COVID-19: Use CBNAAT machines in Manipur
Currently, there are 10 CBNAAT machines, two at Intermediate Reference Laboratory (IR), state TB cell and eight others spread across state districts. CBNAAT - diagnostic machines are normally used to test drug-resistant tuberculosis.
With the unprecedented increase in the number of COVID-19 active cases in Manipur, it is time to further enhance the existing facilities and add more teeth to the current preparedness by introducing the use of Cartridge Based Nucleic Acid Amplification Test (CBNAAT) in addition to the existing two TrueNat machines in the state. Currently, there are 10 CBNAAT machines, two at Intermediate Reference Laboratory (IR), state TB cell and eight others spread across state districts. CBNAAT - diagnostic machines are normally used to test drug-resistant tuberculosis.
It has been reported that the use of CBNAAT is part of Indian Council of Medical Research (ICMR)’s larger plan to have options for testing when the pandemic peaks in India. A decision in this regard was taken in the first week of April by an empowered group constituted by the Ministry of Home Affairs for planning and ensuring implementation of COVID-19 response activities. ICMR had apparently issued a detailed guideline for the same on April 19 last.
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Maharashtra and some other states had earlier decided to use CBNAAT for early diagnosis of individuals with severe acute respiratory syndrome coronavirus 2 (Sars-CoV-2), which causes COVID-19. It has been reported that Maharashtra conducts the molecular test —CBNAAT – using the GeneXpert technology to diagnose TB. The CBNAAT detects Mycobacterium tuberculosis, the bacteria which causes TB. However, the customised test for COVID-19 will detect the E gene (found in RNA of coronaviruses) and N2 gene (specific to SARS-CoV2) in the samples.
The CBNAAT machine can test four samples at a time and declare results in 45 minutes. This will indeed fasten the process of testing in Manipur. Medical experts say that to run the diagnosis, there is a need for a different type of cartridge. At present, testing for TB involves extraction of DNA from the sample. The new cartridge will extract the RNA from COVID-19 samples.
The Manipur government can request the Centre to provide COVID cartridges and all district hospitals which have CBNAAT can apply to ICMR for permission for testing on an urgent basis.
As per the ICMR, the CBNAAT should be carried under Biosafety 2 level (BSL-2) conditions and with appropriate biosafety precautions.
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The idea behind mobilizing bigger number of testing machines is that in the absence of a vaccine or drugs to treat COVID-19, faster diagnosis and early medical intervention is a must. Observers had noted that under the present testing procedure, diagnosis takes almost eight hours. However, CBNAAT test can provide faster results, saving more time and lives.
Currently, the government and private hospitals in India conduct three kinds of testing for COVID-19: Real-Time RT PCR, TrueNat Test, and CBNAAT Test. Reverse transcription-polymerase chain reaction or RT-PCR is a nucleic acid-based test that is the most sensitive in early detection of infection. In this test, healthcare staff collects a sample by swabbing the nasal passage or throat.
TrueNat Test is generally used to detect tuberculosis. In TrueNat test doctors take sputum samples of patients.