Tony Zitek, MD

Disclosures

Western J Emerg Med. 2020;21(3):470-472. 

In This Article

Abstract and Introduction

Abstract

Many public officials are calling for increased testing for the 2019 novel coronavirus disease (COVID-19), and some governments have taken extraordinary measures to increase the availability of testing. However, little has been published about the sensitivity and specificity of the reverse transcriptase-polymerase chain reaction (RT-PCR) nasopharyngeal swabs that are commonly used for testing. This narrative review evaluates the literature regarding the accuracy of these tests, and makes recommendations based on this literature. In brief, a negative RT-PCR nasopharyngeal swab test is insufficient to rule out COVID-19. Thus, over-reliance on the results of the test may be dangerous, and the push for widespread testing may be overstated.

Introduction

A novel coronavirus disease (COVID-19), caused by SARS-CoV-2, has rapidly spread throughout many countries including the United States since its discovery in December 2019.[1] Many locations in the US are looking to rapidly expand their testing capabilities for this virus as they believe this could provide an important means to battle the COVID-19 pandemic.[2–6] However, the benefit of widespread testing depends on the accuracy of the test, and how the results of the test will affect treatment. For mild cases of COVID-19 (which are the primary target of the outpatient testing facilities), no specific medications are indicated, so in most cases, the results of the test would not change treatment. With regard to the accuracy of the test, the most commonly used test for detecting SARS-CoV-2 is a nasopharyngeal swab that uses a reverse transcriptase-polymerase chain reaction (RT-PCR) to identify viral RNA. Data from in vitro analyses suggest that the RT-PCR test is highly specific for SARS-CoV-2, as it is not positive when exposed to the nucleic acid of other common viruses.[7] Similarly, the in vitro sensitivity of RT-PCR tests is high, but in clinical settings the sensitivity of the nasopharyngeal RT-PCR swab tests for diagnosing COVID-19 is questionable. This article will review the clinical data regarding the accuracy of the COVID-19 RT-PCR test.

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