Electron Microscope based detection of novel corona, India must explore fast

In the testing time of lock down, people of India often hear the term - testing, wants more test kits, test kits ordered by India from china have been diverted due to US intervention, more in-house test kits must be manufactured by India, antibody based test must be explored…… etc. 

As on date, PCR based confirmation of viral genome is followed in the samples collected from the nasal or throat region of the suspected individual.  Today PCR is considered to be the most reliable tool because it detects the presence of viral genome in the host sample. 

The limitation of PCR is high cost and prolonged processing time.  We also must gracefully accept the marvellous fact that any simple error in sample collection and the skill of the scientist or lab technician who runs the PCR also can heavily alter the result.  The sensitivity of PCR is reported to be only 60-70%.  Imagine the consequences of false negative cases to our society? 

In the larger sense, PCR in India is used more for research than for diagnosis but this scenario got changed a bit with the advent of the colleague novel corona, the HIV, another RNA virus, in India. 

Due to the obvious limitations of PCR test, rapid antibody detection method is being discussed and researched globally.  The error the antibody based test can bring in the case of novel corona is immense, because, the antibody test is obviously an indirect method of detection and would often yield more confusion than clarity.  In India, large proportion of population may show antibody to Mycobacterium tuberculosis, but may not carry the pathogen or and may not have any history of the disease.  Under such circumstances, the dilution factor is considered.  

 

Our medical and scientific fraternity are deeply infected by western style of research mind-set and they love to talk only about are PCR, ELISA, Immunofluorescence assay, MR scanning etc.  

In this respect, a few clinicians from Tamil Nadu recently came up with a simple, workable, table top method to ascertain the risk status of COVID 19 patients called regular detection of oxygen saturation level in blood because what they have observed so far was hypoxia during the disease progression which ultimately cause death.  India must appreciate the group of doctors from Tamil Nadu who brought out their clinical experience to the world in the hour of corona crisis. 

India has large number of medical microbiology graduates, post graduates, Ph.D degree holders, diploma holders etc.  Some of the post-graduates had studied more than three or four years in M.Sc course in Medical microbiology due to their inability to clear the course in the stipulated three year period and hence had to write the exam again and again for several times. Certainly such people would have gathered relatively more experience in medical microbiology because they have studied the same subject several times.   

Why we should not explore the possibility of Electron Microscope (EM) for detecting the presence of novel corona.  The number of well commissioned EM and the number of skilled personals who know to operate EM may be less in India.  But if we develop the skill and standardise sample collection method, we can test large number of samples in short time, test cost would be least, and above all, we will be capturing the image of the virus, which is quite credible. 

Our fancy attitude towards basic science only has pushed us to such situation.  Within 15 minutes, with the help of EM, we can complete one sample and no interpretation of the result is requited because the image of the virus would appear on the monitor.   But sample collection procedure may require some tweaking. 

The microscope only gave birth to microbiology and until then, all concepts and hypothesis about microbes were residing inside the womb of mere scientific speculations.  

In recent days, medical microbiology has unfortunately moved away from its basic tenets, started to relay mostly on indirect methods, colour based confirmations etc. 

Exploiting several rapid, non-subjective methods is not wrong but we have moved far away from the core realm of microbiological tenets and fashioned to the title called immunologist, molecular biologist, sequence specialist etc. 

The medical microbiologists must jump to the caldron like a Gladiator and must solve the crisis by exploring EM based detection of corona virus. 

Clinicians at best only know to treat the patients based on the symptoms and the drugs as described by the scientists who invented and developed the drug.  

In UK, USA and other countries like South Korea, China etc., medical graduates are the core research group involved in various medical researches but in India, most of the medical graduates may not know even the preparatory aspect of scientific research and all they know is to diagnose and administer certain drugs to the patient and record the clinical outcome either by interacting with the patient or simply relying upon modern day gadgets; as principal investigator of a clinical trial. 

Our clinicians are too busy in practice than know anything about research in general.  Scientists are the real back bone of every medical research in India.  The research that our clinicians know are case reporting and publishing them in their respective association’s affiliated journals. 

Starting from identifying the pathogens, mapping their behaviour, exploring several rapid methods of detecting the pathogens in the clinical material etc., all fall under the domain of microbiologists.

Microbiologists must give new strength and hope to our country by explore Scanning Electron Microscopy for quick, cost effective, less time intensive and most reliable detection of corona virus. 

Otherwise the medical microbiologists in various medical colleges may have to remain as glorified technicians, testing and writing the lab reports and assisting the clinician, despite having coveted Ph.D degree and post-doctoral experience from world class research centres. 

If microbiology enters effectively between PCR and yet to introduce antibody based test method, the war against novel corona, India can win easily. 

Time is up for India to develop newer skills and simpler, cost effective and less time intensive diagnostic methods to detect many pathogens that are visible only to the microbiologists.  

India must adopt simple methods linked to the fundamentals of microbiology where skill, experience and intelligence become the real collateral and not westernized, highly fashioned mind-set look for machine based diagnosis.  S Ranganathan