HEALTH: THE ANTIBODIES AND I

May 24 2020

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Dr Khurram Hussein supervises a test | Photos by the writer
Dr Khurram Hussein supervises a test | Photos by the writer

Things are unusually quiet at the Karachi head office of Getz Pharma on a breezy, summer afternoon in May. The pharmaceutical company’s brownish-orange building, located amid swaying palm trees in the Korangi Industrial Area, usually sees much more hustle and bustle. But these are not normal times.

Inside the main building, the elevator rises from the ground to the training halls on the fourth floor, which have recently been converted into a sort of a testing facility. The corridor that leads from the elevator to the halls has a few people waiting on settees lined up against picture windows. More people wait on chairs, placed at safe distances apart, in the extended corridor that is currently being used as a waiting room. They are all waiting to get tested for Covid-19.

The test they will undergo is not the regular swab or Polymerase Chain Reaction (PCR) test for the detection of Covid-19 that is mostly being used in Pakistan. The Getz Pharma office is carrying out screening tests for antibodies, or seroprevalence in medical terms.

One drop of blood taken from the index finger — similar to how diabetics check their blood sugar levels — is enough to tell whether the person being tested was previously infected by the coronavirus, whether they have developed antibodies or whether they are currently Covid-19-positive.

The first hall that the waiting area opens into has more chairs, placed again at the required distance as per the World Health Organisation’s (WHO) safety guidelines. The people seated are being shown a five-minute educational video about proper washing of hands and the need to quarantine and isolate in case they are infected. They are also given consent forms to fill out.

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In the neighbouring hall, doctors and other medically trained staff assist the visitors in taking their medical history. There are queries about whether they have a fever, a cough, a sore throat, breathing difficulties, a loss of smell, fatigue or muscular pain, etc. Recent travel history is also documented and whether anyone has been in contact with a confirmed or probable case of Covid-19.

That done, trained staff, wearing white Personal Protective Equipment (PPE), carry out the tests by pricking the visitor’s finger and using the drop of blood as a sample for a small device resembling a USB drive. The result is out within 15 minutes. On closer inspection, one sees that the device has three bands on it, which light up to show the result: one indicates that antibodies have developed after a bout of the virus, one indicates the body is currently at the acute stage of infection, fighting the virus, and a third band shows if the sample taken is negative, pronouncing one clear of the infection.

A sample medical history questionnaire
A sample medical history questionnaire

The result data is revalidated at other desks or stations and the third hall has counsellors to guide anyone who has been infected, about their next step and about the precautions to take.

This is what has been going on at the pharma company for a week prior to this day. Since the coronavirus pandemic broke and crippled business activity, Getz is the first big company in Pakistan to attempt to test all of its employees. The company’s principals claim that what they are doing could provide a roadmap for the safe reopening of businesses.

Getz Pharma makes around 70 million tablets a day, including of the malarial drug hydroxychloroquine, fulfilling 90 percent of Pakistan’s demands for the drug. After a coronavirus case surfaced in the corporate office of the company in March, it temporarily closed down its offices. When the only WHO-approved pharma company in Pakistan temporarily shut, the country’s health sector felt the impact. But even after reopening, they were also quick to send all their staff with minor issues, such as coughs and sore throats, home to isolate.

“We had 1,300 to 1,500 employees in this facility in Karachi alone and, during the scare — when we were sending everyone who was suspect home, along with the vulnerable to keep them out of harm’s way — there were also days that only five people would be present here,” says epidemiologist Dr Wajiha Javed, head of public health and research at the company.

The company’s employees are aged between 18 to 65 years. “In the beginning, we also sent home all the elderly staff in view of their own safety,” she adds. “There was a need to care for them [those employees displaying symptoms of possible Covid-19] as well as the others they had been in contact with,” she says.

Just a little drop of blood from the index finger is required for the test
Just a little drop of blood from the index finger is required for the test

Meanwhile, the company’s doctors were in discussion about how to get everyone there tested. But at the time, there was a shortage of PCR kits. The tests were also quite expensive and the results were not available immediately. “PCR kits require large machines to read and one test is worth around 8,000 rupees — not to mention that the results come after 24 hours,” says Javed. Moreover, PCR tests were conclusive only after the surfacing of symptoms and therefore could not act as a precautionary measure, which the company was hoping for.

While researching for testing kits to procure for their staff, the doctors received some reading material about antibodies testing kits from their director of sourcing at their project office in China.

“The antibodies kit was one-fourth the cost of a PCR kit and more conclusive, even when there are no apparent symptoms of the virus,” explains Javed. “That got us speaking to vendors via video conferencing.” There were a couple more types of tests China was using on a massive scale, such as nucleic acid kits. They are molecular and usually need cold-chain transport. There was also the bronchoalveolar lavage (BAL) tests, which were 100 percent accurate but required a hospital setting and were very invasive and painful.

“We were weighing our options,” Javed tells Eos. “The PCR tests can only be conducted by doctors, with 32 percent accuracy when doing a throat swab test and 64 percent when doing it through the nose, whereas the antibodies tests had 80 percent accuracy and could be carried out by non-medical personnel with quick results and room for prevention.

“Still, we didn’t want to believe their manufacturers. We approached five large hospitals in China for their data about the antibodies tests before being totally convinced,” she says. The pharmaceutical firm ordered 25,000 kits initially. Out of these, it donated 15,000 to the Sindh government, as it was the Chief Minister of Sindh who had sent the plane out for the transportation of the kits. Then, in just three days, Getz Pharma trained 80 of its doctors to carry out testing and they in turn trained more people. Some of their doctors also worked with the Sindh government to train others. The provincial government now has imported 100,000 more kits.

“Apart from our doctors, we trained 56 other staff to carry out the extensive exercise of testing thousands of people in three days,” says Dr Khurram Hussein, director, commercial and human resource at Getz Pharma. “The entire company, including its manufacturing facility, training halls and head offices were turned into a testing facility. There was no other work being done during those days, other than testing and sanitising the place in between. Now we are also being contacted by the CEOs of other major companies in Pakistan to come and train their staff,” he says.

According to him, the antibodies testing has caught several asymptomatic persons and also those who have developed antibodies to gain immunity. “It is more than what meets the eye,” he says of the testing method. “It is [also] how they tightly screened and mass-tested and controlled coronavirus in South Korea, Singapore, China and a few other countries reporting success. Because, otherwise, each person who is infected is bound to infect 10, 30 or up to 100 other people, and then those people do the same as the infection grows and grows,” he says.

At Getz Pharma, they carried out the tests in two main phases. In the first phase, the factory was closed down and all the employees were tested. Those who were found infected in any way were counselled and sent home on a 30-day paid leave and the premises were disinfected. In the second phase, the families of the staff members who were infected were called in for tests.

“Meanwhile, those who had antibodies to fight the virus are also not considered safe forever,” says Dr Hussein. “We test them as well as the others who are healthy after every seven to 10 days.”

The Managing Director and CEO of Getz Pharma Khalid Mahmood felt grave responsibility to protect his staff, considering they help produce life-saving medicines for others at their factory. “Yes, it was costly to close down work for a week but it was the only way to protect our employees,” says Mahmood. “They are our Getz Pharma family so we were duty-bound to keep them safe no matter what. It was a small cost to pay because life is priceless.”

“This is how you screen people,” says Dr Hussein about the ongoing testing protocols. “After all, there is a pandemic out there and they may still catch the virus, or its mutated form. By testing our colleagues we are at least preventing them from infecting others. If more companies can do this for their employees too, it will help ease the government’s burden,” he says.

The writer is a member of staff. She tweets @HasanShazia

Published in Dawn, EOS, May 24th, 2020