The National Academies of Sciences, Engineering, and Medicine released a new report on COVID-19 testing, examining four topics related to the use and interpretation of COVID-19 diagnostic tests: the advantages and limitations of reverse transcription polymerase chain reaction (RT-PCR) testing; the status of point-of-care tests; strategies and considerations for certain types and sequences of tests; and next-generation sequencing (NGS) testing.
The report, known as a rapid expert consultation, does not cover antibody tests.
Even when vaccines become widely available, diagnostic testing will continue to be critical to guide COVID-19 treatment, disease surveillance, contact tracing efforts, and plans to reopen the economy and schools. At present, at least 30 million tests will need to be performed each week in order to quickly diagnose individuals and their contacts, while screening of asymptomatic individuals may require up to 14 million tests per day, the rapid expert consultation said.
Currently, RT-PCR tests — which must be performed in a central laboratory — are considered the gold standard for detecting the presence of infectious viruses.
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This may change, however, as more evidence emerges on antigen-based diagnostic tests and on other highly sensitive testing methods.
The report noted trade-offs between RT-PCR tests versus the rapid point-of-care (POC) tests that are commonly used to screen asymptomatic individuals. POC tests may have lower sensitivity and specificity. They often need to be run multiple times per week for each person to quickly detect and isolate cases to reduce prevalence in certain environments, such as college campuses. The rapid expert consultation notes that at this time, there are few systems and compliance measures in place for reporting rapid POC test results to public health authorities, especially when the tests are conducted by employers or universities. Therefore, the numbers and locations of individuals who are infected may not be documented, and infection transmission may go unchecked.
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