COVID Update, May 4: Amid an alarming surge in coronavirus cases in the country, the Indian Council of Medical Research (ICMR) on Tuesday recommended measures to optimize RT-PCR testing, suggesting that RT-PCR tests must not be required for domestic travel if an individual is healthy.

Stating that laboratories are presently “facing challenges” to meet the expected testing target due to the “extraordinary caseload”, the ICMR said that optimizing the RTPCR testing and increasing the availability of testing to all citizens is important.

An unprecedented upsurge of COVID-19 cases and deaths are currently being witnessed across India. The overall nationwide test positivity rate is above 20%. As of today, India has a total of 2506 molecular testing laboratories including RTPCR, TrueNat, CBNAAT, and other platforms,” the ICMR said.

The medical research regulator also stressed that “testing-tracking-tracing, isolation and home-based treatment” of positive patients is the key measure to curb transmission of the viral disease.

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 caseload and staff getting infected with COVID-19. In view of In this situation, it is imperative to optimize the RTPCR testing and simultaneously increase the access and availability of testing to all citizens of the country,” it said in a statement.


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Recommended measures to optimize RTPCR testing

  1. RTPCR test must not be repeated in any individual who has tested positive once either by RAT or RTPCR.
  2. No testing is required for COVID-19 recovered individuals at the time of hospital discharge in accordance with the discharge policy of MoH&FW (https://www.mohfw.gov.in/pdf/ReviseddischargePolicyforCOVID19.pdf).
  3. The need for RT-PCR test in healthy individuals undertaking inter-state domestic travel may be completely removed to reduce the load on laboratories.
  4. 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.
  5. All asymptomatic individuals undertaking essential travel must follow COVID appropriate behaviour.
  6. Mobile testing laboratories are now available on the GeM portal. States are encouraged to augment RTPCR testing through mobile systems.

 

Measures to improve access and availability of testing:

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 health care settings. RAT has a short turn-around time of 15-30 minutes and thus offers a huge advantage of quick detection of cases and the opportunity to isolate and treat them early for curbing transmission.

So far, ICMR has approved 36 RATs of which 10 are on the GeM portal. To meet the overwhelming testing demand, it will be prudent to upscale testing using RATs.

 

Measures to ramp up testing through RAT:

  1. RAT may be allowed at all available government and private healthcare facilities.
  2. Set up dedicated RAT booths in cities, towns, and villages to offer to test to people.
  3. Testing booths may be set up at multiple locations including healthcare facilities, RWA, offices, schools, colleges, community centres, and other available vacant spaces.
  4. These booths should be operational on a 24X7 basis to improve access and availability of testing.
  5. Drive – through RAT testing facilities may be created at convenient locations as identified by the local administration.
  6. Stringent measures must be instituted to avoid overcrowding at RAT testing facilities.

 

Additional advice by ICMR on RT-PCR Domestic Travel

  • All states are advised to ensure full utilization of the available RTPCR testing capacity, both in public and private laboratories.
  • RAT testing must be conducted in compliance with the ICMR advisory available at: https://www.icmr.gov.in/pdf/covid/strategy/Testing_Strategy_v6_04092020.pdf
  • Symptomatic individuals identified positively by RAT should not be re-tested and advised to go through home-based care as per ICMR guidelines available at: https://www.icmr.gov.in/pdf/covid/techdoc/COVID_HOME_CARE.pdf
  • Symptomatic individuals identified negative by RAT should be linked with the RTPCR test facility and in the meantime be urged to follow home isolation and treatment.
  • All RTPCR and RAT test results should be uploaded on the ICMR portal at: https://cvstatus.icmr.gov.in
  • During the current upsurge of COVID-19 cases, any individual presenting with fever with/without cough, headache, sore throat, breathlessness, body ache, the recent loss of taste or smell, fatigue and diarrhoea should be considered as a suspect case of COVID-19 unless proven otherwise by confirmation of another aetiology.
  • The vaccination status of all individuals tested for COVID-19 must be entered into the Sample Referral Form (SRF) in the RTPCR app both for individuals tested by RTPCR and RAT. This information is of critical importance.
  • Payment modalities for upscaled RAT testing may be decided by the state health authorities.