ICMR's new strategy: In Covid-19 hotspots, test everyone with a runny nose

New Delhi: With 20 new deaths taking place due to Covid-19 in India on Thursday (taking the total to 169), the central government has decided to begin clinical trials of convalescent plasma therapy for critical patients.

This involves giving critically ill Covid-19 patients antibody-rich plasma from patients who had the infection earlier but recovered from it.

Convalescent plasma therapy has reportedly been successful in countries like South Korea, China and the US, where doctors have claimed substantial improvement in Covid-19 patients.

This therapy is among the several medical options India is exploring, besides hydroxychloroquine (HCQ) given in combination with the antibiotic azithromycin, and anti-viral drugs.

Elsewhere the world, a drug called EIDD-2801 is going into clinical trials after it showed it can reduce lung damage during Covid-19.

On the testing front, the Indian Council of Medical Research (ICMR) has changed the testing strategy it will follow in coronavirus hotspots: now everyone with influenza-like symptoms (fever, cough, sore throat, runny nose) will be tested.

Health authorities are anticipating a surge in new cases. With 540 new cases added since Wednesday evening, the total number of Covid-19 positive cases has risen to 5,865.

Under ICMR’s revised testing strategy for hotspots, clusters, large migration gatherings and evacuee centres, everyone showing symptoms of influenza-like illness will be tested irrespective of whether or not they had previous contact with a patient.

They will be subjected to the regular rRT-PCR test within seven days of the illness; if negative, an antibody test will be done after another seven days of illness.

Until now, only five categories of people were being tested: all symptomatic individuals with history of international travel in the past 14 days; all symptomatic contacts of lab-confirmed cases; all symptomatic healthcare workers; all patients with Severe Acute Respiratory Illness (fever, cough and/or shortness of breath); and asymptomatic direct and high-risk contacts of a confirmed case who are tested once between day 5 and day 14 of coming into contact.

To this has been added the category of everyone with flu-like symptoms regardless of contact.

This new strategy will considerably increase testing in India -- 13,143 samples were tested Wednesday – and health agencies believe the number of coronavirus positive cases is likely to shoot up now.

ICMR’s changed testing strategy comes a day after a study conducted in 36 districts in 15 states found that about 40 per cent of COVID-19 cases with severe acute respiratory infection (SARI) did not in fact have any history of contact with a positive patient or international travel.

According to the study, which has been published in the Indian Journal of Medical Research, a total of 104 (1.8 per cent) of the 5,911 SARI patients tested positive for COVID-19 in these districts. Out of this, nearly 40 cases did not report any history of contact with a known case or international travel.

"In all, 39.2 per cent COVID-19 cases did not report any history of contact with a known case or international travel," the study said while 2 per cent reported contact with a confirmed case and 1 per cent reported recent history of international travel.

Data on exposure history was not available for 59 per cent of the cases.

The ICMR study highlighted that COVID-19 containment activities need to be targeted in districts reporting positive cases among SARI patients and stated that intensifying sentinel surveillance for COVID-19 among SARI patients may be an efficient tool to effectively use resources towards containment and mitigation.