A Look Back at 2 Years of COVID-19 Testing

In March 2020, Suburban Diagnostics was one of the first private labs to be approved by ICMR for COVID-19 testing. Since then, we have been at the forefront of the war against the virus. We have tested more than 2.5 MILLION COVID-19 samples and gained invaluable experience in all 3 modalities of COVID-19 testing viz RT-PCR, antibody and antigen testing; all the while maintaining the highest of standards.

Meeting The Initial Challenges:

In the beginning, we faced a number of challenges that we overcame satisfactorily by taking a number of proactive measures some of which are listed below:

• Training a sufficient number of staff to be able to handle the collection of an ever-increasing number of COVID-19 samples while also minimizing the chances of false-negative results due to inadequate sampling.
• Enhance the testing capability of the lab by recruiting and training more technologists in a short time span.
• Sourcing a substantial quantity of high-quality collection kits.
• Upscaling of our logistics network and its efficiency to ensure timely transport of samples from additional geographies by adding more manpower, training the team and increasing the number of logistics rounds. This allowed us to maintain a rapid turn-around time for every COVID-19 report.
• Ensuring a continuous supply of PCR kits, reagents and consumables required for testing.

Compounding these difficulties was a strict lockdown imposed by the authorities between 24th March 2020 and 31st May 2020 that severely restricted normal activities, but we not only increased our COVID-19 testing capacity but also maintained an uninterrupted service throughout.

We went from strength to strength, gradually increasing our testing capacity from a mere 150 samples per day in March of 2020 to 10,000 samples per day by the beginning of 2021 with 24/7 processing.

Measures To Counter Worsening COVID-19 Pandemic Scenario - Geographic Expansion Of Our Footprints:

As the COVID-19 situation worsened, we adapted to the situation and started the first drive-through COVID-19 collection centre in Mumbai. In order to maintain social distancing and protect healthcare workers, the drive-through collection point enabled the collection of samples while patients were ensconced in the safety of their vehicles.

In August of 2020, we established a satellite molecular laboratory in Pune to cater to the high testing load of patients in Pune and surrounding areas.

As travel resumed slowly, Suburban Diagnostics was there again to assist passengers by being one of the first to set up kiosks and provide rapid RT-PCR reports at the Mumbai International Airport. When COVID-19 negative reports became prerequisites for travel, we were among the first to issue reports with QR codes for authentication of reports.

Ensuring The Highest Quality Of Reports:

From the beginning, we have strived for maximum quality and accuracy in our reports:

• We have used only the highest quality RT-PCR kits – all of which are ICMR approved and which have passed a thorough in-house validation process.
• We use high-throughput, high-quality PCR platforms which undergo periodic maintenance to ensure maximum processing capacity.
• Viral RNA extraction is automated to guarantee consistency with every batch. Quality checks are instituted with every batch to prevent cross-contamination; samples are reprocessed if there is an internal control failure or any other indication of an assay related problem.
• A strict maker-checker system is followed for any step that requires manual intervention, so as to minimize human error.
• Every batch of PCR is run with positive and negative controls to ensure 100% accuracy of the report.
• All processing staff are highly trained and periodically re-trained and assessed, as required. They are involved in the continuous improvement of the processes & workflow to ensure efficiency and zero error.
• Inter-laboratory comparisons were performed with government testing centres and we have always received satisfactory concordance scores on each occasion.

Suburban Diagnostics was also one of the first labs to give a Ct value in its RT-PCR reports, which was a widely requested parameter by many physicians.

Research Studies For Better Understanding Of COVID-19 Infection:

As a part of our attempt to understand the behaviour of COVID-19 infection better so that the diagnostic and management strategies could be made more objective, we engaged in the research studies as well:

• One study followed up patients with a known history of COVID-19 infection over the course of a year in order to study the seroconversion, and trend and persistence of antibody response post-infection.
• We also studied the concordance between the rapid antigen test and the RT-PCR test with different Ct values.

7 Lessons We Learned From The Past Two Years:

1. Learn to be flexible and agile:
   It was our ability to adapt to the ever-changing situation that helped us keep our heads above the water and then eventually flourish during the COVID-19 pandemic. Whether it was the sourcing of kits and materials during a national and global logistics shutdown or quick hiring and training new staff to be able to collect samples or process massive numbers of tests, our agility and flexibility put Suburban Diagnostics in a leadership position in the diagnostics industry in Western India.
2. Prepare for the worst: 
   The COVID-19 pandemic and subsequent lockdowns were unprecedented healthcare catastrophes. We quickly learned to plan for and deal with the worst possible scenarios in the organization. And this held us in good stead when the second wave and the omicron crisis hit the country subsequently.
3. Continuous up-gradation of lab infrastructure and accreditations is essential:
   Quality has been a byword at Suburban Diagnostics since the day Dr. Arora opened the first lab in Andheri in 1994. Accreditation of Suburban labs by NABL and CAP is a testimony to the continuous practice of the highest levels of quality standards by these labs. Simultaneously we have been upgrading our platforms, systems and processes. This continued even during the two years of COVID-19 pandemic. 
   When ICMR approved private labs for RT-PCR testing, many labs neither had the necessary infrastructure nor the accreditations required to be able to offer COVID-19 testing. We were in an ideal position and so we were among the 1st four labs in the country to have received permission to perform COVID-19 tests.
4. Digital health ecosystems and home diagnostics are the future:
   Home visits, digital reports, QR code report authentication became invaluable during this pandemic. Prior to the pandemic, home visits were looked upon as a premium service and hard copy reports were preferred. COVID-19 has turned this on its head with home visits and digital reports, telemedicine, etc., fast becoming the norm. Suburban Diagnostics was able to stay relevant because of a strong home visit team and a robust IT infrastructure that was in place even before the pandemic.
5. Never stop innovating:
   Innovative ideas like the drive-through collection points, disease-related diagnostic and monitoring packages, QR codes for report authentication were key differentiators which helped us offer better service to the public.
6. Never make assumptions:
   We have also learned never to make assumptions. Just prior to the second wave, everyone had assumed the worst was over. So the second wave was a shock to the system and tested our ability to cope with a sudden increase in cases. However, we handled this challenge well as we adapted quickly to the rapidly evolving situation drawing on our past experience. We had learned our lesson; so the Omicron wave did not catch us off-guard.
7. Invest in your people and give them the opportunity to grow:
   The biggest contributors to our success in the past 2 years of managing the COVID-19 pandemic are the people who make up Suburban Diagnostics. In the midst of a crisis and especially during the lockdown, most of our employees performed several notches beyond their normal assignments. They stepped forward and took on new roles and responsibilities, learned new skills and stood at the frontlines.

The biggest lesson of all is that the past 2 years have exemplified what the Roman philosopher Seneca said – “Luck is what happens when preparation meets opportunity.”