As India continues to witness a rise in the number of cases of COVID-19, the Union Health Ministry has released a containment plan in the event of a large outbreak of the disease as well as an advisory on antibody testing guidelines. In two separate notices, the Union Health Ministry issued guidelines for testing using rapid antibody-based tests and also detailed a plan of containment in the event of a large outbreak.
Rapid testing kits are largely advised for use in areas where there are large clusters of cases of coronavirus disease and in “large migration gatherings” or “evacuation centres,” as per the advisory issued by the government. As a precaution, anyone with flu-like (influenza-like illnesses or ILI) symptoms is advised to stay home and quarantine themselves for a minimum of 14 days. If the condition doesn’t improve, they should visit a hospital for further testing.
At the hospitals or testing centres, individuals who fall under the ILI category will be subject to rapid antibody testing as per government protocols.
Antibody based rapid testing kits are used to determine if someone has had recent exposure to coronavirus. If the antibody to the virus is present in an individual’s blood sample, further tests are required to determine whether the individual is in fact at a risk of developing COVID-19.
In areas where there may be large clusters of cases, people will be categorized based on the history and symptoms they give. An antibody test will be done to determine if there has been any recent exposure to the virus. If this test returns positive, a doctor will examine the individual and determine if they require home isolation or if they need to be admitted to a hospital for the same.
If the antibody test is negative, but the individual has relevant history or has flu-like symptoms, then a nasal or throat swab is done and real-time polymerase chain reaction (RT-PCR) test done. The RT-PCR is the standard test used to determine if someone is COVID-19 positive or not. Should the sample return negative, then the person is said to be suffering from a non-COVID-19 influenza and are advised to rest at home. If the RT-PCR is positive, the individual will be admitted to the isolation ward at a hospital, or may be advised to home quarantine if their symptoms are relatively mild.
So what if someone’s antibody test returns negative but they have no relevant symptoms or history? In this case, an RT-PCR is not required and the individual is asked to quarantine themselves at home for 10 days. The antibody test is repeated after the 10 day home quarantine period to further determine what course of action to take.
Source: Ministry of Health and Family Welfare
The other advisory issued by the health ministry explains the specific steps to be taken towards containment of COVID-19 in the event that the outbreak worsens and more cases are seen.
Of these, four steps: geographic quarantine, cluster-containing strategies, laboratory support and hospital care have been emphasised upon.
Geographic quarantine essentially aims to close off the area in which there have been positive cases reported and aims to “erect a barrier around the focus of the infection.” As per the health ministry, similar efforts were taken to contain the spread of H1N1 (swine flu) pandemic and were met with success. Districts and areas adjacent to affected places are marked as ‘buffer zones’.
Emergency response teams have been advised to be ready and offer any support required to the states.
Contact tracing and other extensive surveillance measures are to be implemented to keep a strict track of the cases of Severe Acute Respiratory Illnesses (SARI) which are reported. SARI can be the result of an underlying infection with the novel coronavirus or could be due to any other pathogen as well.
“The identified VRDL (Virus Research and Diagnostic Laboratory) network laboratories and designated private laboratories nearest to the affected area, will be further strengthened to test samples. The other available government laboratories and private laboratories (BSL 2 following BSL 3 precautions) shall also be engaged to collect/ test samples, after ensuring quality assurance by ICMR/VRDL network,” reads the release of the laboratory centres. Samples will be sent to an Indian Council of Medical Research (ICMR) approved lab, such as National Institute of Virology (NIV) in Pune, for testing. Results must be made available within 12 to 24 hours as per the government’s advisory.
Hospital facilities must have enough capacity to accommodate for both confirmed and suspected cases who require isolation and treatment. Safety protocols for disinfection and the use of PPE must also be mandated.
Other containment efforts such as practicing social distancing, closing of schools, colleges and other public places are also to be implemented.