IMR doctor speaks of experience testing Malaysia's first Covid-19 positive cases

 

It was Jan 25, 2020. The sun hasn't risen yet. But for a team of doctors and lab technicians attached to the Institute of Medical Research Malaysia (IMR), their eyes could not have opened wider.

They each had just received a phone call. Perhaps the most shocking one in their lives as researchers in the country's most elite medical laboratory.

"The National Public Health Laboratory (MKAK) in Sungai Buloh has concluded their tests, and it looks like we might have the first positive Sars-CoV-2 cases in our country," a voice at the other end of the phone told Dr T Ravindran, the head of Virology Unit at IMR.

Sars-CoV-2 refers to the scientific name of the new coronavirus, which later becomes widely known as Covid-19, taking from the last digit of the year when it was first discovered in Wuhan, China.

Without waiting much further, Ravindran started his car and headed to IMR. Just before 6am that day, the whole team members arrived at their office, which is located at Jalan Pahang, just next to the Kuala Lumpur Hospital.

Sars-CoV-2 may be new to the world then, but Ravindran's team had already made their preparations for this day. Just days earlier, IMR had developed its own reagent to enable detection of the virus.

"Fortunately, on Jan 11, Chinese scientists have uploaded full genetic sequencing of the virus. Based on this data, IMR managed to develop their in-house primers and probe, which are key ingredients in the PCR test for Sars-CoV-2.

"We then ordered the production of the reagent, which arrived at our lab on Jan 21. For positive control, we use a sample containing inactivated Sars-CoV-1, which was provided by Universiti Malaya Medical Centre. In layman’s language, we can say Sars-CoV-1 is a cousin of Covid-19, as they share almost 80 percent genomic similarities," he told Malaysiakini in an interview.

The interview was held in conjunction with the first anniversary of the day Covid-19 was found in the country.

Ravindran said in the days that followed, IMR had used the new probes to test about 20 other samples, taken from individuals who had developed symptoms of Covid-19. But all returned with negative results, until four days later.

The samples they were about to test then for confirmation came from three individuals, part of a group of 10 who came from Wuhan, China. The individuals in the group, many of whom are related, were travelling to Malaysia through Singapore for a holiday.

As they were about to enter Johor from the island republic, two members of the group were found positive for the virus and had since been detained at the hospital there. The rest were allowed to continue their journey on Jan 23 as they did not show any symptom for the coronavirus.

However, they were immediately detained by Malaysia's health authorities at a hotel in Johor, upon being alerted by Singapore. Body fluid samples were taken from the group members for tests.

Mixed feelings of excitement and worry

According to Ravindran, the team immediately got to work as soon as the samples arrived from Sungai Buloh MKAK that morning.

The team was thrilled, he said, when asked to describe how they felt when running the samples. But that was not as much as how much they were worried about a positive result.

"Because a positive result means that the virus has come to our shore," he said.

It took the team of eight about five hours to complete the reverse transcription-polymerase chain reaction test, known as RT-PCR in short.

Starting with heat inactivation to deactivating the dangerous virus, the team then carefully conducted RNA extraction and followed by PCR.

What they worried about was then proven through. And the rest was history.

"To make sure the tests were correct, we included test controls. These are positive controls to ensure the tests worked and negative controls as a marker for contamination. The test and controls worked perfectly.

"Results must be verified correctly, with 100 percent accuracy. We must be very confident and then only we report (to the chain of command).

"Of course, when we saw the positive results, it was a bit shocking. But we basically already have an idea that their (close) contacts were already tested positive in Singapore. So, there was a very good epidemiological link."

The confirmed results were then sent to the Health Ministry top management. An announcement was later made by the then health minister Dzulkefly Ahmad together with Health director-general Dr Noor Hisham Abdullah in a press conference televised live on all major television stations and social media.

Preparing the nation to brace a pandemic

The Health Ministry has five MKAK labs in total nationwide. Apart from Sungai Buloh, which is the main national public health lab, the four others are located in Sabah, Kelantan, Perak and Johor.

On top of these, there are 12 other main laboratories operated by the health authorities, and smaller labs at state hospitals nationwide.

However, when the first confirmed cases were announced by the Health Ministry, all the other laboratories except for IMR and Sungai Buloh MKAK still did not have the probes needed for Covid-19 testing.

"So, when we detected the cases on Jan 25, we quickly called all the labs. Luckily, Malaysia has already set up molecular testing at the 12 main laboratories back in 2009, when we were facing the H1N1 bird flu.

"We trained the labs to do Covid-19 tests and sent seed reagents for them to start testing. At that juncture, we were still not sure what was the capacity we needed to come up with, but we knew we had to get ready," Ravindran said.

At the same time, IMR also started training private labs to do Covid-19 tests to boost the country's capacity.

When asked to look back and compare with the current pandemic situation in Malaysia, Ravindran said it had never occurred to him that the outbreak would last for a year, let alone to reach today's stage where the country records over 3,000 cases daily.

"It never occurred to me, because basically what we are dealing with is a coronavirus. If we look back at history, what we all virologists are afraid of is influenza.

"We expect influenza as a virus that can cause a pandemic. Like what happened in 1918 when the Spanish Flu killed more than 50 million people, the Asian Flu, the Hong Kong Flu. The last pandemic was also caused by influenza, the H1N1. But it only killed around 18,000.

"This is the first time we are dealing with a pandemic caused by another type of virus, which is a coronavirus."

Ravindran also advises the public to continue abiding by the SOPs, even after Covid-19 vaccines arrive in the country.

He said while the most effective control for the pandemic is a safe and effective vaccine, the country needs to reach 60 percent herd immunity first to protect the rest 40 percent. - Mkini

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