PLoS ONE (Jan 2021)

Characteristics of SARS-CoV-2 testing for rapid diagnosis of COVID-19 during the initial stages of a global pandemic.

  • Jennifer L Guthrie,
  • Allison J Chen,
  • Dalton R Budhram,
  • Kirby Cronin,
  • Adriana Peci,
  • Paul Nelson,
  • Gustavo V Mallo,
  • George Broukhanski,
  • Michelle Murti,
  • Anna Majury,
  • Tony Mazzulli,
  • Vanessa G Allen,
  • Samir N Patel,
  • Julianne V Kus,
  • Vanessa Tran,
  • Jonathan B Gubbay

DOI
https://doi.org/10.1371/journal.pone.0253941
Journal volume & issue
Vol. 16, no. 7
p. e0253941

Abstract

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Accurate SARS-CoV-2 diagnosis is essential to guide prevention and control of COVID-19. Here we examine SARS-CoV-2 molecular-based test performance characteristics and summarize case-level data related to COVID-19 diagnosis. From January 11 through April 22, 2020, Public Health Ontario conducted SARS-CoV-2 testing of 86,942 specimens collected from 80,354 individuals, primarily using real-time reverse-transcription polymerase chain reaction (rRT-PCR) methods. We analyzed test results across specimen types and for individuals with multiple same-day and multi-day collected specimens. Nasopharyngeal compared to throat swabs had a higher positivity (8.8% vs. 4.8%) and an adjusted estimate 2.9 Ct lower (SE = 0.5, p<0.001). Same-day specimens showed high concordance (98.8%), and the median Ct of multi-day specimens increased over time. Symptomatic cases had rRT-PCR results with an adjusted estimate 3.0 Ct (SE = 0.5, p<0.001) lower than asymptomatic/pre-symptomatic cases. Overall test sensitivity was 84.6%, with a negative predictive value of 95.5%. Molecular testing is the mainstay of SARS-CoV-2 diagnosis and testing protocols will continue to be dynamic and iteratively modified as more is learned about this emerging pathogen.