Medical experts hail ICMR’s move to relax testing guidelines though a large number of asymptomatic contacts stand to be excluded
Medical experts have hailed the move by the Indian Council of Medical Research (ICMR) to relax guidelines for novel coronavirus disease (COVID-19) testing, even though it will exclude a large number of asymptomatic contacts.
Asymptomatic contacts of those who have tested positive for the SARS-CoV-2 virus are no longer required to get tested, unless they fall under the high-risk category based on age or comorbidities, according to the new guidelines.
“This is no longer about finding all who were in contact with a COVID-19 positive person and testing them,” Gagandeep Kang, a virologist at the Christian Medical College-Vellore, told Down To Earth.
Kang, who is an ex-officio member of a working group on COVID-19 vaccines established by the Strategic Advisory Group of Experts at the World Health Organization since 2020, added:
We are already missing nine out of 10 asymptomatic infections in any case. The difference between total cases till now and the result of serosurveys conducted till now indicates that.
K Srinath Reddy, president of the Public Health Foundation of India, agreed. The treatment of an asymptomatic person who came in contact with a COVID-19 positive patient does not change with their test result, he said.
They must continue to isolate for a few days, wear a mask and practice physical distancing whether they are positive or negative for the SARS-CoV-2 virus.
“Any diagnostic test should be conducted only when the management of the patient depends on the test result. In situations where the decision is not driven or will remain the same, the test is not required,” Reddy said.
He added that the aim of testing now is to identify those who can fall severely ill and to detect the emergence or entrance of a new variant.
Kang argued that testing contacts of COVID-19 patients was not helping stop the spread of the virus.
“We must test people in a defined strategy so as to have a handle on what is happening outside the population of symptomatic individuals. Every disease has its strategy for what gives you the maximum information for the least amount of resources. I believe we finally have a strategy that is more reasonable for the time that we are in today,” she said.
T Jacob John, a retired professor of clinical virology at CMC-Vellore, said testing asymptomatic contacts now will not result in any dampening of the spread. He said it was more important to prepare for those who were likely be hospitalised.
Testing, now, should be driven by the clinical status of the patient and comorbidities, experts argue. If conducting an RT-PCR test was an easy and quick process that did not burden the system, there is no harm in testing everyone, Reddy said.
He added that the idea of conserving testing resources and not overloading diagnostic labs made sense.
Reports have revealed that the sale of self-testing kits have spiked, while RT-PCR tests are also taking time — in terms of sample collection and result, indicating that the system is stressed.
This, said Chandramouli Bhattacharya, an infectious diseases expert with Kolkata’s Peerless Hospital, could be the reason behind these relaxed guidelines. “From a purely scientific perspective, I don’t think this is the correct policy,” he told DTE.
ICMR also noted in its guidelines that “genome sequencing is done for surveillance purposes and is not required to be undertaken for treatment purposes.”
Here, Kang disagrees with them. “The decision to administer a monoclonal antibody depends on what variant one is infected with, thereby requiring genome sequencing for treatment,” she said.
On genome sequencing for surveillance purposes, not everyone needs to be tested. At present, we are testing people who are being hospitalised, those who are reporting a clinical illness of some kind and those who are entering India internationally. We have enough samples to test if a new variant is emerging or entering the country.
Other changes in the guidelines include no need for a test of asymptomatic people in community settings, after discharge from home isolation or hospitalisation and those traveling from one state to another.
The guidelines also stress that no medical procedure should be delayed and no patient should be transferred from one facility to another due to delay in or lack of testing. Those undergoing surgeries need not be tested unless they show symptoms.
The test that can be use according to the guidelines are: RT-PCR, TrueNat, CBNAAT, CRISPR, RT-LAMP, Rapid Molecular Testing Systems or through Rapid Antigen Test (RAT).
If a RAT comes positive, it should be considered confirmatory requiring no repeat tests. If it’s negative and the patient is symptomatic, an RT-PCR test should be undertaken.
India has recorded 0.168 million new COVID-19 cases and 277 deaths in the past 24 hours — a 6.4 per cent drop since the day before.
The country’s current active caseload stands at 8,21,446. There are, at present, 4,461 omicron cases across the country. Cases have been on a steep incline since the past few weeks.
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