Bangladesh’s capacity is far cry from mass testing

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It is imperative to increase capacity significantly to avoid dire consequences for the population, say public health experts

Concerns continue to grow over Bangladesh’s limited coronavirus testing capacity, with experts urging the government to focus on increasing daily tests to ensure a successful fight against the pandemic.

With a population of over 160 million, the country has one of the lowest number of tests in Asia with just 240 per one million people, according to data compiled by Worldometer.

On April 16, the Directorate General of Health Services (DGHS) said that the whole country is at risk of infection as patients were detected in most of the 64 districts.

With the recent surge in cases and deaths, public health experts say it is imperative for Bangladesh to increase its testing capacity significantly to avoid dire consequences for the population.

According to official figures, a total of 43,133 people have been tested by Friday since the first cases were reported on March 8.

“We are now testing 4,000 samples per day, which we will gradually take to 10,000,” said DGHS Additional Director General Nasima Sultana.

However, DGHS data shows the country was testing less than 3,000 samples daily until April 20, which, however, now stands at some 3,300 samples.

There are 19 laboratories in Bangladesh, including 10 in capital Dhaka, which can carry out coronavirus tests.

The Dhaka Division, which accounts for 85% of the total infected people, is testing samples with only 11 Real Time PCR (RT-PCR) machines in three state-owned labs. Four other hospitals in capital Dhaka are testing samples with some five machines.

Three more private sector facilities are testing with their 11 machines.

There are only 16 RT-PCR machines across the country, with the labs overburdened with pending samples.

Despite plans to test 10,000 samples daily, the health authorities seemed to be unsure when they can make it happen.

“There is a shortage of RT-PCR machines in the world market. We also need time to set up labs ensuring the biosafety standards too. It’s actually not possible to say when it can be done,” says DGHS Additional Director General Sultana.

Fewer testing machines, scarcity of equipment

State-run facilities across the country are now using 26 RT-PCR machines to conduct tests.

Each of these machines are capable of testing 94 samples and it takes some 7 to 10 hours to get back the results of a batch.

Many of these machines are used to test more than a batch of samples every day.

Microbiologist Samir Kumar Saha, who is the executive director of Child Health Research Foundation (CHRF), explained the whole process.

Specimens need to be sorted in tubes according to where it came from, he said before adding: “We have to neutralize, meaning deactivate the virus so that they die, and later on we add reagent to that specimen,”

According to Saha, the RT-PCR machine detects how the specific gene (SARS coronavirus specific gene) of RNA is multiplying or growing.

“More RNA means more virus in the body,” he said.

But it’s not only the machines for testing, there’s a shortage of VTM (viral transport media) tubes and other kits for collecting samples.

Doctors across Bangladesh are now having to make the tough call on a daily basis to choose patients for testing.

“This is a huge problem. We can’t just test every suspected case as we have only 30 VTM tubes for some 300,000 people here,” says SM Milon Mahmud at the Bera Upazila Health Complex in Pabna before adding that they have to wait for about three days for the results.

A doctor at state-run hospital in Sherpur said they send two samples for testing every day.

“We need to get a clearance from the hospital chief in case we come across a patient, who is highly suspected to be a virus case,” said the doctor asking not to be named.

Backlog in labs

Districts in the north-western, southern and south-western regions are having less tests than other parts of the country.

Outside Dhaka, 11 labs are conducting test with 12 machines and turnaround of tests are getting longer as due to backlogs.

The lab at Sylhet MAG Osmani Medical College has not been able to test all the samples coming in a day.

“Out of 188 samples, we tested 134 samples on Wednesday, the highest so far,” said its Vice-Principal Shishir Ranjan Chakraborty.

The Mymensingh Medical College’s lab is finding a hard time with its lone testing machine as it has been receiving some 400 to 500 samples every day.

“We barely manage to test some 188 samples while the rest are sent to Dhaka,” said Principal Chittaranjan Debnath.

He said they were in talks with the Bangladesh Agricultural University for using one of their machines.

The scenario is more or less the same in several testing facilities across Bangladesh.

But the backlogs in labs for testing samples of districts in Dhaka Division seems to be very high as no results came back in two days.

Narayangaj, Gazipur, Narsingdi, and Kishoregonj account for 27.32% of the 4,186 infected people as of April 23.

However, test results of no samples from Gazipur, Narsingdi, and Kishoregonj came back in two days.

“We received no test results on April 20 and 21,” said Kishoreganj Civil Surgeon Mujibur Rahman. He said on an average 120 samples are being sent to labs every day.

Gazipur Civil Surgeon Khair Uz Zaman echoed. “We collect some 150 to 190 samples every day,” he said. Narsingdhi also did not get back test results on April 19 and 20.

Only three dedicated state-run labs for Dhaka division

With the 85.36% of total infected people from the capital and districts of the Dhaka division, samples are tested at 11 machines in three state-run labs — IEDCR, National Polio, Measles and Rubella Laboratory at the Institute of Public Health (NPML-IPH), and National Institute of Laboratory Medicine and Referral Centre (NILMRC).

However, the labs at Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka Medical College and Hospital (DMCH), Armed Forces Institute of Pathology (AFIP) at Bangladesh University of Professionals (BUP), and Mugda Medical College only test samples of its patients.

Meanwhile, non-government entities, the Child Health Research Foundation (CHRF), International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), and the institute for developing Science and Health initiatives, ideSHi are assisting the government with testing samples at their labs.

The icddr,b lab has seven machines and it tested 156   samples on April 22, according to IEDCR statistics.

The Child Health Research Foundation (CHRF) has two machines, said its Executive Director Samir Kumar Saha.

“We have about 400 samples from Comilla, Chandpur and Brahmanbaria. Sometimes, we have a backlog,” he said adding they have plans to add another machine and deploy more staff members.

The institute for developing Science and Health initiatives, ideSHi, has two machines for sample testing.

“We test 150 to 180 samples per day,” said its Chairperson Firdausi Qadri, before adding: “We can test 400 samples a day, but we focus on quality.”

Not enough medical technologists

After the coronavirus pandemic unfolded in Bangladesh, the health authorities scrambled to set up testing and sample collecting facilities when it resorted to train medical technologists through short videoconference sessions.

There is only one medical technologist against four doctors in Bangladesh whereas the World Health Organization suggests five against one doctor.

No technologists were appointed in the state-run hospitals in the last 11 years. In 2018, the DGHS reported that the posts of 2,736 technologists out of the total 7,920 in medical college hospitals were vacant.

Md Abdul Motaleb is one of five medical technologists working in the entire Sherpur district.

“We have been trained for regular pathological tests until the videoconference, which showed us how to collect samples [from suspected Covid-19 patients],” he said.

According to public health experts, even those working as technologists at labs are not properly trained, which they say contributed to the lower number of cases in Bangladesh compared to other countries.

Field-level health workers’ infection raises concern

Bangladesh’s rural medical care facilities are majorly operated by a large network of health workers, who in recent times are being diagnosed with Covid-19.

As much as 40 percent of the total cases in Kishoreganj were health workers, according to Civil Surgeon Mujibur Rahman.

“We have fewer health workers than we need and now they are being infected from the community they work with,” he said.

Narsingdi health department reported that 44 of its staff members, including five doctors, were tested positive, leaving no one to collect samples from suspected patients.

Sherpur Civil Surgeon Abul Kashem Mohammad Anwarur Rauf said half of the 24 cases in the district were health workers, including himself and two doctors.

‘More time needed’ for more labs

In the wake of cases rising by the thousand every two days, the Directorate General of Health Services (DGHS) says it “needs time” to increase testing capacity.

“It’s not easy to import testing machines. Moreover, we need to maintain biosafety standards to set up new labs,” said its Additional Director Sultana.

Biosafety includes methods that are used to stop a biohazard, something such as a disease or chemical that may harm people, animals, or the environment, from spreading out of a place or from causing harm.

Asked about different results of the same sample, DGHS official Sultana hinted that it was natural.

“That’s why there is the system of repeated tests. The work is manual. Those tested negative are not out of risk as they can come in to contact of a positive case anytime. That’s why we are asking everyone to stay indoors and maintain social distancing measures.”  

Dismissing any shortage of test kits at rural areas, she said, “We have more than 100,000 kits in stock. But importing more depends on the international market. We are now focusing on manufacturing swabs locally, but the raw materials need to be imported and it will take time.”