India allows testing on demand for Covid-19
The Indian Council of Medical Research (ICMR) has allowed testing on-demand for Covid-19 even as it has allowed states to adapt to the recommendation as per their requirements. “ICMR’s advisory is generic in nature and may be modified as per the discretion of state health authorities,” said the national research agency in its advisory.
The advisory came after the Delhi high court asked the state government to re-strategise its policy to include asymptomatic patients for testing. ICMR told the court it is just an advisory body and states were free to make changes as per their needs.
Rapid antigen testing (RAT) is the preferred strategy for screening in Covid-19 containment zones. People with influenza-like illnesses, all direct and high-risk contacts (family members, colleagues, those above 65, immunocompromised, or have conditions such as diabetes, hypertension, or heart, kidney, and lung diseases), are required to be screened.
The new strategy lists situations where molecular testing such as reverse transcription-polymerase chain reaction (RT-PCR) should be preferred over the cheaper and faster but less accurate RAT. “Ideally, it is suggested that 100% of people living in the containment zones should be tested by RAT particularly in cities where there has been a widespread transmission of the infection,” say ICMR guidelines.
In non-containment areas, the ICMR strategy suggests that preference should be given to molecular methods to test all those with influenza-like symptoms, all symptomatic contacts of confirmed cases, and all asymptomatic high-risk contacts. Testing methods like RT-PCR should also be used for routine surveillance of all symptomatic travellers within seven days of illness and healthcare or frontline workers involved in Covid-19 management.
The ICMR strategy says that molecular tests should be preferred over RAT within hospitals for testing those with severe acute respiratory infections, all patients with influenza-like symptoms, all asymptomatic high-risk contacts in need of hospitalisation, asymptomatic patients undergoing surgery or other invasive procedures, and all pregnant women in or near labour.
The guidelines say that no emergency procedure should be delayed for the want of a test.
Hospitals have been directed not to refuse admission to pregnant women citing lack of testing facility. “All arrangements should be made to collect and transfer samples to a testing facility. Mothers, who test positive for the infection, have been advised to wear masks, wash hands frequently while handling babies, and cleaning breasts before feeding them.
The ICMR guidelines say all neonates with acute respiratory or sepsis-like illnesses– or those with non-respiratory symptoms such as fever, lethargy, poor feeding, seizures, and diarrhoea -- should be tested for Covid-19 using RT-PCR.
The strategy also suggests testing those with the atypical presentations for Covid-19 such as stroke, encephalitis, blood mixed sputum, pulmonary embolism, acute heart conditions, etc.