Latest Surveillance Testing Guidance To Prioritise Health Staff, Prisoners

The Indian government has updated its testing strategy for COVID-19 and included a section on testing for epidemiological surveillance and not just for clinical diagnosis.

The new guidelines say that IgG antibody testing will be used for surveillance. Serological surveys will be used in two ways: for testing large groups for the presence of antibodies, and for testing specific high-risk or vulnerable groups such as health workers and people in containment zones.

Serological surveys would help "understand the proportion of population exposed to infection with SARS-CoV-2 including asymptomatic individuals", the guidelines say.

High-risk groups should be prioritised in the serological surveys, the guidance says, listing among these healthcare and frontline workers, immunocompromised individuals, people living in containment zones, police and paramilitary personnel, civil defense personnel and volunteers, prisoners and press corps.

This is the sixth update to the testing strategy since March 2020 and the eligibility criteria for those who can get tested have been broadened gradually in every guideline since then.

The new guidelines admit that "access to testing still remains a huge challenge in a large country like India. There is a definite need to increase the outreach of testing." The stated intention is to "include additional testing methods to improve the access and availability of testing in various parts of the country".

IndiaSpend has previously reported on India’s shortage of epidemiologists to carry out disease surveillance. We have also reported on the government’s fiasco over antibody kits purchased from China, their decision to pause antibody testing and skepticism among state governments to conduct antibody testing for surveillance.

While the government recommends IgG antibody testing for surveillance, RT-PCR remains the technology to be used for diagnosis, which the government calls the "gold standard". The government also says that TrueNat and CBNAAT technologies, used for tuberculosis diagnosis, are being used for COVID diagnosis.

The new guidelines specify the categories of people who can get tested for diagnosis of COVID-19 with RT-PCR testing, in containment zones, hotspots and healthcare settings. The previous guidelines on May 18 listed the people who could get tested in any setting.

The World Health Organization (WHO) lists the symptoms of COVID-19 in three categories: 

• most common symptoms (fever, dry cough, tiredness)
• less common symptoms (aches and pains, sore throat, diarrhoea, conjunctivitis, headache, loss of taste or smell, a rash on skin, or discolouration of fingers or toes) 
• serious symptoms (difficulty breathing or shortness of breath, chest pain or pressure, loss of speech or movement)

India's testing guidelines list out a shorter and more basic list of symptoms for which people can get tested. Even as the WHO has listed a number of symptoms present in people with SARS-CoV-2, the Indian guidelines allow for testing only for those who have symptoms of influenza like illness (ILI) or Severe Acute Respiratory Infection (SARI). ILI is defined as having acute respiratory infection with fever ≥ 38oC as well as cough. SARI is defined as having all the symptoms of ILI but also requiring hospitalisation.