Dr. Shashi Sudan Sharma
“In hard times, we learn something incredibly precious: The fist of the universe can hit us anywhere anytime; make your preparation before the universe attacks you! In this universe those who anticipate the thoughts and actions of the universe beforehand will survive!”
– Mehmet Murat Ildan
Man is the master of his own reality. He digs his grave, jumps inside, tells people to cover it and declares he is dead. Not that people want to die but they choose to die. One dies when the awareness that life is still an option is gone. His mental virii prevents him to live. His exile, fear and doubt make him a victim. He creates his own world where he allows the environment to overpower him. In illusion, the master suffers and dies.
COVID 19 is mans own chastisement. All speculations related to it whether it is a result of unnatural lifestyles and food culture of a particular community, a naturally emerged novel agent because of a deranged micro-ecosystem, an accidental leak from a devils laboratory or the demon arising of the act of bioterrorism against whole humanity are supportive of this fact. Humanity noticed it during the last legs of 2019 when a cluster of cases of atypical pneumonia arose suddenly in Wuhan city of Hubei province of the communist China. The devil of misfortune had begun ringing His bell but the vibrations just fell on the deaf ears of all. World saw the fire spreading fast in Wuhan and kept gossiping without realizing that wild fires take no time to reach your own homes. Italy and Iran were the next unprepared victims and before the world could wake up, the fire of SARS CoV 2 had already engulfed the whole globe. Worth appreciation is the timely characterization of the virus by the Chinese and timely sharing with the World Health Organization (WHO) and within no time the diagnostic kits based on detection of Genes were ready.
As on 7th May, 2020 there had been 3.76 million Corona virus cases, with 2,64,000 deaths while 1.25 million had already recovered. Very interestingly the highest numbers of recorded deaths belong to USA followed by UK, Italy and Spain. Compare these figures with that of India. As on 7th May, 2020, in India there were 53,045 cases, with 1787 deaths while 15331 patients had recovered. In Jammu and Kashmir there were 726 with 8 deaths on record. Understandably, by the time you are reading the article in your newspapers in the morning of someday with your taste buds rejuvenating your senses with sips of tea in your hand the figures would have changed. The very small numbers of deaths in your union territory might just add to the rejuvenation. Thanks to the strong political will and the timely decisions of our policy makers followed by the strict administrative implementations of lockdown policy coupled by the trust of the people of republic of India in their democratically elected regime. Our echelons wisely chose precious lives over the growing economies.
While the hopes of the common man were piercing the skies made clearer by the lockdown of humans, the Intelligentsia and the Academia were busy coordinating to find ways and means and frame the strategies to combat the menace under a strong political desire. A dire need of setting up laboratories was felt to test the samples where the invisible enemy could be hiding. It was a double edged sword. At one side it could diagnose the SARS COV 2 causing COVID 19 and segregate the sick from the community to prevent it spread and on the other side it could guide the epidemiologists by molecular tracking this time to assess the direction in which the fate of the nation was moving. The tests were few and the journey long and challenging. The nation needed to know if she was moving towards the direction of Italy or South Korea. We all knew the difference. The eyes of hope stuck on the microbiologists and an anticipation of intrepidity was born for them. We took the challenge the way a soldier takes it at the time of war. The only difference here was that the enemy was invisible. We started the molecular testing at the Department of Microbiology, GMC Jammu, as one of the first 50 ICMR/DHR designated labs of India and the first in the UT of J&K. The Distinguished Administration took our nod and we took an assurance in return. The goal was common- protecting the citizens of India from the wrath of Corona Virus. Our job had begun as the team was determined.
9th of March, 2020 was the day when we officially started with the molecular testing of COVID 19 and this was after six failed trial runs till finally the graphs were approved by the experts of NIV Pune and the test run begun. The whole testing facility had to stand on three pillars of critical responsibilities. These included High Quality operative procedures to ensure the reliability of the results of this Qualitative assay, a desired Turn-Around Time (TAT) as per the documentation of the Centre for Disease Control (CDC) for Real Time Polymerase Chain Reaction (RT PCR), the Gold Standard which is twelve to seventy two hours, and a timely data entry of all tests within 24 hours. The most important and over and above these was the challenge of the Laboratory Personal Bio-safety as SARS CoV 2 is highly contagious and also a quicker identification epidemiologically meant a reduced transmission through contact tracing and isolation. It also meant building of the nation’s confidence to fight against a virus that had the potential to get the growing economies crashed.
There is an absolute admitting the fact that the ready support we got in terms of assurance, encouragement, guidance, consumables and equipments from the Administration of the UT of J&K to the already laid down Viral Research and Diagnostic Labs(VRDLs) under Indian Council of Medical Research and the Directorate of Health Research (ICMR/DHR) was the only facilitating factor or the goal was unachievable and soon our UT was at Second Position in COVID 19 testing, next only to Maharashtra. Still at many instances we found that the number of samples received by us exceeded our capacity but there was no looking back as the team was working with a missionary zeal. Another challenge was to protect our trained human resource dealing with the processing of an increasing number of samples. The bio-safety cabinet installed in the sample processing area was a compromise to deal with sample that could possibly contain an unknown agent. And time could not be wasted to get the desired one installed. The intrepid team of Microbiology department of GMC Jammu got to work with some calculated risks.
The maximum risk of getting laboratory infections remains in the area where samples are initially processed. All the protocols like donning and doffing of Personal Protective Equipment (PPE) and restricted movements with limited minimum number of laboratory technicians working in that area was strictly followed. The capacities of the laboratory was enhancing each coming day as the number of samples increased. A COVID 19 testing of the staff of Department of Microbiology was an open offer initially to ensure both the confidence and safety of each member. On exactly the 20th day of the start something very undesirable happened. The sample of one faculty member tested strongly positive. The news was a shock wave to the entire city and the Department was the epicenter of that shock. Everyone working in these challenging conditions became apprehensive of his/her own safety. A sense of insecurity prevailed. The whole of the department was declared CONTACTS and were immediately put to hotels under quarantine by the administration. The pioneer laboratory on which the whole reporting depended was undesirably and fearfully limited. There was no equivalent alternative for Jammu region. The soldiers of Microbiology however simply refused to quit the war. A bold decision was taken. The laboratory will continue to be functional and the quarantine transformed to an administrative and a Departmental and a Performing quarantine where the entire team willed so. Almost all the staff including scientists and technicians many of whom were females became a voluntary part of that decision. The mothers left their children and homes for sake of service. Prayers were made and all hopes left to the Almighty. There was a breathless wait for the test results of the entire testing team. All turned negative. God was with us.
Good actions performed with a right intent are always bestowed with divine energies. But we also need limbs to perform actions. A thresh-hold came when the in pouring sample size began to exceed the physical capacities of our laboratory. The spirits though remained limitless. As is always done before, a hand of help was extended by the Army. This time it was Command Hospital Udhampur. I was appointed a consultant by ICMR DHR to assess them develop a laboratory. It was more than a pleasure and those at the receiving end were confident of their capacities. The only thing they wanted of me along with another expert from ICMR was recognition and a designation by ICMR. Another tributary grew to the river of service. The command Hospital became ready with RT PCR for COVID19 in addition to us as they were well versed with technique for H1N1 (Swine Flu). And RT PCR again became their weapon to identify the invisible enemy. An addition of an extension counter at the BSL3 Lab in IIIM CSIR was another off shoot. It was soon followed by start of CB NAAT-Cartridge Based test at the Intermediate Reference Laboratory situated at the CD Hospital. This was a ready relief for the test results with the TAT of two hours and a compliment to already existing RT PCR in the department as the Indoor Suspects, their Families and also our Health Care Professionals could be readily relieved by this rapider test.
We needed our challenge to grow. The team wanted to know its strength. More samples from every nook and corner of Jammu division started pouring in. The limited resources could not limit the limitless hopes to serve the mankind. We conceived to train the lab technicians from everywhere. A massive training campaign began. Almost every day, the technicians were taught in the department, the correct procedure to collect the samples, packaging and transportation as per guidelines. The skills were not restricted. The knowledge of RT PCR was shared with the faculty of new Medical Colleges that stand to serve the periphery. I being the principal investigator of VRDL appointed by ICMR DHR intend to see beyond horizon. I see a future where all New Medical colleges are equipped with state of art VRDLs. May this increase both our work and our resilience. The Virological techniques took very long time to develop after Sir Louis Pasteur’s routine Microbiological practices came into being.
(The author is HoD Microbiology of GMC Jammu)
Dr. Shashi Sudan Sharma