Health workers take a blood sample from a child through the window of a car during a drive-through rapid testing for coronavirus outside Lippo Mall Puri in West Jakarta on April 18. (JG Photo/Yudha Baskoro)

PCR Testing Spearhead in Fight Against Covid-19: Siloam

BY :ADITYA L. DJONO, LONA OLAVIA, DINA MANAFE

APRIL 27, 2020

Jakarta. Siloam Hospitals' deputy president director, Caroline Riady, said specimen testing using real-time reverse transcription polymerase chain reaction, or RT-PCR, method should spearhead efforts to contain the Covid-19 pandemic in Indonesia.

RT-PCR is one of the most accurate lab tests available to detect Covid-19. 

It allows immediate actions to be taken to treat patients and helps determine the next steps to break the chain of viral transmission.

"Testing lets us know who [has been infected] and what to do. That's a crucial step in fighting and overcoming Covid-19," Caroline told BeritaSatu Media Holdings in Jakarta last Thursday.

She said the past eight weeks have been a challenging and difficult time because hospitals and their medical personnel must respond to an unprecedented situation.

"When we saw the number of [Covid-19] cases starting to escalate globally, Siloam started preparing for what we would do when they start to appear in certain cities. We've devised our plan in stages," Caroline said.

According to her, once Indonesia reported its first Covid-19 cases in early March, Siloam began implementing its pandemic mitigation plan.

But the reality on the ground was much different than what was anticipated, especially because Indonesia had little experience in dealing with a pandemic.

As the number of Covid-19 cases spiked, mostly in urban centers, there were fewer available beds in the government's referral hospitals.

As a result, some patients had to be treated at Siloam.

"We also noticed there was a problem with diagnostics, there wasn't enough of them. From then on, we decided to focus on ramping up testing. We found out what methods were available, and we make sure we have the ability and access to do it," Caroline said.

Siloam decided to perform PCR testing in collaboration with the Mochtar Riady Institute for Nanotechnology (MRIN).

Efforts were made to bring in as many reagents as possible into the country so specimens could be examined immediately.

Since then, Siloam has continued to expand its PCR testing capacity.

"We can now test 288 PCR samples per day. We've received many samples, even from other hospitals. We also continue to use rapid testing," Caroline said.

According to her, PCR testing is more complicated than other tests. Samples taken from patients have to be put into a transport medium so the virus can remain viable. After that, the virus is extracted and tested using the PCR method to see if Covid-19 is present.

At Siloam, the testing is done using four PCR machines owned by MRIN. 

"We do the test in a bio-safety level 2 laboratory as the government requires. This prevents the virus from infecting the lab staff and any other sort of contamination," Caroline said.

Usually, PCR testing takes several days to complete. At Siloam, it takes about three days. However, results can be obtained in 24 hours for urgent cases.

Still Not Enough

The director of the Eijkman Institute for Molecular Biology in Jakarta, Prof. Amin Soebandrio, said the lack of PCR testing is the main obstacle in flattening the curve of the pandemic in Indonesia.

According to him, there are only 46 laboratories across the country with the ability to do PCR testing, but some of them are not ready to do it because the facilities are minimal, and the staff have not had enough training.

As a result, test samples are still being sent to Jakarta, including to the Health Ministry's Research and Development Agency, able to examine 1,000 samples per day, the Eijkman Institute for Molecular Biology and the University of Indonesia's Clinical Microbiology Laboratory, both with a testing capacity of 360 samples per day.

To reach President Joko "Jokowi" Widodo's target of 10,000 tests per day, Amin said, can only be done by increasing laboratory capacity.

"If we have ten laboratories, each with a testing capacity of 1,000 samples per day, then the target of 10,000 tests a day can be achieved. Each lab must have at least 4 to 5 PCR machines and have enough stock of reagents," Amin told Suara Pembaruan on Sunday.

Amin said training new lab personnel can take around three weeks.

"The existing laboratories are overwhelmed by samples from everywhere in the country. The Eijkman Institute, for example, can examine 360 samples per day, but we've been receiving between 400 to 700 samples. We often need five days to produce results," he said.

Separately, State-Owned Enterprises Ministry's senior official Arya Sinulingga said 20 new PCR machines purchased from Swiss pharmaceutical company Roche had arrived in Indonesia on April 8. 

They are now being distributed to 12 provinces: Jakarta, West Java, Banten, Central Java, East Java, Bali, Lampung, South Sumatra, North Sumatra, East Kalimantan, South Sulawesi and Papua.

"The [PCR] machines are being distributed from April 14 to April 29. They are being sent to 18 hospitals across the country from April 15 to May 6. Once all of them are operational, we can test up to 25,000 samples per day," Arya said in Jakarta on Sunday.

The government has also bought more reagents from Switzerland and South Korea for the PCR testing.

"Some of them have arrived and are already being used at the Pertamina Jaya Hospital," he said.

The SOE Ministry also encourages state-owned pharmaceutical companies, including Bio Farma, to produce their own reagents – which are used to examine the swab test samples.

As of Monday, Indonesia has reported 9,096 confirmed cases of coronavirus with 765 deaths and 1,151 recoveries.

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