The need for RT-PCR test in healthy individuals undertaking inter-state domestic travel may be completely removed to reduce the load on laboratories, recommended an ICMR advisory for COVID-19 testing during the second wave of the pandemic. The advisory stated that RT-PCR test must not be repeated in any individual who has tested positive once either by RAT or RT-PCR and that testing is not required for COVID-19 recovered individuals at the time of hospital discharge in accordance with the discharge policy of the Ministry of Health.
The advisory was issued in view of laboratories facing challenges to meet the expected testing target due to extraordinary case load and staff getting infected with COVID-19. The apex health research body also recommended upscaling testing using RATs and stated that RAT may be allowed at all available government and private healthcare facilities and setting up dedicated RAT booths in cities, towns and villages to offer testing to people.
"The RT-PCR test must not be repeated in any individual who has tested positive once either by RAT or RT-PCR. The need for RT-PCR test in healthy individuals undertaking inter-state domestic travel may be completely removed to reduce the load on laboratories," the advisory recommended. Non-essential travel and interstate travel of symptomatic individuals (COVID-19 or flu- like symptoms) should be essentially avoided to reduce the risk of infection and that all asymptomatic individuals undertaking essential travel must follow COVID appropriate behaviour, it stated.
An unprecedented upsurge of COVID-19 cases and deaths is currently being witnessed across India. The overall nationwide test positivity rate is above 20 per cent, the ICMR said. Testing-tracking-tracing, isolation and home-based treatment of positive patients is the key measure to curb transmission of SARS-CoV-2, the causative agent of COVID-19.
As of May 4, India has a total of 2,506 molecular testing laboratories, including RT-PCR, TrueNat, CBNAAT and other platforms. The total daily national testing capacity is close to 15 lakh tests considering a three-shift operationalization of the existing laboratory network.
"At present, the laboratories are facing challenges to meet the expected testing target due to extraordinary case load and staff getting infected with COVID-19. In view of this situation, it is imperative to optimize the RT-PCR testing and simultaneously increase the access and availability of testing to all citizens of the country," the apex health research body said.
Further, the ICMR said rapid antigen tests (RATs) were recommended in India for COVID-19 testing in June 2020. However, the use of these tests is currently limited to containment zones and healthcare settings. RAT has a short turnaround time of 15-30 minutes and thus offers a huge advantage of quick detection of cases and opportunity to isolate and treat them early for curbing transmission.
So far, the ICMR has approved 36 RATs of which 10 are on GeM portal. To meet the overwhelming testing demand, it will be prudent to upscale testing using RATs, the advisory said.
Listing the measures to ramp up testing through RAT, the advisory stated, testing booths may be set up at multiple locations, including healthcare facilities, RWAs, offices, schools, colleges, community centers and other available vacant spaces.
These booths should be operational on a 24X7 basis to improve access and availability of testing. Drive-through RAT testing facilities may be created at convenient locations as identified by local administration and stringent measures must be instituted to avoid overcrowding at RAT testing facilities, the ICMR stated.
The ICMR also advised all states to ensure full utilization of the available RT-PCR testing capacity, both in public and private laboratories, and added that symptomatic individuals identified positive by RAT should not be re-tested and advised to go through home-based care as per ICMR guidelines.
Symptomatic individuals identified negative by RAT should be linked with R-TPCR test facility and in the meantime be urged to follow home isolation and treatment.
During the current upsurge of COVID-19 cases, any individual presenting with fever with/without cough, headache, sore throat, breathlessness, bodyache, recent loss of taste or smell, fatigue and diarrhea should be considered as suspect case of COVID-19 unless proven otherwise by confirmation of another etiology, the advisory said.
The vaccination status of all individuals tested for COVID-19 must be entered into the Sample Referral Form (SRF) in the RT-PCR app, both for individuals tested by RT-PCR and RAT. This information is of critical importance, the advisory said.