ESTABLISHMENT AND MANAGEMENT OF COVID-19 TESTING MOLECULAR LABORATORY IN MINIMAL RESOURCE SETTING, CHALLENGES AND ISSUES REPORTED FROM BIRGUNJ, NEPAL – AN EXPERIENCE OF PATHOLOGIST

Abstract

Nepal reported the first COVID-19 case on January 23, 2020. A rapid increase in the number of COVID-19 cases was being reported in Nepal as of June 2020. Limited molecular laboratory capacity in a minimal resource setting is a challenge in the diagnosis of the ever-increasing cases. We share the experience and challenges in the rapid establishment of COVID-19 testing laboratory in Birgunj of Parsa district which is one of the SARS-CoV-2 transmission hotspots in Nepal. The initial step in establishing the COVID-19 molecular testing laboratory were i) identifying a suitable space ii) renovating it and iii) mobilizing materials including consumables, mainly from the hospital store and administration. A chain of experimental design was set up with distinct laboratories to standardize the extraction of samples, preparation of the master mix and detection. At the commencement of sample testing, laboratory contamination was among the primary challenges faced. The source of the contamination was identified in the master mix room and resolved. The established COVID-19 testing lab (Narayani PCR Lab) has tested more than 40,000 samples as of 31st August, 2020 and is now one of the preferred laboratory for CoVID-19 testing. The lessons learnt may benefit the further establishment of testing laboratories for COVID-19 and/or other epidemic/pandemic diseases in resource-limited settings.