IDSA outlines testing recommendations for COVID-19
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The Infectious Diseases Society of America has released diagnostic recommendations for both symptomatic and asymptomatic patients with COVID-19.
“As infectious diseases physicians and clinical laboratorians, we recognized that the number of new scientific papers devoted to diagnostics for SARS-CoV-2 was exploding. Every day, there were new studies and new data being released in a setting of increasing availability of commercial tests that are approved under emergency use authorization by the FDA,” Kimberly E. Hanson, MD, MHS, member of the IDSA board of directors and lead member of the IDSA COVID-19 diagnostic guidelines expert panel, said during a press briefing. “This was the perfect time to ask, ‘Can we create guidance on how to use these tests that’s evidence based?’”
According to Hanson, a panel of clinicians “on the front lines,” including ID physicians, clinical microbiologists, experts in synthesizing clinical research and others convened the panel to examine research on COVID-19 diagnostics and assess who should be tested, the accuracy of the tests being used, the repetition of negative testing and the factors that contribute to the availability of tests.
The recommendations from the IDSA regarding COVID-19 testing are summarized by the IDSA are as follows:
Recommendation 1. A SARS-CoV-2 nucleic acid amplification test should be given to symptomatic individuals in the community who are suspected to have COVID-19, even when the clinical suspicion for COVID-19 is low. (Strong recommendation, very low certainty of evidence)
Recommendation 2. Nasopharyngeal, or midturbinate (MT), or nasal swabs rather than oropharyngeal swabs or saliva alone should be collected for SARS-CoV-2 RNA testing in symptomatic individuals with upper respiratory tract infection (URTI) or influenza-like illness (ILI) suspected of having COVID-19. (Conditional recommendation, very low certainty of evidence)
Recommendation 3. Nasal and MT swab specimens may be collected for SARS-CoV-2 RNA testing by either patients or health care providers in symptomatic individuals with URTI or ILI suspected of having COVID-19. (Conditional recommendation, low certainty of evidence)
Recommendation 4. A strategy of initially obtaining an upper respiratory tract sample (eg, nasopharyngeal swab) rather than a lower respiratory sample for SARS-CoV-2 RNA testing should be implemented in hospitalized patients with suspected COVID-19 lower respiratory tract infection. If the initial upper respiratory sample result is negative and the suspicion for disease remains high, a lower respiratory tract sample (eg, sputum, bronchoalveolar lavage fluid, tracheal aspirate) should be collected rather than another upper respiratory sample. (Conditional recommendations, very low certainty of evidence)
Recommendation 5. A single viral RNA test, not repeat testing, should be performed in symptomatic individuals with a low clinical suspicion for COVID-19. (Conditional recommendation, low certainty of evidence)
Recommendation 6. Repeat viral RNA testing should be performed when the initial test is negative in symptomatic individuals with an intermediate or high clinical suspicion of COVID-19. (Conditional recommendation, low certainty of evidence)
Recommendation 7. The panel makes no recommendations for or against using rapid (ie, test time of 1 hour or less) vs. standard RNA testing in symptomatic individuals suspected of having COVID-19. (Knowledge gap)
Recommendation 8. The panel suggests that SARS-CoV-2 RNA testing should be performed in asymptomatic individuals who are either known or suspected to have been exposed to COVID-19. (Conditional recommendation, very low certainty of evidence)
Recommendation 9. SARS-CoV-2 RNA testing should not be performed in asymptomatic individuals with no known contact with COVID-19 who are being hospitalized in areas with a low community prevalence of COVID-19. (Conditional recommendation, very low certainty of evidence)
Recommendation 10. Direct SARS-CoV-2 RNA testing should be performed in asymptomatic individuals with no known contact with COVID-19 who are being hospitalized in areas with a high community prevalence of COVID-19. (Conditional recommendation, very low certainty of evidence)
Recommendation 11. SARS-CoV-2 RNA testing should be performed in immunocompromised, asymptomatic individuals who are being admitted to the hospital regardless of exposure to COVID-19. (Strong recommendation, very low certainty of evidence)
Recommendation 12. CoV-2 RNA testing (vs. no testing) should be performed in asymptomatic individuals before immunosuppressive procedures regardless of known exposure to COVID-19. (Strong recommendation, very low certainty of evidence)
Recommendation 13. SARS-COV-2 RNA testing should be performed in asymptomatic individuals (without known exposure to COVID-19) who are undergoing major time-sensitive surgeries. (Conditional recommendation, very low certainty of evidence)
Recommendation 14. SARS-CoV-2 RNA testing should not be performed in asymptomatic individuals without known exposure to COVID-19 who are undergoing a time-sensitive, aerosol generating procedure (eg, bronchoscopy) when personal protective equipment (PPE) is available. (Conditional recommendation, very low certainty of evidence)
Recommendation 15. SARS-CoV-2 RNA testing should be performed in asymptomatic individuals without a known exposure to COVID-19 who are undergoing a time-sensitive, aerosol generating procedure (eg, bronchoscopy) when PPE is limited and testing is available. (Conditional recommendation, very low certainty of evidence)
“Evidence, information and data are coming out so quickly. We really intend for these guidelines to be living documents that are frequently updated,” Hanson said, while adding that the IDSA panel is hoping to address serological tests in the upcoming weeks as part of their series of guidelines, which also includes recommendations for treatment and PPE use.
Reference:
IDSA. Infectious Diseases Society of America guidelines on the diagnosis of COVID-19. https://www.idsociety.org/practice-guideline/covid-19-guideline-diagnostics/. Accessed May 8, 2020.
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