SARS-CoV-2/COVID-19 Testing: The Tower of Babel

SARS-CoV-2/COVID-19 Testing: The Tower of Babel

Authors

  • Chiara Reno Dipartimento di Scienze Biomediche e Neuromotorie, Alma Mater Studiorum - Università di Bologna
  • Jacopo Lenzi Dipartimento di Scienze Biomediche e Neuromotorie, Alma Mater Studiorum - Università di Bologna
  • Davide Golinelli Dipartimento di Scienze Biomediche e Neuromotorie, Alma Mater Studiorum - Università di Bologna
  • Davide Gori Dipartimento di Scienze Biomediche e Neuromotorie, Alma Mater Studiorum - Università di Bologna
  • Carlo Signorelli Università Vita-Salute San Raffaele; Dipartimento di Medicina e Chirurgia, Università degli Studi di Parma
  • John Kraemer Department of Health Systems Administration, Georgetown University
  • Michael A. Stoto Department of Health Systems Administration, Georgetown University; Emergency Preparedness Research, Evaluation and Practice (EPREP) Program, Harvard T.H. Chan School of Public Health
  • Elisa Avitabile Dipartimento di Farmacia e Biotecnologie, Alma Mater Studiorum - Università di Bologna
  • Maria Paola Landini IRCCS Istituto Ortopedico Rizzoli; Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale, Alma Mater Studiorum - Università di Bologna
  • Tiziana Lazzarotto Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale, Alma Mater Studiorum - Università di Bologna, Bologna
  • Maria Carla Re Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale, Alma Mater Studiorum - Università di Bologna
  • Paola Rucci Dipartimento di Scienze Biomediche e Neuromotorie, Alma Mater Studiorum - Università di Bologna
  • Gloria Taliani Dipartimento di Medicina Traslazionale e di Precisione, Università degli Studi di Roma "La Sapienza"
  • Davide Trerè Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale, Alma Mater Studiorum - Università di Bologna
  • Caterina Vocale IRCCS Azienda Ospedaliero-Universitaria "Policlinico Sant'Orsola-Malpighi" di Bologna
  • Maria Pia Fantini Dipartimento di Scienze Biomediche e Neuromotorie, Alma Mater Studiorum - Università di Bologna

Keywords:

COVID-19, SARS-CoV-2, Pandemic, Molecular Diagnostic Techniques, Rapid Antigen Test, Pooling Test, Predictive Value of Tests, Public Health Surveillance, Screening

Abstract

Background and aim: Testing represents one of the main pillars of public health response to SARS-CoV-2/COVID-19 pandemic. This paper shows how accuracy and utility of testing programs depend not just on the type of tests, but on the context as well.

Methods: We describe the testing methods that have been developed and the possible testing strategies; then, we focus on two possible methods of population-wide testing, i.e., pooled testing and testing with rapid antigen tests. We show the accuracy of split-pooling method and how, in different pre-test probability scenarios, the positive and negative predictive values vary using rapid antigen tests.

Results: Split-pooling, followed by retesting of negative results, shows a higher sensitivity than individual testing and requires fewer tests. In case of low pre-test probability, a negative result with antigen test could allow to rule out the infection, while, in case of a positive result, a confirmatory molecular test would be necessary.

Conclusions: Test performance alone is not enough to properly choose which test to use; goals and context of the testing program are essential. We advocate the use of pooled strategies when planning population-wide screening, and the weekly use of rapid tests for close periodic monitoring in low-prevalence populations.

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Published

09-11-2020

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Section

ORIGINAL INVESTIGATIONS/COMMENTARIES - SPECIAL COVID19

How to Cite

1.
Reno C, Lenzi J, Golinelli D, Gori D, Signorelli C, Kraemer J, et al. SARS-CoV-2/COVID-19 Testing: The Tower of Babel. Acta Biomed [Internet]. 2020 Nov. 9 [cited 2024 Jul. 17];91(4):e2020144. Available from: https://www.mattioli1885journals.com/index.php/actabiomedica/article/view/10911