”

Also Read: ICMR Recommends Rapid Antibody Test for Coronavirus Hotspots

How Has the Lockdown Impacted Operations?

With the lockdown in place, these private labs are facing hurdles in terms of movement of their employees, transportation of equipment and goods, and a disrupted supply chain.

Dr Dang says, “The curfew and the lockdown is the best move for the country and we really appreciate it. But it has made things difficult for people like us. My employees have been stopped on state borders, even though I have managed to procure a few passes. Our supply chain has been disrupted, PPEs are taking longer to reach us. Logistics has become a major issue.”

Vasudevan speaks about the need to keep her employees motivated, considering that they are all working in such uncertain times. They don’t have the option to stay home, and when their daily work is interrupted, it becomes challenging to keep their spirits up. “I am being stopped at various points despite having branded my cars and bikes. The same has been happening with my employees. When all this happens, the amount of motivation tends to fizzle out among the workers. Replacing their fear with motivation is something we are constantly doing.”

Aishwarya Vasudevan“Courier services have been shut. Even getting stuff transported from Mumbai to Pune has become difficult. This is not just impacting our testing for COVID-19, but also people with other chronic diseases who need their supplies and tests on time. If these logistics can be sorted out with help from the government, our work can be made a lot smoother.”

Arindam Haldar, CEO, SRL Diagnostics shares a similar experience when he says that even though the intent of the senior leadership was clear regarding these services to not get interrupted, at the ground level, things haven’t necessarily been the same. “It is getting better every day. But with the severe restriction on public transportation, it is difficult to sustain a normal operation even for an essential service like our labs. I think the first day we faced the biggest problem, where many of our riders, who carry our samples from one location to another, were stopped and they had to convince and cajole the local police people to let them pass and we had to intervene in many places.”

Arindam Haldar“At some places. we had organized buses for people at our labs, especially in these two labs so that they reach on time. On the first day, many of those buses in Mumbai were stopped, however when we reached out to the commissioner’s office in Mumbai they were incredibly helpful.

“Likewise, the Govt has been supportive, but the teething trouble at the ground level will always be there. I believe it is getting better and better and hopefully, things will get sorted out in the next few days,” he adds.

Also Read: You Can Visit these Private Labs in 11 States for COVID-19 Tests

The Question of Expenses: The Test is Capped at Rs 4500

When enquired about the price cap of Rs 4500 that ICMR has mandated, the private lab representatives tell me that for them, it is a non-profit initiative considering the many overhead expenses they incur.

Haldar says, “As you understand, the government has controlled the upper cap on this test price, and the current price barely covers the cost of procuring samples, transporting and running RT PCR assays, and further transporting all positive samples to the designated nodal centres of government. Besides, the government has made sure various options are available to people. There are more than 124 labs of the government, where tests are done for free and then they are paying people who can come at the private labs as well. We are conducting a confirmatory test at a government-defined price of Rs 4500 and not making any profit on this price.”

Dr Dang adds that in order to maintain the integrity of the samples and carry the PPE kits, the lab is only doing home collections in cars and not on bikes, with mini coolers installed in the vehicles.

Dr Arjun Dang“There are a lot of extra investments that go into the test, making it an expensive one for us. It is a non-profit initiative by the private labs.”

Neuberg Diagnostics, in fact, is offering the tests for free in Karnataka and has set up a social support fund for the poor in all their cities of operation. “If you walk in with a BPL card, the entire test is done free of cost”, Vasudevan tells FIT.

But none of this has been easy, she says. “Revenue across the country has dropped, and that stands true for healthcare as well. People are not coming in for other tests with the lockdown in place.”

Is the Test Price Proving to Be Prohibitive for People?

These private labs have constantly reiterated that the number of testing requests that they have been receiving shows that for those who can afford, the test price is not a deterrent. For confidentiality reasons and as per the ICMR directives, they don’t give me an exact number.

Haldar says, “We have received thousands of calls on our Toll-free helpline number (1800-222 -000) and so far we do not have any reason to believe that price of the test is acting as a bottleneck or deterrent for COVID 19 testing.”

However, there are other factors that can be prohibitive for people to get the tests done. Dr Dang shares, “We have been receiving a large number of requests, but once the people find out they need a prescription and a government ID, they just drop out.”

Arindam Haldar lists down the current deterrents of COVID-19 based on SRL’s experience:

• The inability of labs to scale up due to shortage of PPE and kits
• Social stigma around tests – the inherent reluctance of people to come forward and do the tests.
• The additional hurdle of testing criteria, which requires possible carriers to demonstrate/satisfy certain criteria to an authorized physician before getting a prescription and then book an appointment
• Reluctance to call for home collection due to the possibility of being temporarily ostracized in the neighbourhood/community
• Lockdown restriction on movement across the country

If India aims to ramp up its testing, a combined effort between the private and government organisations and a smoother manufacturing process will have to be pushed for. Activists are calling for government intervention to make testing free in private labs, but that is only possible if a reimbursement mechanism is put in place.

Malini Aisola, the co-convener of the All India Drug Action Network (AIDAN) tells FIT, “Testing needs to be free in the private labs as well. The government needs to take charge. It should step in and set up a mechanism for procuring commercial kits & provide them to private labs, along with capping fees for testing that may be reimbursed by the Government.”