Rational use of SARS-CoV-2 polymerase chain reaction tests within institutions caring for the vulnerable

Yates, T. A., Cooke, G. S. and MacPherson, P. (2020) Rational use of SARS-CoV-2 polymerase chain reaction tests within institutions caring for the vulnerable. F1000Research, 9, 671. (doi: 10.12688/f1000research.24872.1) (PMID:32968484) (PMCID:PMC7489272)

Abstract

Institutions such as hospitals and nursing or long-stay residential homes accommodate individuals at considerable risk of mortality should they acquire SARS-CoV-2 infection. In these settings, polymerase chain reaction tests play a central role in infection prevention and control. Here, we argue that both false negative and false positive tests are possible and that careful consideration of the prior probability of infection and of test characteristics are needed to prevent harm. We outline evidence suggesting that regular systematic testing of asymptomatic and pre-symptomatic individuals could play an important role in reducing transmission of SARS-CoV-2 within institutions. We discuss how such a programme might be organised, arguing that frequent testing and rapid reporting of results are particularly important. We highlight studies demonstrating that polymerase chain reaction testing of pooled samples can be undertaken with acceptable loss of sensitivity, and advocate such an approach where test capacity is limited. We provide an approach to calculating the most efficient pool size. Given the current limitations of tests for SARS-CoV-2 infection, physical distancing and meticulous infection prevention and control will remain essential in institutions caring for vulnerable people.

• Item Type: Articles
• Additional Information: TAY is funded via an NIHR Academic Clinical Fellowship and acknowledges support from the NIHR Imperial Biomedical Research Centre. GSC is supported in part by the Biomedical Research Centre of Imperial College National Health Service (NHS) Trust and a National Institute for Health Research (NIHR) Research Professorship. PM is funded by the Wellcome Trust [206575].
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: MacPherson, Professor Peter
• Authors: Yates, T. A., Cooke, G. S., and MacPherson, P.
• College/School: College of Medical Veterinary and Life Sciences > School of Health & Wellbeing > Public Health
• Journal Name: F1000Research
• Publisher: F1000Research
• ISSN: 2046-1402
• ISSN (Online): 2046-1402
• Copyright Holders: Copyright © 2020 Yates TA et al.
• First Published: First published in F1000Research 9:671
• Publisher Policy: Reproduced under a Creative Commons licence