• To standardize laboratory testing criteria for SARS-CoV-2 in Nepal
• To facilitate and ensure common understanding on COVID-19 laboratory testing throughout the country
• To ensure rational use of the laboratory resources in order to contain COVID-19 spread
Priorities for COVID-19 testing
• Priority 1:
Ensure early detection, isolation, and prevention of the spread
o All suspected cases with high risk of infection (e.g. highly mobile population, returnees from other countries or high-transmission areas)
o Contacts of the confirmed cases
• Priority 2:
Ensure optimal care at health facilities, lessen the risk of healthcare- associated infections, and maintain the integrity of the healthcare system
o Front-line health care workers (e.g. doctors, nurses, laboratory personnel, paramedics) and support staffs (e.g. ambulance driver, health facility support staffs)
o Staffs working in critical functions (e.g. security force, waste care management workers)
o Patients requiring urgent medical and surgical attention with high suspicion of COVID-19
o Patients at higher risk of adverse outcomes (e.g. people with underlying chronic conditions; elderly) with high suspicion of COVID-19
• Priority 3:
Ensure containment in the community spread as well as health of essential workers
o Individuals in the surrounding community of rapidly increasing cases
o Individuals who have symptoms, but do not meet any of the above categories
o Individuals without symptoms AND no contact AND no travel history
o Individuals with interest in self recommended testing
• RT-PCR will be used for diagnostic purpose.
• All serology tests including the Rapid tests can be used for surveillance and/or research purpose and for screening purpose during discharge from the quarantine.
Criteria For Testing
1. Test the following cases using RT-PCR as follows:
a. All suspected cases of COVID-191 :
i. A patient with acute respiratory illness (fever and cough OR fever and shortness of breath), AND those coming from COVID-19 transmission areas during the last 14 days prior to onset of symptoms.
ii. A patient with any acute respiratory illness (fever and cough or fever and shortness of breath) AND having been in contact with a confirmed or probable COVID-19 case in the last 14 days prior to onset of symptoms.
iii. A patient with severe acute respiratory illness-SARI (fever and cough or fever and shortness of breath, AND requiring hospitalization).
b. All other cases with following criteria:
i. A patient with acute respiratory illness (fever and cough or fever and shortness of breath) AND new loss of smell OR taste.
ii. A patient with acute respiratory illness (fever and cough or fever and shortness of breath) AND any two of these (chills, muscle pain, diarrhea, sore throat).
iii. A patient with acute respiratory illness (fever and cough or fever and shortness of breath) in the absence of an alternative diagnosis that fully explains the clinical presentation.
iv. Any person having been in contact with a confirmed or probable COVID-19 case.
v. A patient with acute respiratory illness (fever and cough or fever and shortness of breath) with underlying chronic conditions, immuno-compromised conditions, as well as elderly patients.
2. Test the following medical and surgical cases using RT-PCR:
a. For life and limb-threatening conditions, do not delay the surgery/procedure, even for patients that meet the criteria outlined under 1a or 1b above. Proceed with appropriate COVID-precautions without waiting COVID-19 tests/results. Do not delay the procedure in order to take a swab. Take a swab – if indicated – either before or after the procedure, as appropriate.
b. For elective cases, conduct the test only if there is clear indication (i.e. meeting the criteria stipulated under 1a or 1b above). If negative proceed with surgery/procedure.
For medical conditions requiring admission including dialysis, test only those meeting the criteria stipulated under (1) and (2) above) coming from COVID-19 high transmission areas.
d. Children under 18 years test those with fever (>3 days) AND two of the following:
(i) rash, non-purulent conjunctivitis or muco-cutaneous inflammation;
(ii) hypo-tension or shock; (iii) new cardiac abnormalities; (iv) new bleeding disorder; and (v) diarrhoea,
vomiting or abdominal pain.
3. Test following Health Care Workers and Support Staff using RT-PCR:
a. All asymptomatic front-line healthcare workers and support staff including ambulance driver, laundry cleaners, those involved in caring and transferring of probable or confirmed COVID-19 patients, AND with history of accidental breach of infection prevention and control measures (PPE), test between 5-7 days of such incident/last exposure (Note: the incident must be properly documented).
b. All healthcare workers and support staff working in COVID and Non-COVID health facilities having symptoms (fever and cough or fever and shortness of breath).
c. All front-line healthcare workers and support staff those involved in caring and transferring of probable or confirmed COVID-19 patients test as per need.
4. Test all front-line staff other than healthcare workers (Security force, waste care management workers) having symptoms (fever and cough or fever and shortness of breath) with RT-PCR.
5. People in holding center and quarantine:
a. For all symptomatic cases, test RT-PCR.If negative, rule out other cause of illnesses and treat accordingly.
b. For those asymptomatic in quarantine, keep in and release from quarantine as per the quarantine guidelines – no tests required*
*तर हाललाई क्वारेन्टिनमा रहेका व्यन्िहरुको १४ दिन पछि आर.डी,टि. पररक्षण गररनेि ।
6. Confirmed cases in isolation:
a. For asymptomatic cases who have completed 14 days – no tests required.
b. For symptomatic cases who have completed 14 days AND spent at least 3 days
without symptoms – no tests required.
Annex I: Definitions of Key Terminologies
• Confirmed Case: A person with laboratory confirmation of COVID-19 infection, irrespective of clinical signs and symptoms.
• Probable Case: A suspect case for whom testing for the COVID-19 virus is inconclusive. OR A suspect case for whom testing could not be performed for any reason.
• Contact1 :
o Face-to-face contact with a probable or confirmed case within 1 meter and for more than 15 minutes;
o Direct physical contact with a probable or confirmed case; OR
o Direct care for a patient with probable or confirmed COVID-19 disease without using proper personal protective equipment.
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