India’s diagnostics landscape has changed, ever since the COVID-19 pandemic hit us. Pressured by the existing goals to strengthen and expand COVID-19 screening services as well as following wavering guidelines and protocols, while maintaining quality standards, the industry is set to witness regulatory metamorphosis in the coming times. So, Arindam Haldar, CEO, SRL Diagnostics, speaks with Raelene Kambli, updating us on the current changes that the industry is facing and the latest developments at SRL
What is the impact of the price restrictions and guidelines due to the COVID-19 pandemic on your diagnostics business?
The world today is facing one of the greatest health threats of a generation – COVID 19 – one that profoundly not just impacts our nation’s economy, but the global economy and its people at large.
Low public expenditure on health (as low as 1.4 per cent of GDP), lack of enough qualified doctors and a dearth of good medical facilities are some the biggest challenges to improving healthcare in India. Therefore, India’s healthcare sector is largely private-driven. The private healthcare sector, in general, and private diagnostics labs, in particular, are working shoulder to shoulder with the government machinery across the country.
However, apart from fighting COVID-19, private labs are every day fighting whole new practical challenges in their COVID-19 journey that include complex and ever-changing regulations, cost pressures, lengthy data entry requirements, lack of skilled manpower, health workers falling victim to the infection, to name a few, putting incredible pressure on already overworked medical professionals. Some of the additional restrictions imposed on private labs are paralysing the testing and healthcare systems at a critical juncture when they need to be on top of their capabilities. Today, if one notices, the restrictive guidelines of each state often counter to each other. These guidelines rather should be fabricated keeping in mind our country’s needs at large, and should not act as a roadblock in increasing the testing rate. Besides, the price capping done by each state also varies anywhere from Rs 2,000 to 3,000 for RT-PCR, clearly shows that not enough thinking has gone behind while fixing these prices. This narrow focus on price capping completely overlooks the fact that for years, indeed decades, private players have been adhering to global benchmarks. One cannot forget that if India is one of the top destinations in medical tourism, it is largely because of the hygienic, upscale facilities provided by private players. These also include top medical talent, some globally renowned. It’s also fair to say that the diagnostic test price table in India is far lower than the western countries and the entire developed world. Further, while we are in an agreement to relook at the initial price cap (of Rs 4,500) and bring that down in line with actual costs, we feel the new and lower price should be fixed by the government which has to be reasonable and uniform across the country. As one of the largest lab chains in the country with sufficient testing capacity, we are more than willing to work with the government to fight the pandemic.
Do you think we are conducting adequate testing within the country?
To tackle the rising cases of COVID-19 in India, extensive testing is imperative and we have already seen testing capacity in our country increasing manifolds within a short span. From 20 thousand a day, we are today conducting more than three lakh tests in a day, which is quite commendable. Moreover, the government is willing to take this number significantly higher soon with its network of close to 1,000 private and public labs. However, if we look at the test per million ratios, then we are still far behind many of the countries across the world. In addition, our testing ratio to population varies widely from state to state.
SRL has launched its antigen testing units. Tell us more about it.
While our existing PCR machines are already testing for COVID, the new rapid antigen test will allow quick detection of the virus followed by treatment and isolation of the infected individuals. We have initiated the tests at some of our labs that are operating in tertiary care and multi-speciality hospitals, and at our clinical reference labs in Delhi NCR and Mumbai.
Currently, as per the government guidelines, symptomatic patients with influenza, asymptomatic persons who are in direct relation to positive patients, high-risk contacts with co-morbidities of confirmed cases, people above the age of 65 years, patients with SARI and ILI symptoms and asymptomatic patients who need hospitalisation for other ailments are all eligible for this test. SRL’s COVID-19 rapid antigen test is priced at Rs 1,200. The documents required for the testing entails a doctor’s prescription (except in Mumbai) and the patient’s Aadhaar Card, including current address proof.
What are the precautions that labs need to take in order to devise a robust testing protocol? How is SRL ensuring quality and safety?
We were amongst the first few private labs chosen by ICMR to conduct COVID -19 testing. We started at two of our clinical reference labs at Mumbai and Gurugram, and currently, four labs within our network are conducting these tests. Our testing labs in these two cities started testing from the last week of March and are NABL- and CAP-accredited, and run by highly professional, qualified and experienced doctors. That apart, we are only using ICMR-approved kits and testing technique to conduct the tests.
There are established protocols for transporting samples which are religiously followed, making sure that the samples are sent across in cold chain in the viral transport medium (VTM). The sample collected is packed immediately in triple-layer packing and is then sent to the SRL Reference Laboratory for testing under temperature-controlled conditions, ensuring no chance of spreading infection. At our drive-thru facilities, we sanitise the booth and the surrounding area at regular intervals in addition to all patient vehicles to ensure safety and hygiene. The whole area from outside is sanitised with a hypo solution immediately after a patient sample is done and then only the next patient is asked to park his car. The facility allows a patient to remain inside the car, and the nasal/throat swab sample is taken through the car window by the phlebotomists wearing PPE in the booth, so that there is no aerosol generation in the procedure.
In order to maintain and follow social distancing protocols, the sample collection is done through a prior appointment and all documentation is collected and verified over electronic medium before fixing up the appointment time for the sample collection and payments are done digitally.
Additionally, to ensure safety and precautions for COVID-19 patients and caregivers, our specially trained phlebotomists collect samples while observing all biosafety precautions and are using personal protective equipment. We are undertaking training and re-training of our staff relating to the use of protective gear, disposal, sample collection and ensure accurate testing, safety of patients and employees. We undertake frequent check-ups for our staff, and in any such unfortunate case, they are advised home and self-quarantine immediately.
You have also initiated this platform called WhatsApp for business to share patient reports, etc. How does this help healthcare organisations and what about data privacy, security etc.?
The current situation presents an opportunity for more sophisticated and flexible use of technology, time to strategise and re-strategise, focus on better analytics work to understand the requirement and preferences of people. It is important to use technology in terms of improving the quality of care and work efficiency at an affordable cost. The COVID-19 pandemic has affirmed our move to be digitally ready. We are gearing up to ride the trend wave and serve our customers.
Recently, we introduced WhatsApp for Business to share test reports, which has been useful in reducing patients’ waiting times and hence minimising crowd in the public waiting area and thus allowing us to safely implement social distancing. However, this is an opt-in option available to a patient which they can initiate if they wish to receive their reports on WhatsApp. The medium is password-protected; hence, ensuring data privacy. We already have a system in place where the reports are shared over email which is again password-protected. WhatsApp is another medium that we have introduced to ensure the flawless customer experience.
What more can India, as a country, do to improve its diagnostics landscape?
The COVID-19 pandemic has underpinned the significance of a robust healthcare system in such crisis situations. Despite the testing cost in India valued at 1/5th of the cost of the USA, a significant number of the middle class and lower class families still can’t afford it in India. As of now, more than 60 per cent of the expenditure is out-of-pocket-expenditure, insurance coverage would be in single digit, and the remaining would be a corporate spent, and a few government initiatives took place in some of the states.
However, one must note that despite the testing cost in India being lower as compared to other countries, the reagents and equipment being used in India are at par with global standards. Our doctors are also equally qualified as their western counterparts. Adding to the insights, the equipment used for conducting tests in India are imported, and also come with the impact of import duty. The only way a commercial enterprise can survive in the market would be by consolidating volumes and getting higher efficiencies from their lab machinery and manpower. This is especially true for high-end tests.
With schemes such as Ayushman Bharat in the pipeline, it presents a great opportunity for the diagnostics sectors and for the poorer patients across the country. The scheme and the industry together could do wonders, as individuals would be able to access diagnostic services simply with an Ayushman ID, and I would appeal to the authorities to work out a win-win operating model jointly with the private sector.
Thus, diagnostics tests and OPD coverage under medical insurance for paying patients, and government schemes like PM-JAY for weaker sections of the society would surely help both the consumers as well as players in this industry. However, to make this implementable, we need states and central authorities to think and work in sync keeping the national interest in mind.