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India sets out new approach to Covid testing as second wave overwhelms system

<p>The guidelines came after the central government has been criticised for low testing numbers in recent days</p> (AFP via Getty Images)

The guidelines came after the central government has been criticised for low testing numbers in recent days

(AFP via Getty Images)

India has issued new guidelines for the testing of Covid-19 to ease pressure on diagnostic laboratories which are struggling due to an increased caseload as the country grapples with a second wave of the pandemic.

An advisory by the Indian Council of Medical Research (ICMR) said that RT-PCR tests must not be repeated on any individual who has already tested positive for the virus once, either through rapid antigen test or through RT-PCR.

It also said that testing is not required for individuals who have recovered from Covid-19 at the time of hospital discharge, in accordance with the health ministry policy.

ICMR suggested that 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 ICMR guidelines came after the central government has been criticised for its low testing numbers in recent days. Experts said the drop in India’s coronavirus cases earlier this week could have been due to lower testing numbers.

Daily testing had fallen sharply to 1.5 million on 4 May, off a peak of 1.95 million on 30 April.

India increased testing on Wednesday and tested more than 1.9 million samples. The country reported 412,262 new Covid-19 cases in the 24 hours ending Thursday morning, taking the total to over 21 million. A record 3,980 deaths were reported.

Experts told The Independent that the new guidelines will help at a time when the laboratories are under stress and to clear the backlog.

“The new testing guidelines are useful to find true cases in a rapid way with low cost and quick turnaround time of results. Higher TAT (turnaround time), random testing, and people rushing to get tested under fear or for inter-state travel have created huge backlogs and delays in getting results of RT-PCR,” said Usha Manjunath, director of the Bengaluru-based Institute of Health Management Research (IIHMR).

She said the delay increases the transmission because people tend to wait for results before quarantining or isolating.

Gautam Menon, professor at Ashoka University, also told The Independent that he is broadly in agreement with the new guidelines. “At a time when testing is under stress, while ramping RT-PCR testing up, it makes sense to ensure that resources are not diverted where they needn’t be,” he said.

He said the requirement of RT-PCR test before inter-state travel, when there are no symptoms in an individual, may be an overkill at this point.

The ICMR also suggested that rapid antigen tests be used to upscale testing amid growing demand: “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.”

There have been concerns that antigen tests, which are currently being used in containment zones, have a high proportion of false negatives. But experts said the use of antigen tests can help boost India’s testing capacity.

“Unlike in the first wave period, people are crowding up in the hospitals even with mild symptoms. This brings strain on the existing healthcare system and severely infected cases do not get the required medical support. Thus, increasing antigen tests without compromising the number of RT-PCR tests we are currently undertaking is fine,” said Lekha D Bhat, assistant professor in the department of epidemiology and public health at the Central University of Tamil Nadu.

However, she said the effort should be to increase both RT-PCR and antigen tests by identifying potential stakeholders. Universities, college laboratories and other laboratories need to be encouraged to get approval from ICMR for testing, she said.

Mr Menon said he “has always been a proponent of RAT tests employed at a much larger scale – their quick turn-around time compared to RT-PCRs, the fact that they are relatively less expensive and thus more easily affordable by states as well as the fact that testing facilities can be easily set up in public locations are genuine advantages.”

Ms Manjunath also said it is prudent to ramp up testing using antigen tests because they yield results in a short time and can help in quickly providing treatment to Covid-19 patients.

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