A Narrative Review of Testing Recommendations for COVID-19: The Changing Scenarios

Abstract

The novel coronavirus infection (COVID-19) has affected millions of people, globally. India ranks among the worst affected countries. As the pandemic progresses, the risk of asymptomatic transmission is largely debated. Such transmission may lead to additional loss in terms of healthcare settings, that are already facing shortage of healthcare workers (HCWs) due to quarantine protocols or COVID-19 infection. We reviewed the evolving guidelines for testing specified by the apex Indian (Ministry of Health and Family Welfare recommended - ICMR guidance), and major international (World Health Organization -WHO, and Centers for Disease Control and Prevention -CDC) agencies; with focus on asymptomatic HCWs. We observed that in early directives, the organizations had unanimously emphasized testing of symptomatic cases. With the progression of the pandemic however, the guidance has intensified and suggests testing of asymptomatic contacts as well. This holds true for CDC and ICMR. WHO and CDC being global organizations suggest countries to test as per local conditions and diagnostic capacity. In India, ICMR has expanded testing directive to include asymptomatic direct high-risk contacts. Premier medical institutes of the country also reported ICMR guidelines on their websites. Despite the international directive being adjustive to local conditions, ICMR has reinforced testing directive to include vulnerable asymptomatic persons. The Indian testing strategy thus addresses the concern of asymptomatic transmission among HCWs.