April 13, 2020 -- Are healthcare providers and the public putting too much faith in the accuracy of diagnostic tests for COVID-19? An article published April 9 in Mayo Clinic Proceedings warns that a second wave of novel coronavirus infections could occur among individuals who believe they are in the clear because their COVID-19 test was negative.
In the article, the authors maintain that the sensitivity and other aspects of reverse transcription polymerase chain reaction (RT-PCR) testing for COVID-19 have not been clearly reported. RT-PCR testing is most useful when tests are positive, but it's less useful for ruling out infection with SARS-CoV-2, the virus that causes COVID-19. Therefore, a negative RT-PCR test does not mean a person is free of the disease, noted Dr. Priya Sampathkumar of the Mayo Clinic in Rochester, MN, in a release.
Diagnostic RT-PCR tests for COVID-19 can have sensitivities of 90%, but this still means that the test will miss many infections, especially as testing capacity ramps up. This has major implications not only for the public but also for healthcare professionals, according to the authors.
They urge public health officials to follow principles of evidence-based reasoning regarding diagnostic test results and how to handle false negatives. They offer four recommendations:
The authors concluded that while negative RT-PCR test results may be reassuring for low-risk individuals, those at high risk of infection should continue to take additional measures such as extended self-isolation. Also, providers should consider factors such as chest x-ray or CT scan results and contact history in guiding care decisions for those at high risk.
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