test-by-choice-on-rising-coronavirus-cases-in-india

 

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Context: Recently, India crossed four million novel coronavirus cases. The ICMR’s latest advisory provides for testing on demand to “ensure higher levels of testing”. 

Background:

  • Rapid Antigen Test (RAT) is gaining grounds and has led to a spike in the number of tests being conducted, as it is quick and cheap.
  • The Indian Council of Medical Research (ICMR) has allowed testing on-demand for Covid-19 even as it has allowed states to adapt to the recommendation as per their requirements.
    • ICMR is just an advisory body and states were free to make changes as per their needs.
  • Rapid antigen testing (RAT) is the preferred strategy for screening in Covid-19 containment zones. 
    • People with influenza-like illnesses, all direct and high-risk contacts (family members, colleagues, those above 65, immunocompromised, or have conditions such as diabetes, hypertension, or heart, kidney, and lung diseases), are required to be screened.
  • The new strategy lists situations where molecular testing such as reverse transcription-polymerase chain reaction (RT-PCR) should be preferred over the cheaper and faster but less accurate RAT. 
  • Benefits of test on demand:  Since many of those infected have mild or no symptoms, tests on demand might be particularly helpful in detecting cases that might otherwise have been missed. 

Concerns

  • Less testing: Though the number of tests done each day has been over one million for the past week, the test positivity rate nationally is still high at 7.7%, indicating that testing has to be ramped up. 
    • Nearly 50% of them are rapid antigen, of only about 50-60% sensitivity. 
  • False negative results: RAT can give a high number of false negatives. There is no repeat testing of negative cases. Only a small percentage of people with symptoms but negative results are being validated with a RT-PCR, many of the infected are not being diagnosed.
    • The primary test of COVID-19 infection is RT-PCR (Reverse transcription-polymerase chain reaction) which is considered as the gold standard for testing.
    • According to the ICMR protocol, if RAT gives negative result and an individual has symptoms of ILI (influenza like illness), then he/she should undergo RT-PCR test.
  • Low testing capacity: The ICMR recent advisory is theoretically making India’s 1.3 billion people eligible for a test, even when there is no capacity to undertake this. 
  • States might be forced to use their discretionary power to deny tests for people not exhibiting symptoms or in low-risk categories, or selectively charge for testing to pay for procurement of testing kits and to avoid more pressure on the testing infrastructure. 
  • Antigen testing: There is also the possibility of an over-reliance on antigen testing to cope with the growing demand for testing. 
  • States are not validating the negative results from rapid antigen tests with RT-PCR. Non-directed tests on demand might help more in increasing the number of tests done each day and hence in reducing the test positivity rate than in early detection and containment. 

Way forward:

  • The focus must remain on diagnosing the most probable cases listed out by the ICMR — those with symptoms or at high risk. 
  • Test on demand strategy should be restricted to clusters, hotspots, and containment zones, besides dense urban areas with anticipated high transmission in the unlock phase. 
  • Balance between RAT and RT-PCR test: All states must ramp up testing by not only increasing the number of rapid antigen tests, but also backing it by RT-PCR tests.

A more nuanced approach to testing guidelines is necessary.

Kinds of tests for COVID-19 diagnosis – RT-PCR and RAT 

RT-PCR 

  • This is performed by taking swabs from nasal and oral tracts which are then put in viral transport medium and brought to the lab. 
  • It is processed under biosafety level 2 plus facilities.
  • RNA (Ribonucleic acid) extraction is done to detect the presence of the virus.
  • RT-PCR test will not give false positives but there are 30-35 per cent chances of getting false negatives.
  • At the initial stage of the Coronavirus pandemic, RT-PCR test was priced at Rs. 4,500 but now the cost has been brought down to Rs. 2,500. 
  • It is still expensive and takes a day to give results.

Rapid Antigen Test (RAT) 

  • Only nasopharyngeal swabs are collected by trained healthcare workers. 
  • RAT detects the presence of viral proteins (antigens – attributes of the virus) in a sample from the respiratory tract of a person. 
  • However, it is capable of giving more false negatives.
  • Also, RAT is a point of care test which means it can be performed only in hospital settings rather than standalone testing labs. 
  • Advantages: 
    • It can be done on a mass level. 
    • It is quick and cheap

Image source: ToI

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Q) Recently, India crossed four million novel coronavirus cases. The ICMR’s latest advisory provides for testing on demand to “ensure higher levels of testing”. But a more nuanced approach to testing guidelines is necessary. Explain. (250 words)