The COVID-19 pandemic is continuing throughout the world, India as well as in Kerala. Kerala state is implementing well planned comprehensive response measures to manage the pandemic with the focus on reducing the infection transmission and reduce mortality. The protocols for the management of patients are developed based on the knowledge gained and research done in the world.

The respective expert groups are studying the progression of epidemic and giving suggestions for the changes in the testing guidelines and management protocols to the Department.

Accordingly, the revised testing guidelines are issued superseding all the previous advisories and guidelines.

Part-1

Sl.no	CATEGORY	TEST	PREFERRED TIME OF TEST
1	ILI# in a person who is not a COVID suspect	Rapid antigen test	Within 5 days of onset of symptoms
2	Severe Acute Respiratory Infection (SARI)	RT-PCR	As early as possible during the symptomatic period
3	ILI among persons from clusters	Rapid antigen test	As early as possible during the symptomatic period
4	Non-ILI patients from containment zones requiring admission	Rapid antigen test	On Admission
5	Asymptomatic vulnerable persons in large community clusters a. Elderly (age more 60yrs) b. Antenatal and immediate postnatal c. Children with severe malnutrition d. Persons with severe comorbidity	Rapid Antigen test	Beginning of containment period
6	Symptomatic international / interstate traveller in the last 14 days or symptomatic contacts of a lab confirmed case on quarantine	RT-PCR	As early as possible during the symptomatic period
7	Asymptomatic high risk primary contacts* of lab confirmed cases	Rapid antigen test	On 8^th day from last contact
8	Symptomatic persons who are contacts of international/interstate travellers in the last 14 days	Rapid antigen test	As early as possible during the symptomatic period
9	Symptomatic Health Care Worker and other front-line workers (police personnel, community volunteers etc)	RT-PCR	As early as possible during the symptomatic period
10	Follow-up samples of COVID positive patients	Rapid Antigen test	As per discharge guidelines
11	For Emergency surgeries	TrueNat / XPERT	As soon as possible
12	Brought dead bodies - 1^st Sample	XPERT	As soon as possible
13	Brought dead bodies - 2^nd Sample	RT-PCR	As soon as possible- send to ICMR Unit, NIV Alappuzha
14	Before Elective surgeries	TrueNat / Pooled RT- PCR	1-2 day before elective surgery
15	Prisoners / persons before or after parole / convicts	Rapid Antigen test	On request
16	ILI among recovered COVID cases	RT-PCR	As early as possible during the symptomatic period

Influenza like Illness (ILI)- Is an Acute Respiratory Infection with fever >= 38° C (>=100°F) and any one of the following; Cough, Coryza, Sore throat

within the last 10

COVID Suspects (symptomatic) who test Rapid Antigen negative should be tested sequentially by RT-PCR and if negative should undergo 7 days of home isolation from the start of illness. Evaluate other causes as required.

The category of patients mentioned in the table above may get tested in any of the approved Government or private laboratories.

Part-ll

TEST WISE SUMMARY

NAME OF TEST	Sl.no in Table	CATEGORY
Rapid Antigen Test	1	ILI^# in a person who is not a COVID suspect
	3	ILI among persons from clusters
	4	Non-ILI patients from containment zones requiring admission
	5	Asymptomatic vulnerable persons in large community clusters a. Elderly (age more 60yrs) b. Antenatal and immediate postnatal c. Children with severe malnutrition d. Persons with severe comorbidity
	7	Asymptomatic high risk primary contacts* of lab confirmed cases
	8	Symptomatic persons who are contacts of international/interstate travellers in the last 14 days
	10	Follow-up samples of COVID positive patients
	15	Prisoners/persons before or after parole/convicts
RT-PCR	2	Severe Acute Respiratory Infection (SARI)
	6	Symptomatic international / interstate traveller in the last 14 days or symptomatic contacts of a lab confirmed case on quarantine
	9	Symptomatic Health Care Worker and other front-line workers (police personnel, community volunteers etc)
	13	Brought dead bodies-2^nd Sample
	16	ILI among recovered COVID cases
TRUENAT / Pooled RT-PCR	14	Before Elective surgeries
TRUENAT/XPERT	11	For Emergency surgeries
XPERT	12	Brought dead bodies (1^st Sample)

Part-Ill

Classification of Contacts

Primary Contact: Any person who has come in contact with a confirmed case of COVID-19.

Secondary Contact: Any person who has come in contact with a primary contact.

High Risk (HR) Contact:

1. Contact with a confirmed case of COVID-19.
2. Travelers who have visited an area of hospital where COVID-19 cases are being treated
3. Travel to a locality where active COVID-19 community spread is suspected or clustering of confirmed COVID-19 cases are detected in the last 14 days.
4. Touched body fluids of patients (respiratory tract secretions, blood, vomitus, saliva, urine, faeces).
5. Had direct physical contact with the body of the patient including physical examination without PPE.
6. Touched or cleaned the linens, clothes or dishes of the patient
7. Close contact, within 3 feet (1 metre) of the confirmed case
8. Со-passengers in an airplane /vehicle seated in the same row, 3 rows in

front and behind of a confirmed COVID 19 case_______________________

Low Risk (LR) Contact:

1. Shared the same space (same classroom/same room for work or similar activity and not having high risk exposure to the confirmed/suspected case)
2. Travel in the same environment (bus/train) but not having high risk exposure as cited above.
3. Any traveller from abroad not satisfying high risk criteria

Table of contents Ministry of Health &
Family Welfare Kerala Data : By C-DIT Situation Report : WHO

PPE requirement calculator Orders from GoK & DHS COVID 19 - Library Corona About outbreak Virus Morphology Transmission Pathophysiology Clinical Features Red flag signs Treatment Vaccines Definition of case Classification of contacts Classification of risk Clinical Categorization Treatment Guidelines UIP Guidelines Advisory for Pregnancy Quarantine & Testing IEC materials Drug prophylaxis FAQs Government Orders

Use of masks in the community

PPE Guidelines

Donning of PPE

Coronavirus Disease 2019 - COVID 19

COVID-19-REVISED TESTING GUIDELINES

NO.31/F2/2020/H&FWD dated 15th August 2020

Part-Ill

Classification of Contacts

High Risk (HR) Contact:

Low Risk (LR) Contact:

NO.31/F2/2020/H&FWD dated 15^th August 2020