Why continue with rapid antigen tests when false negatives so high: HC to Delhi govt

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Published: July 27, 2020 7:24 PM

The HC also noted that the sero survey of the national capital carried out by the National Centre for Disease Control indicated that more than 22.86 per cent of the population have gone through the illness without even realizing they were infected as they probably were asymptomatic.

RT/PCR, short for Reverse Transcription Polymerase Chain Reaction, is a laboratory technique widely used in the diagnosis of genetic diseases and to measure gene expression in research.

The Delhi High Court on Monday asked the AAP government why it was going with Rapid Antigen Testing (RAT), which has a high rate of false negative results, as the primary test of COVID-19 infection. It also made it clear to the Delhi government to “strictly” follow the guidelines on COVID-19 testing as issued by ICMR and not according to its own interpretation. The high court also noted that the sero survey of the national capital carried out by the National Centre for Disease Control (NCDC) indicated that more than 22.86 per cent of the population have gone through the COVID illness without even realizing they were infected as they probably were asymptomatic.

A bench of Justices Hima Kohli and Subramonium Prasad said in such a scenario how can the Delhi government go with RAT as its front line test, when its rate of false negatives was very high, with RT/PCR being recommended for only those who were symptomatic. It added that the Indian Council of Medical Research (ICMR) has not said that testing has to be done in this manner.

RT/PCR, short for Reverse Transcription Polymerase Chain Reaction, is a laboratory technique widely used in the diagnosis of genetic diseases and to measure gene expression in research. Delhi government additional standing counsel Satyakam told the bench that the health department was strictly adhering to ICMR guidelines which say that people testing negative for RAT but showing influenza like illness (ILI) have to undergo RT/PCR.

The stand was opposed by advocate Rakesh Malhotra, whose plea for increasing of the testing numbers in the national capital and getting speedy results was being heard by the court. He told the bench that ICMR only said that persons showing influenza like illness (ILI) and testing negative in RAT have to go for RT/PCR and this strategy was not applicable to those having severe acute respiratory illness (SARI). However, Delhi government had included SARI also in its list high risk group individuals who have to first undergo RAT.

ICMR, represented by central government standing counsel Anurag Ahluwalia, told the bench that it had never recommended SARI for RAT and that it was not similar to ILI. Dr Nivedita Gupta from ICMR also told the court that it never said asymptomatic RAT negative persons should not undergo RT/PCR testing, it only said the symptomatic RAT negative patients be given priority.

Taking note of the ICMR stand, the bench told the Delhi government that it has to “strictly” follow the guidelines on COVID-19 testing as issued by ICMR and not according to its own interpretation. “Why are you tweaking ICMR advisory? Why are you including SARI? Tell your clients (Delhi government) to strictly follow ICMR advisory. You cannot interpret on your own,” it said.

The high court directed Delhi government to delete SARI from its office orders of July 5 and July 9 which give a list of high risk group individuals who have to first undergo RAT. The high court was also of the view that in light of the NCDC sero survey report and the high rate of false negatives of RAT, RT/PCR tests, whose numbers were plummeting, should be ramped up. It said that while there were 54 labs, both public and private, in Delhi which are capable of carrying out RT/PCR tests and have a combined capacity of 11,000 tests per day, between July 15 to July 23 the number of RT/PCR tests per day have not even crossed 6,000.

The high court said,”ICMR never said that RT/PCR, which is the gold standard test, be replaced with RAT.” Delhi government faced the court’s ire also over the issue of requirement of a doctor’s prescription for undergoing COVID testing. The high court asked the Delhi government how it could in May permit private doctors to issue prescription for COVID-19 when the ICMR and Health Ministry permitted it only on July 1. “This is how confusion is created in public which is running helter-skelter for prescription from government doctors for undergoing COVID tests,” the bench said.

The high court said that the media or the press, which has been doing a commendable job, alone cannot be relied upon to disseminate information to the public and the Delhi government and ICMR too have to do so. The high court asked NCDC, which was also represented by Ahluwalia, as to what were its short term recommendations in light of the sero-survey report and it said that it would advise RT/PCR tests be conducted for general public and RAT be used only in hospital settings where patients need urgent treatment and RAT would give faster results which can be re-confirmed subsequently. The bench asked the ICMR to place before the court its next advisory, in view of the sero survey, on testing strategy and listed the matter for further hearing on August 4. The Delhi government was also directed to give an updated status report of the tests carried out till then.

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