A formula for disaster?
Some government-approved laboratories are using a single kit for RT-PCR testing of two samples for the novel coronavirus -- a novelty practice that several experts termed not only unscientific and unethical but also something that risks producing faulty results.
They even said it may allow the highly contagious virus to spread further.
The Daily Star found at least four laboratories doing such tests and officials of those facilities said they were following this practice due to an acute shortage of testing kits.
These lab officials claimed they have got the full support of the Directorate General of Health Services (DGHS) for employing this unconventional method.
They said they were getting similar results by using this method as achieved with the use of one kit for one test -- which is standard practice here and worldwide. The national guideline on Covid-19 test also recommends one kit for one sample.
A RT-PCR kit contains reagent, the main ingredient of this or any chemical test, which is prescribed for testing one sample. The officials of these four laboratories, however, say they are using half of the reagent in the kit for testing each sample.
Additionally, the national guideline on Covid-19 does not specify the amount of reagent required in a testing kit.
The Daily Star asked several experts in the field about this method but received a mixed response as to whether the practice is scientifically accurate.
"One kit is manufactured for one test. There is no scope of compromising reagents. If it is compromised, the result will be questionable," said Dr Jahidur Rahman, virologist and assistant professor at Shaheed Suhrawardy Medical College.
Be-Nazir Ahmed, former director (disease control) of DGHS, said from the perspective of laboratory science, without the approval of DGHS and without a standard operating procedure (SOP), such a practice is unscientific and unethical.
"It may give false results and it is not acceptable," he said.
Dr Jamal Uddin, virologist and public health specialist of National Institute of Preventive and Social Medicine (NIPSOM), however, claimed that the process is scientific and that the result does not vary if two tests are done using a single kit.
Asked whether any other country in the world uses this method, he said, "Probably India. The kit crisis is acute across the world and some other countries may use this technique, but we don't know."
Prof Dr Shakil Ahmed, in-charge of the Bangladesh Institute of Tropical and Infectious Diseases (BITID) laboratory, said a shortage of testing kits prompted them to use this method of conducting more testing with fewer kits.
He said Bangladesh Livestock Research Institute first initiated this method.
"They did a study first and found positive results. We followed them, and in our study, we also got similar results," said Prof Shakil.
However, the BITID lab study only had a sample size of 15 which they tested over three days.
When asked if the sample size was enough for taking such a crucial decision, he said, "As there is a shortage of testing kits, either I have to do fewer tests or go for more tests reducing the reagent used. I chose the second option."
Prof Shakil said they received 2,500 testing kits against their demand of 5,000 on July 2. BITID conducts around 200 tests each day.
Chattogram Medical College Hospital is also following the same practice but they declined to officially comment on the matter.
"DGHS has asked us to use the reagent of one kit for testing two samples and we are complying with the order," an official related to the testing process told The Daily Star, wishing not to be named.
The 300-bed Narayanganj Hospital also uses less reagent than normal when testing for Covid-19.
"We are getting good results. We are not facing any problems," said Goutam Roy, superintendent of the hospital.
The Chattogram Veterinary and Animal Sciences University (CVASU) Covid-19 testing lab is also using one kit for testing two samples. The facility tests around 200 samples per day.
"We came to know from our other colleagues that using half the reagent of a kit gives the same result. We talked to DGHS and DGHS officials said if it is effective, then to go for it as there is a shortage of kits," said Zonaed Siddiki, lab in-charge of CVASU.
Contacted, DGHS officials said they were aware of the practice but did not give any formal directives in this regard.
"A few labs are getting good results using a single kit for testing two samples. The issue is in our knowledge but we did not give any directives," Dr Ayesha Akhter, spokesperson of DGHS, said.
She also said those who are getting good results are following this practice and the remaining laboratories are following the regular process, i.e. one kit for one test.
Currently, 80 institutions countrywide are conducting Covid-19 tests. The average daily testing capacity in those facilities is between 13,000 and 19,000.
Bangladesh performs low in testing coverage in the region -- with 2,412 tests conducted per 1 million of the population -- which is lower than in India, Nepal, and Sri Lanka, according to a WHO country Covid-19 situation report last month.