Experts divided over ICMR advisory on ‘purposive testing strategy’
COVID-19 experts in Karnataka have expressed mixed views over the Indian Council of Medical Research’s latest advisory on ‘Purposive Testing Strategy for COVID-19’ that said contacts of COVID-19 patients do not need to be tested unless identified as high-risk based on age
COVID-19 experts in Karnataka have expressed mixed views over the Indian Council of Medical Research’s (ICMR) latest advisory on ‘Purposive Testing Strategy for COVID-19’ that said contacts of COVID-19 patients do not need to be tested unless identified as high-risk based on age.
According to the advisory issued on Monday, asymptomatic patients undergoing surgical or non-surgical invasive procedures, including pregnant women in/near labour who are hospitalised for delivery, should not be tested unless warranted or symptoms develop. It said no emergency procedure, including surgeries, should be delayed due to lack of a test. Besides, inter-State travellers also need not be tested.
However, COVID-19 experts in Karnataka said the advisory is against the basic principle of containing the pandemic.
C.N. Manjunath, nodal officer for labs and testing in the State’s COVID-19 task force and member of State’s Clinical Expert Committee, said the advisory is debatable and requires consensus from public health experts and epidemiologists. “It goes against the basic principle of containing the pandemic. If primary contacts are not traced and tested, they can spread the infection easily,” he said.
Asserting that the testing strategy should be individualised, the doctor said important aspects that need to be considered include the proximity between the positive patient and the contact and the duration of exposure. “Whether they are in the same building, whether the place is well ventilated, whether the infected person had a cough and other symptoms: all these need to be considered before deciding on whether to test or not,” he said. Epidemiologist and public health specialist Sunil Kumar D.R., who heads the department of community medicine at Akash Institute of Medical Sciences, said contact tracing and testing is a key strategy for interrupting the chain of transmission of SARS-CoV-2 and reducing COVID-associated mortality.
“Giving an advisory that testing is not required for asymptomatic contacts, asymptomatic patients undergoing surgeries, and for persons taking inter-State travel will increase the caseload and healthcare system may be overburdened with shortage of healthcare staff. If asymptomatic patients are not tested prior to surgery, healthcare workers will be at risk,” said Dr. Sunil, who is part of BBMP’s death audit committee.
However, V. Ravi, member of the State’s Technical Advisory Committee (TAC), termed the ICMR advisory as a practical piece of guideline, specific to Omicron variant.
“As the incubation period is so short and considering the pace at which the infection is spreading, it is practically not possible to trace contacts of all positive cases,” he said.
Asserting that the onus is now on people, Dr. Ravi, who is the nodal officer for genomic confirmation of SARS-CoV-2 in Karnataka, said: “If people know they have been exposed and have developed symptoms, they can come forward and get tested. The advisory should not be interpreted that testing is not at all required for contacts.”
U.S. Vishal Rao, member of the State’s Genomic Surveillance Committee, also termed the advisory as an excellent step. “At this juncture when the pandemic is raging, if you go on testing you will overwhelm the diagnostics. This will not even translate into an effective intervention for asymptomatic individuals,” he said.
Pointing out that there is compelling data to show that Omicron will not increase hospitalisation or fatality, Dr. Rao said: “The advisory is a more mature step towards the direction of understanding that as we move towards this phase of endemicity we will have to lower the burden on the healthcare system. This should nor be misconstrued as a premature claim of victory against the virus. The ICMR is only asserting a citizen-driven responsibility and not a State-driven enforcement.”