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ICMR testing norms questioned

Doctors warn that the guidelines could endanger lives by leaving out two categories of patients who need to be checked
Medics take samples of suspected Covid-19 patients for lab test at a government hospital in New Delhi on Tuesday.
Medics take samples of suspected Covid-19 patients for lab test at a government hospital in New Delhi on Tuesday.

G.S. Mudur   |   New Delhi   |   Published 09.06.20, 08:23 PM

Several doctors have questioned the current coronavirus testing guidelines from the Indian Council of Medical Research, warning they endanger lives by leaving out two categories of patients who need to be tested.

The coronavirus testing criteria should include patients with influenza-like illness (ILI) symptoms, no matter where they live, and every patient who needs to be admitted to hospital, senior doctors at government and private hospitals have said.

The ICMR’s May 18 testing criteria — an expanded version of earlier criteria — prescribes testing people with ILI symptoms only if they live in containment zones, delineated by local authorities wherever coronavirus cases are detected. The criteria do not cover all patients who need to be hospitalised.

“The criteria should change. Every patient needing (hospital) admission should be screened,” a senior super-specialist at the central government-run Ram Manohar Lohia Hospital, New Delhi, said.

“We need to know the infection status to determine where to manage patients — in Covid or non-Covid wards.”

Doctors say that Covid-19-positive patients can pose a risk to other hospitalised patients with underlying health disorders, with whom they may be inadvertently housed in the absence of a pre-admission test.

“We have multiple real accounts of patients and healthcare workers in many hospitals getting infected from patients admitted in the same ward,” said Ambarish Satwick, a vascular surgeon at the Sir Ganga Ram Hospital, New Delhi.

Satwick said hospitals were duty bound to prevent cross-infection among patients, and that patients sick enough to need admission for other conditions such as cardiovascular diseases should be viewed as especially vulnerable to severe coronavirus disease.

“The first principle of medicine is: primum non nocere, or do no harm. To adhere to this, every patient needing admission should be tested for Covid,” Satwik said.

Last week, he had tweeted: “But there can be absolutely no justification for withholding emergency treatment for want of a Covid test result.”

The Indian Medical Association (IMA), the country’s largest body of doctors, had in a statement last week asserted that every patient with a prescription from a doctor for a Covid-19 test should be tested.

The demand for further expanding the testing criteria comes amid a surge in Covid-19 numbers in 38 districts across 15 states, including Calcutta, Howrah and North 24-Parganas in Bengal.

Union health secretary Preeti Sudan on Tuesday met district collectors, municipal commissioners and chief medical officers of the 38 districts, urging them to intensify house-to-house surveys, testing and isolation of patients in containment zones.

The ICMR’s current guidelines recommend testing all patients with severe acute respiratory infection, among several other categories of people, but patients with ILI symptoms can be tested only if they live in containment zones.

“This leaves out patients outside containment zones. But under the current epidemic conditions, anyone with ILI symptoms should be tested,” said a senior specialist at a government hospital.

“The decision on testing individual patients should be left to doctors. We can’t wait until patients’ conditions worsen.”

India’s health ministry on Tuesday recorded 9,987 new Covid-19 cases, raising the number of confirmed cases to 266,598, of whom 129,813 are under medical supervision, 129,314 have recovered and 7,471 have died.

The ICMR has ramped up testing capacity nationwide, with 590 government and 233 private labs now testing for Covid-19.

The labs have the combined capacity to conduct around 150,000 tests per day, and the government has said the country will carry out 500,000 tests per day by July.

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