COVID-19: ICMR Releases New Covid Testing Guidelines; Why Is RT-PCR Not Required?

In its new testing guideline issued on Tuesday, the Indian Council of Medical Research (ICMR) mentioned that RT-PCR tests are no longer required in some cases. This statement comes forth amidst the Centre's continual request to states and Union territories to increase the proportion of RT-PCR tests to at least 70 per cent of all COVID-19 tests being conducted.

The new testing guidelines are declared with the aim of reducing the workload of the diagnostic laboratories in the country. The Centre said the over 2,500 labs in the country are working under immense pressure because of the rapidly growing caseloads.

India can test close to 15 lakh tests in its 2,506 molecular testing laboratories, including RT-PCR, TrueNat, CBNAAT and other similar platforms. But the continually hiking number of cases and laboratory staff testing positive have caused a delay.

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"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 Centre said in a circular to states [1].

According To ICMR, Here's When The RT-PCR Test Is Not Needed

• An individual has tested positive by rapid antigen test [2].
• An individual has tested positive once by an RT-PCR test.
• One has completed ten days home isolation period with no fever for the last three days.
• At the time of getting discharged from the hospital.
• A healthy individual is undertaking interstate domestic travel. (While this is a requirement imposed by states, ICMR said this could completely be removed to reduce the load on laboratories).

The guidelines also included the following:

• Non-essential travel of people with COVID-19 symptoms should be avoided to reduce the risk of infection.
• All asymptomatic individuals undertaking essential travel must follow COVID-appropriate behaviour.

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When Should One Take The RT-PCR Test?

According to the ICMR, if an individual identified as negative by Rapid Antigen Test continues to face symptoms of COVID-19, then the person should take an RT-PCR testing facility [3].

It was also added that the vaccine 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.

ICMR Recommends Rapid Antigen Testing (RAT)

With the number of cases increasing, the ICMR is recommending Rapid Antigen Testing for mass detection [4]. RAT may be allowed at all available government and private healthcare facilities in cities, towns, villages, offices, schools, colleges, community centres and other vacant spaces. Mobile testing laboratories are now available on the GeM portal. States are encouraged to augment RT-PCR testing through mobile systems. Drive through RAT facilities may also be created.

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"Rapid antigen tests 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 turnaround time of 15-30 minutes and 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 ten are on the GeM portal. To meet the overwhelming testing demand, it will be prudent to upscale testing using RATs," said ICMR [5].

But the looming concern over RAT for COVID-19 is that it can give a high number of false negatives because it is not as sensitive (accurate) as the standard RT-PCR tests used to accurately identify those infected. Thereby, a significant percentage of those infected pass the test as a false negative [6].

Who Should Be Considered A Suspect Case Of COVID-19?

In the current surge of COVID-19 cases, the ICMR says, any individual presenting with fever (with or 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 cause [7][8].

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On A Final Note...

Reports show that more people are now opting for CT scans that can detect signs of the infection in the lungs due to RT-PCR test results getting delayed by several days in the majority of the COVID-hit states.