Delhi to scale up rapid antigen testing in labs and hospitals
The state health department issued these directions on Monday after the Indian Council of Medical Research (ICMR) released a fresh set of guidelines asking states to increase Covid-19 testing.Updated: Jun 30, 2020 04:03 IST
The Delhi government has asked all hospitals and Covid-19 testing laboratories in the national Capital to start rapid antigen detection tests to scale up its ongoing process of identifying symptomatic patients and isolating them immediately. To further increase testing across the city, all district magistrates (DMs) have also been asked to set up at least seven more antigen testing centres in each of the 11 districts and double their daily testing target to 2,000, senior government officials said on Monday.
The state health department issued these directions on Monday after the Indian Council of Medical Research (ICMR) released a fresh set of guidelines asking states to increase Covid-19 testing. Even private hospitals and Covid-19 testing labs will have to provide the facility of rapid antigen testing, a health department official said on condition of anonymity.
So far, antigen detection tests were being administered to high-risk contacts and those living in containment zones. But with the latest directive, antigen detection tests will be administered to all.
“The Union ministry of home affairs has directed to double antigen tests in Delhi from the current target of 1,000 tests per day per district to 2,000. Delhi currently has 193 rapid antigen testing centres. Today, we have also asked all district magistrates to increase the number of their antigen testing centres to a total of 250, especially near the new containment zones. This means at least seven more antigen testing centres per district will have to be set up immediately. The health department has enough testing kits available for this purpose,” the official said. The Delhi government had recently procured at least 6 lakh antigen detection kits, which cost ₹450 per kit as compared to ₹2,400 for an RT-PCR test kit.
Rapid antigen detection tests are quicker (they take a maximum of 30 minutes to show results compared to an RT-PCR test’s 2-5 hours) and are non-confirmatory. This means that those who test positive through rapid antigen detection tests are considered “truly positive” for Covid-19 and do not have to undertake an RT-PCR test. But, those who test negative are then tested through the RT-PCR test for re-confirmation.
Jugal Kishore, the head of community medicines department in Safdarjung hospital, said making rapid antigen tests available on a massive scale will decrease the high demand for the RT-PCR test which is considered the gold standard of Covid-19 testing.
“The performance of the rapid antigen kits has been very good. Its specificity rate has been over 90% or so, which makes it an excellent tool to identify true positive cases. As a result, the number of people who actually need RT-PCR tests, which requires a high-grade testing lab, is much lower. With this, we won’t see a repeat of the phase we saw about a month back when people were finding it very difficult to get a Covid-19 test done because only RT-PCR kits were being used and the labs were overburdened with samples,” Kishore said.
On Sunday, Delhi’s director general of health services (DGHS) issued an order asking all stakeholders to “strictly follow the advisory issued by the ICMR to increase the outreach of testing”. In its guidelines issued on June 23, the ICMR stated that the rapid antigen test, also known as rapid point-of-care (PoC) test, should be conducted in containment zones, all central and state government hospitals and medical colleges, all private hospitals approved by NABH and all private labs accredited by NABL and approved by the ICMR for Covid-19 testing. It also stated that hospitals and labs intending to perform the test will have to register with ICMR to obtain the login credentials for data entry. “All data of testing needs to be entered into the ICMR portal on a real-time basis. The portal has been modified to include a component on antigen testing,” the ICMR’s rules read.
A senior government official said the testing kits will be used for all symptomatic people with influenza-like illness in containment zones or hot spots, asymptomatic direct and high-risk contacts with co-morbidities of confirmed cases. In hospitals, the kits will be used for all symptomatic Influenza-Like Illness (ILI) patients, asymptomatic patients who are hospitalised or seeking hospitalisation for chemotherapy and transplants or those who are over the age of 65 years with co-morbidities.
Standard Q COVID-19 Ag detection assay by a Korean company, SD Biosensor, is the standalone antigen detection test that is available in India and has been validated by ICMR.
This is the first such rapid test in the world that can be used for Covid-19 diagnosis as positive cases need not be confirmed through an RT-PCR test. These kits will have a wider reach as analysing samples will not require advanced biosafety level 2 labs that may not be available in all places, especially remote villages.
However, some labs seem to be reluctant to conduct antigen-based tests as the sample needs to be processed within a stipulated time frame otherwise it is rendered useless.
“You have to process the sample within an hour of collection, which makes it near impossible to bring it to the lab in time. It’s a point-of-care test that needs to be analysed on the spot for which a set-up needs to be established right at the spot. This is not a feasible idea for us,” a representative of a private lab in Delhi NCR said.