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Longitudinal Assessment of Diagnostic Test Performance Over the Course of Acute SARS-CoV-2 Infection

2021; Oxford University Press; Volume: 224; Issue: 6 Linguagem: Inglês

10.1093/infdis/jiab337

1537-6613

Rebecca L. Smith, Laura Gibson, Pamela P. Martinez, Ruian Ke, Agha Zeeshan Mirza, Madison Conte, Nicholas Gallagher, Abigail Conte, Leyi Wang, Richard Fredrickson, Darci C. Edmonson, Melinda E. Baughman, Karen Chiu, Hannah Choi, Tor Jensen, Kevin R. Scardina, Shannon Bradley, Stacy L Gloss, Crystal Reinhart, Jagadeesh Yedetore, Alyssa N. Owens, John Broach, Bruce Barton, Péter Lázár, Darcy Henness, Todd Young, Alastair Dunnett, Matthew L. Robinson, Heba H. Mostafa, Andrew Pekosz, Yukari C. Manabe, William Heetderks, David D. McManus, Christopher B. Brooke,

SARS-CoV-2 and COVID-19 Research

Serial screening is critical for restricting spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) by facilitating timely identification of infected individuals to interrupt transmission. Variation in sensitivity of different diagnostic tests at different stages of infection has not been well documented.In a longitudinal study of 43 adults newly infected with SARS-CoV-2, all provided daily saliva and nasal swabs for quantitative reverse transcription polymerase chain reaction (RT-qPCR), Quidel SARS Sofia antigen fluorescent immunoassay (FIA), and live virus culture.Both RT-qPCR and Quidel SARS Sofia antigen FIA peaked in sensitivity during the period in which live virus was detected in nasal swabs, but sensitivity of RT-qPCR tests rose more rapidly prior to this period. We also found that serial testing multiple times per week increases the sensitivity of antigen tests.RT-qPCR tests are more effective than antigen tests at identifying infected individuals prior to or early during the infectious period and thus for minimizing forward transmission (given timely results reporting). All tests showed >98% sensitivity for identifying infected individuals if used at least every 3 days. Daily screening using antigen tests can achieve approximately 90% sensitivity for identifying infected individuals while they are viral culture positive.