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In the beginning, the Virology Unit, Infectious Disease Research Centre, Institute for Medical Research (IMR), Ministry of Health Malaysia was the sole laboratory involved in conducting diagnostic tests for the detection of the 2019-nCoV virus in Malaysia. The laboratory had initiated preparedness for any possible transmission of the 2019-nCoV virus to Malaysia on 3 January 2020, by setting up reagents to detect coronavirus using the Conventional RT-PCR method.
Subsequently, on 11 January 2020, scientists from China released the genetic information of the 2019-nCoV virus in a shared database. This information allowed the officers from the Virology Unit to design reagent sequences known as primers and probes specific for 2019-nCoV on the same day. A few days later, the World Health Organization (WHO) also published a protocol for the 2019-nCoV Real-time RT-PCR test, which is almost similar to the one used by IMR.
Reagents to identify the 2019-nCoV virus arrived at the laboratory in IMR on 21 January 2020. At the same time, the University Malaya Medical Centre (UMMC) shared RNA extracts from a killed virus isolate belonging to the same family as the 2019-nCoV virus, to be utilized as a positive control for the test.
Officers from IMR had successfully optimized the real-time RT-PCR 2019-nCoV on 22 January 2020, and these reagents were provided to the National Public Health Laboratory (NPHL), Sungai Buloh on 24 January 2020, to enable successful identification of the first confirmed case of 2019-nCoV among close contacts. On 25 January 2020, IMR also identified the first positive case among patients-under-investigations (PUI).
Subsequently, on 30 January 2020, the IMR conducted training on the real-time RT-PCR 2019-nCoV for 12 Ministry of Health Malaysia hospital laboratories, NPHL Sungai Buloh, PHL Ipoh, PHL Kota Kinabalu, PHL Kota Bahru and PHL Johor Bahru. Currently, the NPHL Sungai Buloh and other Public Health Laboratories test for the close contacts of positive cases. This laboratory capacity has also been expanded to private laboratory chains through related training conducted by the NPHL Sungai Buloh on 6 February 2020.
Every day (including public holidays), the on-call staff prepare to receive samples from the hospitals as early as 7 am. The samples are processed immediately and then subjected to Real-time RT-PCR for 2019-nCoV. This is to ensure that the results can be released within 24 hours even though most of the time, these results are made ready much earlier. Staff are only allowed to conduct tests after undergoing competency tests. They are also trained on the appropriate technique of wearing personnel protective equipment (PPE).
In brief, samples from hospitals are received by staff and recorded in the logbook. The samples will then be taken to the Biosafety Level 2 (BSL2) laboratory and aliquoted in small volume, which will then be subjected to inactivation of the virus, followed by Real-time RT-PCR 2019-nCoV testing. The officer-on-call will be responsible for releasing the result to requesting hospital.
Congratulations and kudos to all the dedicated staff in IMR, all PHLs and hospital laboratories who work tirelessly behind the scenes throughout the day and night in the face of the 2019-nCoV threat. You are unsung heroes performing a critical task for the sake of our nation’s public health and national security, yet hidden from the public eye. Thank you once again.
Datuk Dr Noor Hisham Abdullah
Director General of Health Malaysia
9 February 2020