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Wednesday, September 23, 2020

Explained: Why TrueNat testing for NRIs has become a matter of political prestige in Punjab

A chip-based test for coronavirus, the TrueNat testing involves three steps: elution (RNA extraction), screening and confirmatory test. How well-equipped is Punjab for these tests?

Written by Divya Goyal , Edited by Explained Desk | Ludhiana | Updated: August 20, 2020 9:22:39 am
punjab news, TrueNat test, what is Truenat test, TrueNat testing for NRIs, covid testing in punjab, indian expressDrive through Covid-19 testing in Chandigarh on June 16, 2020. TrueNat tests require nasal or throat swabs. (Express Photo: Kamleshwar Singh)

Last week, the doctors at Moga Civil Hospital went on a strike alleging that the local Congress MLA Dr Harjot Kamal got TrueNat testing done for at least 75 NRIs “using political influence” and when the woman doctor on duty refused to do more tests, he got her transferred. What followed was a letter by the additional chief secretary (health) directing that the NRIs should not be given the facility of free TrueNat testing. Withdrawing the officer’s orders four days later, the state health minister issued another letter stating that NRIs will be tested for free on TrueNat.

What is TrueNat testing? How well-equipped is Punjab for these tests?

A chip-based test for coronavirus, the TrueNat testing involves three steps: elution (RNA extraction), screening and confirmatory test. According to Dr Rajesh Bhaskar, Punjab’s nodal officer for Covid-19, “RNA extraction takes 20-25 minutes in TrueNat testing. If the result is ‘negative’ after first screening, one sample can be tested in just one hour but if it is positive, then a confirmatory test has to be done, which can take upto two hours. But even then, it is much faster than RT-PCR. Hence, we recommend TrueNat only for emergency cases such as Severe Acute Respiratory Infections (SARI) patients, pregnant women, pre-surgery cases etc.”

Currently, there are two types of TrueNat machines being used in Punjab: Two-channel and Four-channel. “There are 30 machines in Punjab of which 15 (two-channel) were received from the Government of India and rest were purchased by the state government,” says Dr Bhaskar.

The state government purchased the machines for Rs 4.5 to 5 lakh each while each chip used for testing costs Rs 1,200.

Currently, TrueNat testing is being done free of cost for needy/emergency patients at all government facilities in Punjab. While bigger districts have four-channel and more than one machine, small districts have two-channel ones. Moga, from where the controversy erupted, has one machine (two-channel), confirmed Dr Amanpreet Kaur Bajwa, civil surgeon.

Before the Indian Council of Medical Research (ICMR) approved TrueNat machines for coronavirus testing, they were being used for tuberculosis testing. They are very handy and can also be taken to the field, if required.

How many samples can be tested on TrueNat machines?

While Dr Bhaskar refused to comment on the ‘testing capacity’ of TrueNat machines, a senior official from Punjab health department, said, “In one shift of 6-8 hours, 30-35 samples can be tested in 4-channel machines and 15-20 samples in 2-channel machines.”

However, the doctors in the field contradict this claim. A pathologist from Ludhiana district where a 4-channel machine is operational, said, “The first step of elution takes 25-30 minutes. Then screening (e-gene), which identifies if the sample is positive or negative, takes 40-50 minutes. If it is positive, then it is put for confirmatory testing for SARS-CoV-2 (coronavirus) which can take upto an hour again. Including the time that goes into chip preparation, we are able to test maximum eight samples in 6-8 hours (single shift),” he said. Moga civil surgeon Dr Bjawa said that “18-20 samples a day are being tested on TrueNat in the district.”

Also in Explained | How useful are saliva tests for Covid-19?

How the issue of TrueNat testing for NRIs took a political turn?

On August 13, the doctors at Moga Civil Hospital went on a protest alleging that Moga MLA Dr Harjot Kamal ‘misbehaved’ with a woman doctor who was on TrueNat testing duty and ‘humiliated’ her after she refused to do more tests of “legislator’s own people who were going abroad and needed quick reports before flight”.

Dr Gagandeep Singh who was leading the protest, said that according to the orders of the state health department, TrueNat testing has to be done only for ‘local and emergency cases’ and ‘needy patients’, not for those going abroad or NRIs.’

The doctors alleged that the MLA got at least 75 tests done, due to which the machine also gave up and broke down.

“On August 2, MLA’s office sent a list of 35 persons — all NRIs and their kin — to get them tested on on TrueNat. All those tests were done but the machine broke down. For the next four days, no tests could be done. After the machine was repaired, MLA sent 40 more people on August 11. The doctor on duty requested that so many samples cannot be tested on the TrueNat at once but he did not listen and started humiliating her,” said Dr Gagandeep. The doctor was later transferred.

Meanwhile, the MLA in his defense said, “There are several family members of NRIs who came to Punjab before lockdown and got stuck here. Now when they are expected to go back, it is necessary for them to get tested 72 hours before their flight. So what is wrong in helping them.” he said the doctor’s transfer was routine matter.

Moga civil surgeon Dr Bajwa said, “We are not sure if the machine had stopped working because of too much testing but yes it had broken down and we got it repaired.”

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How the matter turned into a tug of war between health minister and secretary?

On the day the doctors protested in Moga, Anurag Agarwal, additional chief secretary, department of health and family welfare, issued orders on usage of TrueNat machine for testing, stating that NRIs should not be tested on them. ‘TrueNat machines must be used only for testing emergency cases… should not be used for testing general public including NRIs who should be encouraged to get tested either at the Flu corners or by private testing centres. People coming for testing as per conditions required by certain countries to have a test report before 72 hours of travel must also be advised to go for private testing or at Flu corners.This is strictly to be adhered without any deviation”.

The officer was transferred, four days later on August 17, to the department of power and new and renewable energy. The same day, Punjab Health Minister Balbir Singh Sidhu, withdrawing the orders issued by Aggarwal, issued a fresh letter stating that NRIs will be tested on TrueNat. Sidhu’s fresh orders, sent to the media by Moga MLA, read, “NRIs form an integral part of Punjab and their role and contribution to the society is of great value. The use of TrueNat machines will be done at the district level as per the requirements of the respective civil surgeons”.

In an accompanying statement, Moga MLA took the the credit for health minister’s order. “Saadi mehnat leyaai rang (Our hard work has bore fruit),” he said. In a fresh statement on Wednesday, he ‘thanked’ Chief Minister Amarinder Singh for “allowing TrueNat testing for NRIs” and said that “Punjabi diaspora from across world is sending him congratulatory messages” for this decision by Congress government.

What is the current criteria for TrueNat testing?

Moga civil surgeon Dr Bajwa says, “We have received fresh orders by the minister via WhatsApp, not officially. We are giving preference to needy/emergency cases for TrueNat testing. We will accommodate NRIs as per situation.”

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