Health workers undertake screening and sample collection at Dharavi labour camp (Express photo by Nirmal Harindran) Health workers undertake screening and sample collection at Dharavi labour camp (Express photo by Nirmal Harindran)

Looking at mass testing in areas with a large number of cases — hotspots and clusters — the Centre may start by screening all patients who come to the hospital with flu-like symptoms. This will be irrespective of the disease they have come for. The plan is to eventually extend this to all hospitals in the country.

This will be followed by voluntary community testing. A highly placed source said, “This means that whoever comes forward to get tested, we will test, regardless of whether the person has travel and contact history or not.”

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About how testing all patients with flu-like samples would help, the source said it would not just generate random sampling data for the disease but also mean that if patients clear testing — some private hospitals have already started pool testing — doctors, nurses and others attending to them may not need full personal protective equipment gear. PPEs are in short supply in hospitals across the country.

The source said, “We are looking at opportunistic screening of all patients who come to the hospital with flu-like symptoms, even if they have come to seek medical attention for some other disease. Starting from there, we will gradually expand to mass testing, initially in the hotspots and cluster containment zones.”

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‘Opportunistic’ screening was one of the tools the US used against cervical cancer, screening all women who came into a hospital, regardless of the condition they came for.

The official said the screening and mass testing plan had been in the works for some time, but the impediment was the lack of testing kits. That situation has changed now. Police may accompany medical personnel for mass testing. “We will go mohalla by mohalla, village by village,” he said.

This will be followed by voluntary community testing This will be followed by voluntary community testing

This is in line with what Bihar started some time back, while Chhattisgarh is moving in the same direction. Bihar Principal Secretary, Health, Sanjay Kumar tweeted on Saturday: “#BiharFightsCorona here is a snapshot outcome of the door to door survey we started in16/4/2020 in all 38 districts. please support the health workers visiting your homes. together we can defeat covid-19. we are sharing district wise figures from today.”

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The last revision in the testing strategy was done on April 9, when the parameters for hotspots were changed to cover all patients with influenza-like illnesses (fever, cough, sore throat or runny nose). Sources said field personnel have already been given leeway to conduct tests as per their “judgment”, especially in the hotspots. That has contributed to a large extent to the increase in testing.

A senior official of the National Centre for Disease Control said, “Initially the testing parameters were very strict, but now they have been relaxed. Essentially, in the hotspots, our field personnel have been given room to decide who needs to be tested based on their assessment. This could include secondary and tertiary contacts or whoever else they feel the need to test, even when they are asymptomatic.”

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The guidelines say that in people suffering from such symptoms in hotspots, the lengthier RT-PCR test should be done within seven days of infection and the rapid serological test after seven days have passed. However, the serological kits have only just arrived.

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