On Tuesday, 4 May, The Indian Council of Medical Research (ICMR) issued new guidelines for COVID testing in the country.

The advisory recommends against repeating RT-PCR tests, and lists the different scenarios where the tests may be foregone.

These guidelines have been updated keeping the ongoing COVID crisis, in an attempt to reduce the burden on laboratories due to an increase in caseload.

Is reducing RT-PCR tests at this stage of the pandemic a good idea? FIT asks Dr Anant Bhan, Adjunct Professor & Researcher in Bioethics at Mangaluru’s Yenepoya University, and Dr Swapneil Parikh, an internal medicine specialist in Mumbai and author of ‘The Coronavirus: What You Need to Know About the Global Pandemic’.

First, let's go over the guidelines themselves.

In a bid to optimise the use of these tests, the ICMR has advised that one would no longer need to get an RT-PCR test done,

• When a COVID patient is being discharged.

• If a Rapid Antigen Test, or a previous RT-PCR test has found them positive.

• When a healthy individual is travelling across states.

With the last point, the advisory adds, "non-essential travel and interstate travel of symptomatic individuals (COVID-19 or flu-like symptoms) should be essentially avoided reducing the risk of infection."

ICMR also adds that COVID-appropriate behaviour must be followed by all asymptomatic travellers.

To this, they have added that they simultaneously aim to increase the access and availability of testing to all citizens of the country.

When it comes to completely removing the need for RT-PCR tests for inter-state travel, Dr Parikh doesn't agree with the move.

"The rationale behind this move could be the people aren't able to get tests done or get results in time for their travels because of a backlog," says Dr Anant Bhan, Adjunct Professor & Researcher in Bioethics at Mangaluru’s Yenepoya University.

“That being said we know asymptomatic infections occur, and we also know that travel is a major factor for infections," he adds.

So, how then can we ensure the lack of tests at the time of travel doesn't trigger another wave of infections?

According to Dr Bhan, "the lack of RT-PCR tests could be made up for with the help of other kinds of systematic checks like thermal screening (although they have low sensitivity)."

Adding to this, Dr Swapneil suggests people could follow up an initial RT-PCR test before travel with other self administered tests.

Dr Parikh also bring up the recommendation that ‘people who have recovered don’t need to test’.

"Such blanket statements can also be problematic,” he says.

He further explains this by saying, "let's say an individual who has recovered is going home from the hospital and has elderly relatives in the house. In that situation, it's important that the person get tested even after recovery."

While it is true that the upsurge of cases in the country has been putting immense pressure on the laboratories and technicians, is avoiding RT-PCR tests the way to ease this?

"We are in a crisis situation right now," says Dr Parikh. “So right now we do have to preserve our RT-PCR testing capacity for where we need it the most."

But we have to be careful that it doesn't lead to a reduction in tests altogether, as has been the case of late in different parts of the country.

"The total number of tests should always go up, it should especially not be dipping," he adds. "ICMR needs to look into drastically scaling up even RT-PCR testing capacity."

What then can help ease the pressure on the molecular testing labs in the country?

The ICMR guidelines say that they're pushing to ramp up Rapid Antigen Testing (RAT) in the meantime.

Dr Swapneil agrees, saying that RAT is an “underutilised resource at this point, and its use needs to be increased. "

A major advantage of RAT, as mentioned by ICMR, is that it has a short turnaround time of 15-30 minutes.

Because of this reason, it offers a huge advantage of quick detection of cases and the opportunity to isolate and treat them early for curbing transmission.

We Need to Consider Other Alternative Testing Methods

One of the drawback of the RT-PCR test, and even the RAT is the need for reagents.

According to Dr Parikh, "this is what creates the bottleneck when it comes to these tests”.

An alternative to this is the spectral analysis test that doesn't require reagents.

Other alternative testing modalities that should be considered are Real-time loop-mediated amplification (LAMP) technology, Clustered Regularly Interspaced Short Palindromic Repeats (CRISPR) based tests, and, spectroscopy which can give instant results with satisfactory accuracy.

Speaking of reducing the pressure on RT-PCR tests, Dr Bhan says, “we might not always need to have tests carried out to assume someone has COVID, he says.

"Hospitals shouldn’t require RT-PCR test reports to confirm covid," he adds. “If someone is showing symptoms, it should be assumed they have COVID and treated accordingly."

“Decentralising the process of testing can really help ease the burden on the labs," Dr Parikh says.

He goes on saying, "I would even suggest various cities and states consider providing free home testing kits to people to further decrease the burden on RT-PCR testing."