Reviewing potential vulnerabilities in COVID-19 diagnostics

What is it about?

Since its outbreak, the COVID-19 pandemic caused by the novel coronavirus (also called ‘SARS-CoV-2’) has claimed thousands of lives and made numerous others ill. Hospitals and medical workers faced an un-precedented storm of infected patients requiring medical attention. Such demanding and high-throughput situations can often lead to diagnostic errors in a medical laboratory. The authors of this study provide a clear overview of potential vulnerabilities and factors that could sway the accuracy of reverse transcription-polymerase chain reaction (RT-PCR)— the current gold standard tool for the detection of SARS-CoV-2 infection. They categorise these into three segments. First, the general preanalytical problems–such as inadequate collection, improper swab storage, and manual and identification errors. Second, specific issues like contamination of samples or testing of patients taking antiretroviral therapy. And third, analytical errors such as instrument malfunction, testing outside the diagnostic window, or active viral recombination. The authors suggest that combining clinical evidence from RT-PCR tests with chest computed tomography (CT) results, along with the considera-tion of epidemiologic, clinical and radiological factors while analysing RT-PCR results could help minimise diagnostic errors. They also highlight the need for further refinement of molecular targets and quality assurance in analytical procedures to ensure the highest possible accuracy.

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Photo by Mufid Majnun on Unsplash

Photo by Mufid Majnun on Unsplash

Why is it important?

Diagnostic errors can not only affect the wellbeing of an individual but also jeopardise public health and national/international measures to contain the spread of infection. A false negative might foster the further spread of the virus via human-to-human interaction and endanger lives, while a false positive could lead to unnecessary treatment resulting in social and economic adversities. KEY TAKEAWAY Laboratory medicine plays a crucial role in the diagnosis and containment of infectious and transmissible diseases like COVID-19. Hence, reducing testing errors in RT-PCRs is of paramount importance.