Few pri­vate­ly-owned med­ical lab­o­ra­to­ries have shown in­ter­est in do­ing COVID-19 test­ing, with many say­ing the process is too ex­pen­sive or com­pli­cat­ed to make sense for their bot­tom line.

The T&T Guardian spoke with nine pri­vate­ly-owned lab­o­ra­to­ries to de­ter­mine whether they had ap­plied for val­i­da­tion fol­low­ing Min­is­ter of Health Ter­rence Deyals­ingh’s call for them to be­come part of the pool of op­tions avail­able to test for the virus.

Deyals­ingh con­firmed on Wednes­day that not a sin­gle pri­vate lab had re­ceived the all-clear from the min­istry to pro­ceed with COVID-19 test­ing.

“We did say as soon as that process was com­plet­ed we would make an an­nounce­ment,” Deyals­ingh said dur­ing the min­istry’s vir­tu­al press con­fer­ence up­date.

The coun­try has strug­gled to cre­ate its own test­ing ca­pac­i­ty for COVID-19 in the six weeks since the first con­firmed case was an­nounced on March 12. The Caribbean Pub­lic Health Agency (CARPHA) is the on­ly lab ac­cred­it­ed to test for COVID-19 in Trinidad and To­ba­go. The re­gion­al lab, a prod­uct of CARI­COM co­op­er­a­tion, pro­vides test­ing for 18 coun­tries. It us­es the Poly­merase Chain Re­ac­tion (PCR) test­ing method, which de­tects the pos­si­ble pres­ence of the coro­n­avirus’ ge­net­ic ma­te­r­i­al in a pa­tient’s spec­i­men.

Plans for ramp­ing up lo­cal test­ing in the pub­lic health sec­tor and to help wean T&T off to­tal de­pen­dence on CARPHA have come to­geth­er more slow­ly than the min­istry first an­tic­i­pat­ed.

Four weeks ago, Deyals­ingh an­nounced that CARPHA would val­i­date a PCR ma­chine at the Er­ic Williams Med­ical Sci­ences Com­plex in just a mat­ter of days. Speak­ing then on March 23, Deyals­ingh said the ma­chine would be ready for use three days lat­er. He al­so said a sec­ond PCR ma­chine at the Trinidad Pub­lic Health Lab­o­ra­to­ry would be­gin test­ing in two to three weeks. To date, nei­ther ma­chine has be­gun con­duct­ing COVID-19 tests.

But on April 7, Deyals­ingh an­nounced that pri­vate labs with PCR ma­chines could seek val­i­da­tion from CARPHA to be­gin of­fer­ing ap­proved test­ing to the pub­lic. He said the labs must agree to re­port re­sults on­ly to CARPHA, al­though a pa­tient would pay the pri­vate lab di­rect­ly for the test.

PCR has been used at some pri­vate labs in Trinidad and To­ba­go to di­ag­nose HIV, he­pati­tis, tu­ber­cu­lo­sis and oth­er dis­eases.

A Google search in­di­cat­ed there are at least 14 pri­vate­ly-owned lab­o­ra­to­ry com­pa­nies in Trinidad and To­ba­go.

While at least one lab has pub­licly ad­ver­tised PCR test­ing for COVID-19, it does not have min­istry ap­proval.

A med­ical mi­cro­bi­ol­o­gist who op­er­ates a lab on Cipero Street, San Fer­nan­do, said yes­ter­day that while he did con­tem­plate pur­chas­ing a PCR ma­chine to get in­volved in COVID-19 test­ing, the equip­ment was just too ex­pen­sive.

“A PCR is a very good ma­chine but to get the kits is very ex­pen­sive, to set it up is very ex­pen­sive and of course I would have to be re-trained,” said the mi­cro­bi­ol­o­gist, who has past ex­pe­ri­ence with PCR test­ing.

He said reg­u­lar busi­ness at the lab dur­ing the COVID mea­sures was al­ready down, forc­ing him to scale down his staff.

“I have peo­ple who are ow­ing me and not pay­ing, to in­vest in some­thing like this and not know­ing how this thing will spin-off, a cou­ple of friends who have been in busi­ness with me say we can­not re­al­ly go in­to this right now.”

Mar­i­on Seon, own­er of the Cen­tral Med­ical Lab­o­ra­to­ry in Port of Spain, said glob­al con­cerns about a con­sis­tent sup­ply of reagents mean­while made her hes­i­tant to pur­sue PCR test­ing.

Reagents are the main in­gre­di­ent in the chem­i­cal-based PCR test. De­mand for the chem­i­cal sub­stance has sky­rock­et­ed as coun­tries race to ramp up test­ing.

“You can’t just rush in­to some­thing to make mon­ey, peo­ple’s health is at stake,” Seon said.

She said even be­fore COVID-19, it was dif­fi­cult to es­tab­lish PCR test­ing be­cause it re­quires “a very ster­ile lab with iso­lat­ed sur­round­ings.”

A woman who op­er­ates a lab in east Trinidad but who asked not be iden­ti­fied said she does not own a PCR ma­chine and sees lit­tle need to pur­chase one.

“Based on how the re­quests have been, it isn’t worth­while,” the lab own­er said.

Two oth­er labs al­so in­di­cat­ed they had not ap­plied to the min­istry for per­mis­sion to con­duct COVID-19 test­ing.

How­ev­er, Cunu­pia-based Lab Med­ica Group CEO Richard Ram­rekha be­lieves pri­vate labs should not test for COVID-19 be­cause there would be lit­tle over­sight by pub­lic health of­fi­cials to en­sure all in­fec­tion pre­ven­tion con­trols are met.

“You know what those pri­vate labs will do? They will put it (a swab) in a black bag and throw it by the road­side and a dog will come and burst it up,” he said can­did­ly.

“Labs in this coun­try are not reg­u­lat­ed at all, no one in­spects labs. It is a high­ly un­reg­u­lat­ed prac­tice. The Min­istry of Health should not open that can of worms at all, there is no ac­count­abil­i­ty in the process.”

He not­ed that labs con­duct­ing PCR test­ing, es­pe­cial­ly for in­fec­tious dis­eases, must have prop­er stor­age when the pa­tient’s sam­ple is sent from the doc­tor to the lab, sep­a­rate rooms at the lab to con­duct dif­fer­ent phas­es of the PCR test­ing, a fume ex­trac­tor hood, con­stant sur­veil­lance test­ing for work­ers at the lab, and an in­cin­er­a­tor to dis­pose of sam­ples.

Ram­rekha said CARPHA can­not do field in­spec­tions, while the min­istry may not have the of­fi­cers to con­duct qual­i­ty as­sur­ance checks at pri­vate labs.

Val­i­da­tion process dis­or­gan­ised

Three pri­vate labs told the T&T Guardian they had ap­plied for val­i­da­tion clear­ance from the min­istry.

Pre­fer­ring not to be iden­ti­fied, di­rec­tors at a lab in east Trinidad ex­pressed frus­tra­tion with the ap­pli­ca­tion process, con­tend­ing it was un­clear and dis­or­gan­ised. The lab, which al­ready has a PCR ma­chine, sent doc­u­ments to both CARPHA and the Min­istry of Health. They claimed, how­ev­er, that feed­back from the min­istry has been slow and they re­ceived lit­tle in­for­ma­tion on whom they should li­aise with to get sta­tus up­dates.

Vic­to­ria Lab­o­ra­to­ries Lim­it­ed di­rec­tor Neil Ajod­ha mean­while said he re­quest­ed per­mis­sion from the min­istry’s Pub­lic Health De­part­ment rough­ly a week ago to have his PCR test­ing val­i­dat­ed. Vic­to­ria Lab­o­ra­to­ries has three PCR ma­chines and Ad­jod­ha said he was or­der­ing a fourth. He al­so hoped to re­ceive a ship­ment of the reagents next week.

“I’ve been try­ing to get the reagent since the out­break and I just couldn’t get at all. Word from the (sup­ply) com­pa­ny is that the US has tak­en all the kits and they are not get­ting them to ship to oth­er coun­tries,” Ajod­ha said.

“I am still wait­ing to see if I am go­ing to get the kits.”

He said he re­ceived an up­date from the min­istry about his ap­pli­ca­tion on Tues­day.

The lab di­rec­tor said his com­pa­ny had ex­ist­ing con­tracts with en­er­gy com­pa­nies to screen em­ploy­ees for oth­er ill­ness­es and he an­tic­i­pates in­ter­est in COVID-19 test­ing from such clients.

A third lab in San Juan con­firmed they too were seek­ing val­i­da­tion of their PCR test­ing “to help with the sit­u­a­tion.” A woman said the lab sub­mit­ted a “re­cent” ap­pli­ca­tion but de­clined to re­veal oth­er de­tails.

Deyals­ingh said yes­ter­day there was no stan­dard time frame for labs to re­ceive clear­ance to pro­ceed since each lab is at a dif­fer­ent stage of readi­ness.

“They (the min­istry) are say­ing the test kits have to be val­i­dat­ed by CARPHA but what I am speak­ing about is an en­tire process that needs to be in place,” Lab Med­ica Group CEO Richard Ram­rekha cau­tioned.

Two mem­bers of the UWI COVID-19 Task Force told the T&T Guardian last week that the coun­try needs to ex­pand and ac­cel­er­ate its test­ing to get enough da­ta to con­firm there was no com­mu­ni­ty spread of COVID-19.

The min­istry has start­ed sur­veil­lance test­ing at se­lect com­mu­ni­ty health cen­tres but Chief Med­ical Of­fi­cer Dr Roshan Paras­ram says that would on­ly amount to 40 to 50 ad­di­tion­al sam­ples test­ed each week. As of 4 pm yes­ter­day, the coun­try had sub­mit­ted 1,449 sam­ples to CARPHA for COVID-19 test­ing.