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With 50 new deaths, toll jumps to 652; 1,383 fresh cases reported in 24 hours

India on Wednesday reported 50 new COVID-19 deaths and the recovery of 3,959 patients, taking the recovery rate to 19.36% from 17% previously.

The Union Health Ministry said 20,971 individuals have been confirmed positive as of now, while the death toll stood at 652. Since Tuesday, 1,383 new cases were reported.

However, reports from the States put the toll at 683 and the total number of positive cases at 21,324, out of which 16,489 are active. Maharashtra has the most number of cases (5,649), followed by Gujarat (2,407) and Delhi (2,248).

The Ministry said the Indian Council of Medical Research (ICMR) had promised to collect data from the States to assess the scope and extent of the utility of the rapid antibody test in field conditions.

“It [ICMR] shall keep advising the States on a regular basis. The States have also been advised to follow the prescribed protocol for this test and use it for the purpose for which it is meant,” said a release issued by the Ministry. The ICMR had reiterated that the rapid test was largely to be used as a tool for surveillance.

“Globally also, the utility of this test is evolving and it is currently being used for detecting the formation of antibodies in individuals. The test results are also dependent on field conditions,” the release noted and asserted that the test cannot replace the RT-PCR test to diagnose COVID-19 cases.

The Ministry said it had directed State Chief Secretaries and the UT administrations to ensure the safety of health workers. “Their skill and service amongst all professionals place them in a unique position to save people in present times. The States and the UTs have been advised to take up various measures, including human resource and capacity-building training, medical safety, timely payments, psychological support, training of front line workers and life insurance cover,” it stated.

Union Cabinet approves promulgation of ordinance

Battle ready: Medics performing a mock drill in Ernakulam district of Kerala on Wednesday.PTI

The Union Cabinet on Wednesday approved the promulgation of an ordinance to amend the Epidemic Diseases Act, 1897, making acts of violence against medical staff a cognisable and non-bailable offence and to provide compensation for injury to healthcare personnel or for damage or loss to property.

The ordinance proposes that in cases of attacks on healthcare workers, the investigation will be completed within 30 days and the final decision arrived at within one year.

The punishment for such attacks will be three months to five years and the fine ₹50,000 to ₹2 lakh.

In severe cases, where there are grievous injuries, the punishment will be six months to seven years and the fine ₹1 lakh to ₹5 lakh.

‘Zero tolerance’

Union Health Minister Harsh Vardhan, in a series of tweets after the announcement, said that as per the “new ordinance, there shall be zero tolerance to any incidents of violence against healthcare service personnel and/or damage to property. All offences of violence will be cognisable and non-bailable”.

“This will facilitate punishment under the law in cases of violence against healthcare service personnel serving during an epidemic. Public venting of angst against healthcare service personnel leading to harassment assault and damage to property is being highlighted daily. Portrayal as potential spreaders of COVID-19 pandemic played havoc with the confidence of the medical community which is demanding protection,’’ the Health Minister tweeted.

Seven manufacturers awaiting approval from the National Institute of Virology

For reliable antibody testing kits, India will have to make its own, according to independent epidemiologists and biotechnologists.

A day after the Rajasthan government said that it would stop antibody tests because they were returning inaccurate results, the Indian Council of Medical Research announced that it had advised putting such tests on hold because it was generating widely varying results. The ICMR on Wednesday said it had forwarded a “protocol” for rapid antibody tests to all States, but did not specify the details.

Quick results

Much like home-based pregnancy tests, antibody tests are valuable because they give results quickly and only needs a pinprick’s worth of blood. However, they can only detect antibodies produced by the immune system in response to the virus and this can take as many as seven to 14 days to manifest. “The initial expectation was that an antibody test would soon be available. But it was the PCR technology that came first. That’s also due to the fast moving nature of the virus,” said Iype Joseph, epidemiologist with the Rajiv Gandhi Centre for Biotechnology, Thiruvananthapuram.

The PCR technology is confirmatory because it identifies the SARS-CoV-2 based on genes, whereas the presence of viruses have usually been detected via antibody kits by the proteins produced by the virus’s genes.

An antibody test only tells you whether a person has ever been infected by the virus. These antibodies that are produced are not necessarily specific to SARS-CoV-2 and could even be generated by a variety of other pathogens. “There are other four other common coronaviruses and antibodies could be generated to that too. So far, nobody has found a protein that is specific to SARS-CoV-2.”

Surveillance tool

The ICMR’s current recommendation is to test those who show symptoms such as cough, fever and breathlessness and even a sore throat. After quarantining for 14 days, an antibody test is to be done and if positive, the person ought to be tested by RT-PCR.

The ICMR has underlined that tests are a surveillance tool. The utility of the test was evolving and its value was dependent on field conditions. They were not a replacement for RT-PCR tests.

However, with the accuracy widely ranging from 5% to 71%, there are questions on whether they can reliably help indicate the spread of the infection.

All kits need to be validated by the National Institute of Virology, Pune. They test two things: are the kits detecting antibodies at specified intervals after an infection, mirroring when antibodies actually show up in people with confirmed COVID infections? And do they falsely respond to the presence of other pathogens? It is not clear how tests validated by the NIV began showing widely discordant results for them to be paused by the ICMR. “We need tests that are locally developed and validated,” Dr. Joseph said.

“The need of the hour is to have rapidly deployable RT PCR kits. If we can reduce the time taken for analysis, or have a paper-based strip that can detect the virus, it would be more useful,” said Asha Kishore, Director, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram. The institute has developed a rapid PCR test that awaits final approval from the ICMR.

Renu Swarup, Secretary, Department of Biotechnology, said that India’s challenges with diagnostic kits were temporary. “There are at least seven Indian manufacturers of these kits awaiting approval from the National Institute of Virology and we are hoping to be able to produce at least a million kits by end May.”

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