SANJAY MATHUR: Nigeria’s COVID-19 Testing Is Less Than 120 Tests Per Million

Sanjay Mathur believes in the Nigerian project and has vast knowledge of the corporate world and the business of healthcare. As the Managing Director of VCare Diagnostics Limited, Mr. Mathur seems to hold the aces in helping Africa’s most populous nation successfully contain the ravaging COVID-19 pandemic. The VCare MD says the healthcare firm will address the immediate gap of about 40% diagnostics test which are currently outsourced to labs around the world. In this interview, Mr. Mathur shows the way out of the woods for the Nigerian government in fighting the coronavirus pandemic with its state-of-the-art diagnostic equipment and laboratory. His vision is to create an impact in Africa’s healthcare industry and to address and provide solutions for the huge gap in the industry. He was nominated as a member of the National Planning Commission for Vision 2020 by the President Umaru Yar’Adua administration in 2009. Mr. Mathur, a former Managing Director of Conoil Plc and regional manager of ExxonMobil, in this interview with Demola Ojo says Nigeria needs to test more for COVID-19

What is VCare diagnostics all about?
VCare Diagnostics Limited is a state-of-the-art reference laboratory. What this means is that we are set up to perform quality and cost-effective, high-volume and specialized samples for hospitals and other laboratories. What makes VCare unique from others is our capacity to conduct 100% of our tests in Nigeria. Prior to VCare, up to 40% of samples from Nigeria were exported to countries like India, South Africa, UK and others as local capacity was lacking.

This is the VCare model: we fill key gaps in the healthcare diagnostics space, vis-à-vis the provision of high-quality, accurate results in the least turnaround time, thereby helping patients and physicians to reduce treatment time.
The vision of VCare is to become the go-to reference lab for all the B2B and B2C segments by ensuring that no samples leave Nigeria. The positive impact of this is faster test results which improves treatment outcomes. We believe that this will positively impact on the mortality rate in Nigeria.

Apart from investing heavily in the latest technology and equipment, we also invested in quality manpower. Our lab is headed by Dr. Aramide Kolawale, who is the Lab Director, and our Quality Assurance Unit is led by Mr. Abiola Adejumobi. We also use cloud-based technology where all machines are connected to a cloud and we can, on a real-time basis, seek help from experts through our technology partners, Techmed Healthcare, India, an ISO 15189 and NABL accredited company.

Are you equipped to test for COVID-19?
VCare is well-equipped for biotechnology testing and provides services for microbiology and infectious disease conditions. Though we are one of the very few diagnostics companies to have a prime focus on molecular biology, the testing programme is currently centred on the NCDC, the federal and state governments.

Do you have the equipment for testing COVID19?
Yes. We have a biosafety level 2 (BSL-2) laboratory, equipped with a large BSL-2 cabinet. We also have exclusive rights for marketing and supply of real-time PCR equipment, reagents, and kits. We represent two companies, BIONEER & Boditech, South Korea.

How many tests can the equipment carry out per day and how quickly can the result of the test be known?
BIONEER platform has the advantage of being small, portable, easy to use with a capacity to process 20 – 22 samples per hour. This equipment can be placed closer to the field, thereby saving time and preserving sample stability & integrity. BIONEER products are CE, ISO 9001 & ISO 13485 certified.

Is this what NCDC is currently using?
One of the best decisions the federal government and the NCDC took was to engage only in RT-PCR testing for the detection of COVID-19 infections. Some countries which initially relied on rapid testing kits have reported poor results. For instance, India which initially adopted a rapid testing method has now switched over to 100% RT-PCR. In rapid testing, about 70 to 80% of results are compromised. In Nigeria, the RT-PCR platform was already in use at the NCDC and several other research-based institutions that engage in molecular biology.

Our products are basically the same, except that we have newer and more compact models. For instance, our BIONEER product has an automated RNA extraction component called ExiPrepTM 48A Dx that allows for faster results before amplification and detection using ExicyclerTM 96. BIONEER platform has the advantage of being small, portable and the number of tests it can do per hour.

COVID-19 cases are on the rise in Nigeria and it appears the virus is spreading fast. What should the country be doing to contain the spread?
The World Health Organization emphasizes testing and social distancing as the focus area for all countries. Compared with other countries, Nigeria has performed less than 120 tests per million. Ghana and South Africa are approaching 5,000 tests per million. Hence, there is an urgent need to expand the testing capacity for COVID-19 in addition to current steps being taken in the country. Nigeria should also be doing more in terms of raising community awareness and the ways COVID-19 control measures will affect day-to-day living, albeit temporarily.

In terms of testing, what do you think is the major hurdle?
One of the major hurdles for Nigeria and the NCDC is the limited availability of the RT-PCR testing across the country. Currently, only 13 centres nationwide are providing COVID-19 testing. The Nigeria Centre for Disease Control has plans to expand testing to 30 million Nigerians. To achieve this goal, there will be a need to increase the number of centres providing these tests. Establishing new test centres is capital intensive but serves the important purpose of scaling up biotechnology research in the country, which is useful for other diseases like cancer, HIV, and TB.

Capacity is a big issue for developing countries. How can this be scaled up to meet the current national emergency in Nigeria?
Our product platform makes it easier to scale up capacity. The availability of testing equipment and reagents/kits across the country and nearer to the public is an important gap in our current national strategy. Our portable RT-PCR equipment can be set up easily at field locations such as local government health centre, universities, and government laboratories that are closer to the people for community testing. This equipment can also do a wide variety of other tests like HIV, Hepatitis A/B/C, HPV genotyping, TB, CMV, ZIKA, etc.
We propose that the government should provide portable RT-PCR machines, which could be used at every isolation centre across the states and cities. This will enhance testing capabilities, as well as reduce the downtime for testing. These could be placed either at each isolation centre or each federal/state hospital as it will increase the capacity of testing multifold.

Kano is a big challenge to the Nigerian government right now. What’s your advice to the government?
Testing. Testing. Testing. Even WHO advises that the only way to overcome this pandemic is more testing and isolation. Hence, my advice will be to ramp up the testing from its current levels to several thousand tests per day.

Where should our focus be: is it on testing or lockdown?
The COVID-19 pandemic has taken the world by surprise and most countries were underprepared in terms of testing capacity. This challenge is also worse in low-resource countries like Nigeria where skilled human resources for PCR testing are not readily available. So, it is a global health emergency and it has exposed the deficiencies of public health infrastructure even in some of the best healthcare systems.

Synchronized lockdown is being practised the world over to contain the spread of the virus because it is essential to breaking of the spread of the virus. Hence lockdown is necessary. However, this cannot take away the fact that testing for COVID-19 must be the major focus as the majority of people with COVID-19 will have no symptoms. The danger lies with the demography of people who are asymptomatic.

Think about it: if health workers, teachers, house staff, or other providers of essential services were to have an asymptomatic disease, it will be good to test and isolate them to prevent further spread. Every country needs to make every effort to increase testing. As I said earlier, Nigeria currently has the lowest testing rate per million population and is the most populous country in Africa.

Nigeria can achieve a lot by aggressive testing as contained in the NCDC strategy for COVID-19: ‘In order to characterize the outbreak and also the transmission dynamics of this COVID-19 pandemic in Nigeria, more people have to be tested. To achieve scale, an integrated approach to testing is required.’ NCDC also highlights that the testing capabilities are strained under community transmission and extremely strained under widespread transmission.

How effective do you think social distancing and lockdowns are in preventing the spread of COVID-19?
Lockdown comes with its own sets of problems and opportunities. COVID-19 can be spread by contact but also by air. This means an infected person can spread the virus through sneezing or coughing, the same way as one catches a common cold. A safe distance of six feet reduces the chances of catching the infection but the virus can stay airborne for some time after a person has sneezed. One of the key benefits of lockdown is it helps in the containment of spread through social distancing.
The chain of spread can only be broken through lockdowns when an infected person will not be able to infect more people. Lockdowns also helps countries to buy time to boost strategies to better manage health emergencies so that those who fall ill can get better treatment.

The Lagos State government raised the alarm a few days ago that it was running out of reagents. Can you help since you run a diagnostics laboratory?
The shortage of diagnostic kits and laboratory consumables is a global event that impacts Nigeria as well as the world. Due to increased demand, countries are fighting to get a larger share of testing kits from the few manufacturers of these kits. As holders of exclusive distribution rights from BIONEER, a leading provider of RT-PCR equipment and reagents, we are ready to assist Nigeria with supplying these kits. These are the same test kits and reagents that are being used in South Korea, USA, India, and the UK. We can help the federal and state governments in sourcing these reagents in the shortest possible time. We can also provide our laboratory for testing as we have the required infrastructure like Biosafety cabinet BSL2 for the safety of the environment and staff.

Have you contacted the NCDC with your proposal to scale up testing?
We have reached out to the NCDC with our proposal and hope to get a favourable response from them.