An unprecedented upsurge of COVID-19 cases and deaths is currently being witnessed across India. The overall nationwide test positivity rate is above 20%. Testing-tracking-tracing, isolation and home-based treatment of positive patients is the key measure to curb transmission of SARS-CoV-2, the causative agent of COVID-19.

As of Tuesday, India has a total of 2506 molecular testing laboratories including RTPCR, TrueNat, CBNAAT and other platforms. 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 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.

Recommended measures to optimize RTPCR testing: 

RTPCR test “must not be repeated in any individual who has tested positive once either by RAT or RTPCR”.

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

The need for RTPCR test in healthy individuals undertaking inter-state domestic travel may be completely removed to reduce the load on laboratories.

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.

All asymptomatic individuals undertaking essential travel must follow COVID appropriate behaviour.

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

Measures to ramp up testing through RAT 

RAT may be allowed at all available Government and private healthcare facilities.

Set up dedicated RAT booths in cities, towns and villages to offer testing to people.

Testing booths may be set up at multiple locations including healthcare facilities, RWA, offices, schools, colleges, community centers and other available vacant spaces.

These booths should be operational on a 24X7 basis to improve access and availability of testing.

Drive-through  RAT  testing facilities may be created at convenient locations as identified by the local administration.

Stringent measures must be instituted to avoid overcrowding at RAT testing facilities.

Additional advice  

• 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 positive 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 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 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, recent loss of taste or smell, fatigue and diarrhoea should be considered as suspect case of COVID-19 unless proven otherwise by confirmation of another etiology.
• 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.