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Topic: Testing and Treatment
May 13, 2020
Prolonged Viral RNA Shedding after COVID-19 Symptom Resolution in Older Convalescent Plasma Donors
Re-testing of 86 previously SARS-CoV-2 positive patients from a Wisconsin tertiary care center after self-reported symptom resolution showed that 11 (13%) were still positive at a median of 19 days (range 12-24 days) after symptom resolution. Patients who re-tested positive were not significantly different from test-negative patients with respect to days since symptom recovery. To the extent…
Pre-Procedural Surveillance Testing for SARS-CoV-2 in an Asymptomatic Population Shows Low Rates of Positivity
Among University of Washington Medical Center asymptomatic patients screened prior to admission and patients screened prior to surgical or aerosolizing procedures, a very low proportion tested positive for SARS-CoV-2. Among 349 asymptomatic patients tested at admission, 0.9% (n=3) were positive and 0.6% (n=2) were inconclusive. Among 350 patients undergoing surgical or aerosolizing procedures, 0.9% (n=3)…
May 12, 2020
Use of Corticosteroids in Coronavirus Disease 2019 Pneumonia: A Systematic Review of the Literature
A systematic literature review identified four studies of corticosteroid use in patients with COVID-19 reported through March 15, 2020. The effect of corticosteroids on clinical outcomes for COVID-19 was mixed, with corticosteroids having a detrimental impact in two out of four studies. One study found that methylprednisolone could lower the mortality rate by 62% among patients with severe COVID-19. Veronese et al. (Apr 24, 2020). Use of Corticosteroids in Coronavirus…
Association of Treatment With Hydroxychloroquine or Azithromycin With In-Hospital Mortality in Patients With COVID-19 in New York State
A retrospective multi-center cohort study sampled randomly from all admitted participants with laboratory-confirmed COVID-19 in 25 hospitals (N=1,438) and compared hydroxychloroquine alone, azithromycin alone, and combination of the two relative to treatment with neither medication. There was a greater odds of cardiac arrest in patients receiving combination therapy (OR 2.13 95% CI: 1.12, 4.05), but otherwise no statistically significant associates with mortality or abnormal electrocardiogram findings. However, combination therapy had a non-significant association with…
Rapid and Extraction-Free Detection of SARS-CoV-2 from Saliva with Colorimetric LAMP
Shortages in testing materials, including swabs, PPE, reagents, RNA extraction kits, and labor, have restricted availability of testing. A rapid colorimetric assay using the LAMP amplification method demonstrated high performance on expectorated saliva samples. This method does not require RNA purification or use of swabs, and can be self-collected, which reduces PPE and personnel needs. Lalli. (May 11, 2020). Rapid and Extraction-Free Detection of SARS-CoV-2 from…
May 8, 2020
Detection of Low Levels of SARS-CoV-2 RNA from Nasopharyngeal Swabs Using Three Commercial Molecular Assays
Lowe et al. compared the testing results of SARS-CoV-2 between three commercial assays for SARS-CoV-2 (Xpert Xpress SARS-CoV-2, cobas, and Lightmix Modular SARS) using 37 nasopharyngeal (NP) swabs with lower levels of SARS-CoV-2 RNA (30 with Ct value between 30-33.9, 22 with Ct ≥34, and 5 negative for SARS-CoV-2). The overall concordance was 86.5% (32/37), including a 100% concordance for samples with moderate viral concentrations (Ct between 30 to –33.9), but a discordance…
Occurrence and Timing of Subsequent SARS-CoV-2 RT-PCR Positivity Among Initially Negative Patients
Two independent research teams from the University of Washington (UW) and Stanford Health Care reported a similar frequency of discordant SARS-CoV-2 RT-PCR results among initially negative patients subjected to repeat testing. Among 626 patients who were initially test-negative and re-tested within 7 days, repeat testing yielded a positive result in 3.5% of cases (4.3% UW, 2.8% Stanford). The majority (96.5%)…
Observational Study of Hydroxychloroquine in Hospitalized Patients with Covid-19
Geleris et al. conducted an observational study of the association between hydroxychloroquine use and intubation or death among 1,446 consecutive patients at a large medical center in New York City. During a median follow-up of 22.5 days, 59% received hydroxychloroquine either within 24 or 48 hours after presentation to the emergency department, and 25% experienced a primary endpoint (either intubation or death). Those who were treated…
Meta-Analysis of Diagnostic Performance of Serological Tests for SARS-CoV-2 Antibodies and Public Health Implications
A meta-analysis of the diagnostic performance of several serological tests (commercial ELISA or CMIA/CLIA assays and in-house tests) to assess their real-world performance under scenarios of varying proportion of infected individuals found high specificity (pooled estimates of 98% for IgM and 99% for both IgG and total antibodies) but an unsatisfactory pooled sensitivity of 82-85%. Even…
May 7, 2020
Efficient Prevalence Estimation and Infected Sample Identification with Group Testing for SARS-CoV-2
Group testing of samples for the presence of SARS-CoV2 involves pooling samples from multiple individuals and testing individual samples only if the pool is positive. This strategy can greatly increase testing efficiency. This is especially critical during the use widespread screening and isolation as a part of primary control measures (i.e., absence of an effective therapeutic or vaccine). Using a mathematical model to…
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