A doctor’s prescription will no longer be required for people to get a Covid-19 test, the Indian Council of Medical Research (ICMR) said in its revised testing advisory to states on Saturday, paving the way for walk-in tests.
The move comes after a prod by the Delhi high court that asked why people who show no symptoms of the disease – which can be a large proportion of Covid-19 patients – cannot get a test. The rule until now required people to either have flu-like symptoms or come in close contact with an infected person, following which a doctor could issue a prescription for a test.
“The new guidelines will allow people to get tested for Covid-19 without any prescription. The guidelines also say that states can have their own “simplified modalities” for testing. What this means is that states cannot put in any restrictive requirements on testing. There were some states where people needed a chief medical officer or someone to certify that they needed the test; those restrictions will have to be removed,” said a senior official from the Union health ministry, asking not to be named.
“ICMR’s advisory is generic in nature and may be modified as per the discretion of state health authorities,” said the advisory. In a Delhi HC hearing over improving testing in the Capital, the ICMR stated on September 3 it was just an advisory body and states were free to make changes as per their needs.
“With the new strategy, the doctors will be a little freer in ordering testing. Influenza-like illnesses was too restrictive a category for testing, especially as many patients with Covid-19 are asymptomatic. Clinical testing or depending on a doctor’s judgement should have been allowed a long time ago. This is what is good for medical care,” said Dr Jacob John, former professor of virology at Christian Medical College in Vellore.
He added that the government should now move to an approach where patients with Covid-19-like symptoms living in an area where the disease is in transmission should be considered a positive case and treated as such.
The guidelines also suggest testing those with atypical presentation for Covid-19 such as stroke, encephalitis, blood mixed sputum, pulmonary embolism, acute heart conditions, and Guillain-Barre syndrome (a condition where the body’s immune system attacks the nerves causing weakness in legs, multiple organ dysfunction, progressive gastrointestinal symptoms, and inflammatory disease ) in paediatric patients.
“The new guidelines make testing more freely available and this decision has been taken after ramping up India’s testing capacity to over a million a day,” the ministry official quoted above said.
Dr Lalit Kant, former head of epidemiology at Indian Council of Medical Research, said that the non-ambiguous guidelines will help resolve many systemic issues. “This will make testing more accessible. Although, this was even true earlier, but the clear-cut guidelines on who to test in a hospital or when to do an RT-PCR is helpful in addressing any ambiguities. Like in Delhi, we should increase RT-PCR testing (elsewhere),” he said.
The guidelines also mentions places where molecular testing – such as RT-PCR, CBNAAT, and TrueNat – should be preferred over the cheaper and faster but less accurate rapid antigen tests (RAT).
Within containment zones, a rapid antigen test is the preferred modality for screening. Those to be screened include all persons with influenza-like illnesses, all direct and high-risk contacts (family members, colleagues, above the age of 65, immunocompromised, or have conditions such as diabetes, hypertension, or heart, kidney, and lung diseases).
“Ideally, it is suggested that 100% people living in the containment zones should be tested by RAT particularly in cities where there has been widespread transmission of the infection,” the guidelines mention.
In non-containment areas, however, the ICMR strategy suggests that preference should be given to molecular methods to test those with influenza-like symptoms, all symptomatic contacts, and all asymptomatic high-risk contacts. RT-PCR, CBNAAT, or TrueNat should also be used for routine surveillance of all symptomatic travellers within seven days of illness, and health care or frontline workers involved in Covid-19 management.
Within hospitals, the ICMR strategy says molecular tests should be preferred for testing those with severe acute respiratory infections, influenza-like symptoms, high-risk contacts in need of hospitalisation, asymptomatic patients undergoing surgery or other invasive procedures, and all pregnant women in or near labour.
The guidelines state that no emergency procedure should be delayed for the want of a test; a sample can be sent simultaneously.
Hospitals have been instructed not to refuse admission to pregnant women citing lack of testing facility.