WHY IS THE COST OF A TEST SWAB EXPENSIVE IN INDONESIA?

The swab-PCR test became a popular search during the COVID-19 pandemic. The negative results of this test are a prerequisite for traveling between cities, islands and also countries. The expensive cost of this test is widely discussed. The swab-PCR test cost ranging from 1.7 to 2.5 million rupiah per test, while for a Rapid test it only costs hundreds of thousands rupiah. The Swab-PCR test results will come out after 2 days while the rapid test only takes approximately 2 hours. Regarding of validity period, the swab-PCR test and rapid test are both valid for only 14 days. But why is the swab-PCR test so important?

The Swab-PCR test is the most accurate method of detecting SARS CoV-2 virus infection. These test results are referred to by the Gugus Tugas Percepatan Penanganan COVID-19 as “hasil PCR terkonfirmasi”. The concept is to detect the presence of SARS CoV-2 virus genetic material. The type of PCR used is Real-Time PCR (RT-PCR), different from conventional PCR. In addition to detecting the presence of viruses, RT-PCR is able to detect the number of viruses. Apart from the sophisticated capabilities of this tool, there are critical points in the process, including the sampling process, RT-PCR operations, and the availability of RT-PCR reagents. This is what makes this test expensive. Let's describe one by one.

Sampling by swab method

This technique is sampling by rubbing the swab on the nasopharynx through the nose or on the oropharynx by mouth (optional). SARS CoV-2 virus will be in the lungs during the period of infection and move from one person to another through a droplet bursts from the respiratory tract. Nasopharynx and oropharynx are the path for the virus in and out. This process certainly requires a lot of operational costs such as PPE health workers, swab tools and a sample container that is able to keep the sample from being damaged. Successful sampling will determine the results of the RT-PCR test.

RT-PCR Operations

Samples will be processed first to get viral genetic material in the form of RNA. In short, the swab sample is dissolved in buffer solvents to lysis the virus body, then the genetic material is separated in a special container. This process takes 1-2 hours for this sample to be ready for use.

RT-PCR machine is sold at tens to hundreds of millions of rupiah. It’s expensive. RT-PCR machines in laboratories generally have a testing capacity of 96 samples in 2-3 hours. The RT-PCR machine is equipped with a signal reader for the presence of specific genes that are amplified by reagents. Several genes in the SARS CoV-2 virus that are already targeted for detection are the RdRP gene, E gene and N genes. Positive or negative results are determined by the presence of this gene signal. If the signal is amplified it means that the amount of virus in sample is also high, and the test results will be positive.

In terms of laboratory facilities, This test is conducted in a laboratory with a minimum standard of Biosafety level 3 (BSL-3) to work on virus particles and BSL-2 if working on intact viruses. Meanwhile in Human Resources side, besides having to use PPE, lab skills and an understanding of the concept of biomolecules are important when conducting PCR tests. That requires huge investment and costs for the PCR testing facility.

RT-PCR reagent for SARS CoV-2

RT-PCR reagents are materials used during the PCR process. Commercial reagen sold in the form of a Kit (set). The kit is divided into a genetic material isolation kit and RT-PCR kit.

Isolation kits are reagents for taking the genetic material of the virus. Its contents include a solution for isolation of viral RNA and silica columns to purify viral RNA.

The RT-PCR kit will be available in the form of a master mix solution, which already contains the Reverse Transcriptase enzyme, the DNA polymerase enzyme, dNTP, probes and Forward (F) and Reverse (R) primers. This master mix reagent is the key to specific detection of the SARS CoV-2 Virus. Reverse Transcriptase is a enzyme converter from RNA to DNA, then DNA polymerase can amplify the target gene in the RT-PCR machine. dNTP is the raw material for amplification. The probe is a signal giver. Primer F and R will recognize the target gene.

Commercial RT-PCR kits are generally imported from abroad at high prices. The RT-PCR COVID-19 reagent price range is 14 million to 25 million rupiah per 25 samples, not including shipping costs and taxes. With so many requests from all over the world, availability of PCR reagents can also be an obstacle.

Indonesia has developed domestic RT-PCR kit production through PT. Biofarma. The primer component is made by adjusting the target gene sequence according to the virus that spreads in Indonesia. This will give hope of increasing the accuracy of detection of the CoV-2 SARS virus in Indonesia and will certainly be cheaper if it is produced by our country.