ICMR issues an Advisory on Strategy for COVID-19 Testing in India

The Indian Council of Medical Research has released an advisory on strategy for COVID-19 testing in the country. This is the 6^th version of the advisory and is dated 4^th September 2020.

The advisory caters to the screening of COVID-19 in the following manner:

Surveillance in containment zones and screening at points of entry

For the purpose of containment zones and points of entry the choice of tests in their order of priority is as follows:

1. Rapid Antigen Test (RAT)
2. RT-PCR or TrueNat or CBNAAT

Additionally, the following cases must be screened through the above tests:

1.  Influenza-Like Illness (ILI) symptomatic cases including Health Care Workers (HCWs) or Frontline Workers must be screened.
2. All asymptomatic persons having direct and high-risk contact with a laboratory-confirmed case must be tested once between day 5 and day 10 of coming into contact and
3.  All asymptomatic high-risk individuals.

High-risk individuals are those aged 65 or more years or those suffering from co-morbidities, immunocompromises, etc. High-risk contact involves contact with confirmed cases by such high- risk individuals or the family members or co-workers who have come in contact with such confirmed cases.

The advisory suggests that all people living in containment zones should be tested by RAT particularly in cities where there has been widespread transmission of infection.

Routine surveillance in non-containment areas

For the purpose of containment areas the priority of tests is as follows:

1. RT-PCR or TrueNat or CBNAAT
2. Rapid Antigen Test (RAT)

Additionally, the following ILI symptomatic cases must be screened through the above tests:

1. Cases with a history of international travel in the last 14 days.
2. Contact with confirmed laboratory cases
3. HCWs and Frontline Workers involved in containment and mitigation activities
4. Cases among returnees/ migrants within 7 days of illness

However, in the case of asymptomatic high-risk contacts, the advisory recommends RAT as the first choice of test in the order of priority.

Surveillance in Hospitals

For the purpose of hospitals the priority of tests is as follows:

1. RT-PCR or TrueNat or CBNAAT
2. Rapid Antigen Test (RAT)

Additionally, the following cases must be screened through the above tests:

1. Patients with Severe Acute Respiratory Infection (SARI)
2. ILI symptomatic patients
3. Hospitalised high-risk patients
4. Asymptomatic patients undergoing surgical / non-surgical invasive procedures
5. Hospitalized pregnant women in/near labor
6. Symptomatic neonates presenting with acute respiratory / sepsis-like illness
7. Patients presenting with atypical manifestations will be tested as per the discretion of the physician.  

Testing on demand

All individuals undertaking travel to countries/Indian states mandating a negative COVID-19 test at the point of entry can get themselves tested. The advisory also permits testing of individuals who wish to get themselves tested.

The advisory also states the definitions of ILI and SARI as per WHO. It reiterates the need for HCWs to wear PPEs and provides an algorithm for COVID-19 test interpretation using RAT.