Global shortage of key ingredient could affect COVID-19 testing in Caribbean

Global shortage of key ingredient could affect COVID-19 testing in Caribbean

BY JACQUELINE CHARLES
AND JIM WYSS
(Miami Herald)

Sunday, April 05, 2020

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A global shortage of a key ingredient in the COVID-19 testing process could lead to a slowdown in some Caribbean nations' ability to rapidly test for the virus that causes the respiratory disease just when the toll of the global pandemic is expected to surge.

Dr Lisa Indar, deputy director of the Caribbean Public Health Agency (CARPHA), which is doing testing for 18 Caribbean countries in its regional medical laboratory in Trinidad and Tobago, said the lab is actively looking for reagents. The chemical ingredient is critical to the chemical analysis recommended by the World Health Organization that's being used to detect COVID-19 in specimens.

“Our current reagent capacity is such that we have enough media to take us through the next three weeks,” Indar, an infectious disease specialist, said Wednesday during a video press conference. “We are actively looking for more media.”

Indar said pre-orders were made as far back as January but it's taking time to receive the supply of reagents for the molecular tests because of the global shortage.

While much faster rapid testing has become available, including a two-minute test the US Food and Drug Administration approved for the coronavirus, Indar said such tests are not yet recommended by the World Health Organization. The time-consuming, intricate polymerase chain reaction, or PCR, procedure “remains the gold standard for COVID-19” due to its accuracy, she said.

On Wednesday, both Puerto Rico and Ireland's health ministers expressed concerns about a slowdown in their ability to roll-out COVID-19 test results due to the the global shortage in the supply of reagents. Ecuador, which is struggling to keep up with an overflow of testing demands, has also cited a lack of reagents as a major hurdle in its fight against the coronavirus. The South American nation currently has 2,372 confirmed cases, 3,423 suspected cases and 142 deaths, according to the Pan American Health Organization.

Since February 10, CARPHA has completed 929 regional tests with Trinidad and Tobago leading with 553 tests, said CARPHA executive Director Dr Joy St John. Each test runs about US$250.

Trinidad and Tobago currently has 90 confirmed COVID-19 cases and has registered five deaths related to the disease, according to its health ministry.

“The rate of testing has sped up in the last two weeks or so,” St John said. She noted that CARPHA runs every sample “that comes to us and fits the criteria.” They currently do not test for people who are asymptomatic or samples older than 10 days. Also it does not test for Haiti, Cuba or the Dominican Republic, three of the region's most populous countries. Those countries have their own national laboratories.

Dr Jacques Boncy, who runs Haiti's national lab, said the country is not experiencing any shortages yet. Haiti has 16 confirmed cases and has so far run 154 tests.

“We project that when the number of cases begins to increase we will face a shortage,” Boncy said. “Most of the rapid PCR assays [for the detection of the virus] are being used for US needs.”

Indar said the testing process at the regional Caribbean lab starts as soon as the samples are received, and depending on the time results can be turned around in 24 hours. Each testing kit can produce between 40 and 50 individual tests, and the process itself requires two steps for each sample and the use of two kits.

In the first step, lab technicians extract the virus' RNA. This process takes about two hours.

In the second step, special chemicals are mixed with each sample and the combination is run in a machine for analysis.

At this stage, which can take six to eight hours, “the first thing is to determine if it's coronavirus, and then the second is to determine if it's COVID-19,” Indar said. ''If it is positive for the coronavirus, it is only then we would go into COVID-19 testing.”

Not everyone who gets the virus will get sick; most people will experience only mild symptoms.


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