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An effective strategy that tests suspected cases, tracks people infected and traces their contacts TTT will help to reduce the spread of the Coronavirus virus. The approach of testing, tracking and tracing TTT has become a central tool for achieving this objective as many countries have decisively implemented it or are in the process of scaling it up.

The TTT approach may be used to block the initial or recurrent spreads of a pathogen, aiming for a rapid extinction of local, well defined outbreaks that collectively can control an epidemic.

For diseases where infectiousness begins simultaneously with at the onset of symptoms, TTT can be very effective. Therefore, for the TTT strategy to be effective, contact tracing should be extended to some days before the onset of symptoms in every diagnosed patient; implementation needs to be at large scale, which poses a number of problems particularly in large countries; and it needs to be implemented quickly, to minimise the lag between the onset of symptoms and isolation of infected cases.

Box 2 describes their TTT strategies in more detail. Fast molecular tests can be used as confirmatory, becoming a very good alternative to RT-PCR tests to speed up and ease testing procedures. In the case of SARS-Cov2, expanding testing to asymptomatic or pre-symptomatic cases such as people who have been in contact with a confirmed case is particularly important, given the delay until the onset of symptoms. Tracking: identifying where people infected are, in order to provide the most appropriate management of the case, and to prevent further spreading of the virus.

Accurate tracking of infected patients and monitoring of compliance with isolation measures is key to limit contagion. This also implies following-up of the contacts to monitor for symptoms and signs of infection, and testing then to check for disease infection. A recent outbreak modelling study Hellewell et al. For instance, the majority of scenarios with a reproduction number or ability to spread of the virus, so-called R0 of 1.

The probability of control decreases with long delays from symptom onset to isolation, fewer cases ascertained by contact tracing, and increasing transmission before symptoms. This would require a huge increase in testing. The main purpose is to find and suppress as much as possible the local outbreaks across territories, which will require continuous effort to conduct effective TTT. In addition, TTT helps monitor the evolution of the epidemic, since effective testing and digitally-enabled contact tracing allows the disease spread to be tracked.

Combined with other health system information e. Testing: as of 6 April , Korea had conducted almost ten RT-PCR tests per thousand inhabitants, only behind Germany and Italy among countries with populations over 50 million 2.

This pattern can be explained by a mix of strategic, logistic, capacity, regulatory, and even cultural considerations. Korea developed a strong infrastructure for test kit production, distribution and laboratory analysis, after a strategic early decision to track most possible cases very strictly.

Tracking: after testing suspected cases, the ones testing positive are tracked and provided with treatment free of charge. The cost is covered by central and local governments and the health insurance public corporation. Korea also provides a subsidy to individuals who need to be isolated both self-isolation and hospitalisation to support their living costs and penalises those who are suspected to be infected if they refuse to receive diagnostic test, subsequent treatment or go through self-isolation.

People ordered into self-quarantine must download a mobile phone application, which alerts officials if a patient breaks isolation. All these tools allow for an effective tracking of patients. Tracing: Korea has developed a diverse digital crowd-sourced contact tracing strategy. Mobile phone locations are automatically recorded making possible to trace nearly everyone by following the location of their phones, which is facilitated by the fact that phone companies require all customers to provide their real names and national registry numbers.

The result of these tracing schemes are made public via national and local government websites, free smartphone apps that show the locations of infections, and text message updates about new local cases.

Fines for quarantine violations can reach around EUR 2 A downside of this tracing system relates to privacy issues surrounding the measures, which may also prevent some infected people from coming forward OECD, [14].

Testing: Singapore initiated a large testing strategy for all suspected cases since the early days of the outbreak, reaching 2 tests RT-PCR a day for a population of 5. Testing was deployed in primary care and hospital settings, and drive-through testing stations. In addition, people that died of a possible infectious cause and influenza-like illness were tested in sentinel clinics.

Tracking: A network of more than public health preparedness clinics was activated in the primary care setting, with subsidies extended to residents to incentivise them to seek care, allowing to track many cases. Doctors were instructed to provide medical leave of up to five days for patients with respiratory symptoms, allowing them to quarantine at home. All confirmed cases were immediately isolated in hospitals to prevent onward transmission.

Treatment costs were borne by the government, including for patients from abroad. Tracing: All identified contacts presenting symptoms were referred to hospitals for isolation and testing, and then placed under 14 days quarantine from the last date of exposure. To facilitate compliance and reduce hardship, the Quarantine Order Allowance Scheme provides economic assistance and the Infectious Disease Act provides legal power to enforce contact tracing and quarantine, and to prosecute those who do not comply penalties can be EUR 6 fine, six months jail, or both.

Collaboration exists between public health officials, the armed forces and the police to trace people, for instance, using CCTV footage and data visualisation, conducting labour-intensive detective-like investigations. The latter includes direct interviews with the patient and all identified contacts, calling them by phone requesting several details to determine their movement history seven days prior to symptom onset. Through in-person visits, a legal quarantine order is handed to each person.

Investigation also includes receipts and card payments investigation to trace the movements of the infected person. Accessed on 13 April 13 For example, supposing that the test could be administered to a large majority of people say every two weeks, it would be possible to isolate all those infected, and others could conduct a normal life.

This would be enormously expensive, but the cost would nevertheless be trivial compared to the costs of lockdown. However, there are huge logistical challenges. In practice even with fast RT-PCR that can be administered at the point of care see Box 1 , it is unlikely that testing capacity will be sufficient for population-wide exhaustive testing.

This means that it is necessary for authorities to prioritise who should be tested. Testing strategies have to be feasible within the constraints of testing capacity and taking into account the transmission scenarios that are likely to occur.

The WHO provides laboratory testing strategy recommendations specific to the number of cases an outbreak has reached in a country, between no and sporadic cases, to sustained community transmission WHO, [16].

In other words, there is a clear sequence of whom should be tested first, depending on the stage of the epidemic. Given the number of cases reached in most OECD countries at this stage, the priority for molecular laboratory tests will initially remain for ensuring safe and appropriate medical care, and therefore testing of hospitalised patients, vulnerable people who are likely to require hospital care and health care workers.

Once testing capacity is increased sufficiently, tests can be expanded to suspected non-severe cases and to people who were in contact with confirmed cases. This can allow targeted isolation of people who are infected, including those who show no symptoms. Molecular tests are informative about whether a person is infected at the time of the test.

As discussed above, RT-PCR-based tests represent the most accurate testing method but are also resource-intensive and capacity is therefore constrained. Germany is an example where capacity for lab-based molecular tests was built early in the disease outbreak. Broad testing has allowed targeted isolation of confirmed cases, even if they were not symptomatic.

At the same time, vulnerable people who were infected could be hospitalised and received respiratory support before the onset of severe symptoms, increasing the odds of survival. These factors may have contributed to relatively low mortality in Germany, although a number of other factors also played a role, including that many of the people initially infected were relatively young and healthy.

In the absence of reliable information about contacts between people who carry the virus and others, people at risk of being so-called super-spreaders can also be a priority group for repeated testing.

These are people who come into contact with many other people as part of their daily activities. Beyond health professionals, people working in supermarkets and grocery stores, public transport and in delivery services may be at higher risk of spreading the virus to many other people. Serologic testing , which identifies antibodies produced by the human immune system can serve a different purpose. Their use requires that accurate serologic tests are available see above but in addition, ideally we would also want to understand better the immunological response, and its duration.

For example, whilst it seems clear that having had the disease once confers some immunity, how long this immunity might last is unclear Petherick, [17]. Serologic tests can also be conducted in priority groups such as super-spreaders.

There is a particular interest in the potential for serologic tests as part of a strategy to support restarting economic activity. Most obviously, testing health professionals would limit unnecessary self-isolation, and increase the capacity of the health sector. Beyond this, testing occupational groups who cannot telework during lockdowns; and priority segments of the workforce, to identify those already immune, may be useful in allowing more people to safely return to work.

In addition to targeted testing of priority groups, testing can also take place in random samples of people for estimating prevalence and assessing progress towards herd immunity, as discussed below. People who have an immune response could be released from restrictions to movement, preferably in conjunction with a molecular diagnostic test to confirm that the person does not have an active infection.

If new cases can be tracked and isolated effectively and transmission reduced, restrictions can also more readily be eased gradually for people who are not immune.

People who are not immune may seek to expose themselves to the virus in order to gain immunity and re gain a more normal life and work.

This would be a very understandable response, given that many people have lost the chance to earn their living and support their families due to the lockdowns.

Unfortunately, the risk of such behaviour is that the disease may start spreading very rapidly once again, with the possibility that health services are overwhelmed. Herd immunity can be measured mainly in two ways Reid and Goldberg, [18] :. Indirectly from the age distribution and incidence pattern of the disease, if it is clinically distinct and reasonably common. Directly from assessments of immunity in defined population groups by application of serologic tests, as discussed above.

The assessment of immunity at the population level also called sero-surveillance Wilson et al. Into the future, sero-surveillance could provide relevant information to plan vaccination strategies, avoiding the need to vaccinate those who already have immunity.

In other words, the effective reproduction number at a given point in time Rt in these circumstances is less than 1. These are also key parameters to decide to what extent restrictions e.

As mentioned in Section 2. However, serologic tests’ reliability is still a major issue so governments are struggling to select the most appropriate one and are waiting for independent tests validations to come out. Another relevant factor has to do with better understanding the characteristics and evolution of the virus itself.

So far, researchers have found that the virus is quite stable and does not mutate significantly 8. However, this is another area where further research is desirable in order to inform policymaking. Herd immunity is dynamic and can be lost over time through waning of immunological memory or deaths of immune individuals, and newly susceptible individuals arrive through births or migration Reid and Goldberg, [18].

Evidence from a survivor from the original SARS-CoV infection in indicates that, 17 years later, the person still has antibodies which are capable of neutralising the virus Petherick, [17].

However, immunity can also be diminished if the virus changes, as happens with influenza where a new vaccine is required every year. Implementation of testing in OECD countries is varying rapidly. As of 4 May , tests per 1 population in OECD countries varied from fewer than one to more than tests per 1 population see Figure 1.

Important Notes: UW Laboratory Medicine Virology will prioritize maintaining clinically-actionable turnaround time for inpatient settings. Testing for inpatients or outpatients : We ask that potential clients desiring to send tests to UW Virology contact CSS at We currently cannot accept at-home collected swabs and await further FDA guidance on this issue.

Other Locations eg, reference laboratory client Send all samples with the COVID Test Requisition form is a fillable pdf – please download and enter information before printing.

In cases where BAL and sputum are available, they should be sent as they have the highest positivity rates. Collection Instructions for Nasopharyngeal Swab: Gently insert mini-tipped flocked nasopharyngeal swab swab on flexible plastic shaft through the nostril and into the nasopharynx, reaching the posterior nasopharynx. Shipping Send to the laboratory as soon as possible. Important notes Leaking samples will not be processed.

Send to UW Virology Lab via courier. The timeline of PCR positivity is different in specimens other than nasopharyngeal swab. PCR positivity declines more slowly in sputum and may still be positive after nasopharyngeal swabs are negative. Occasional false-positive results may occur due to technical errors and reagent contamination.

Serological diagnosis is especially important for patients with mild to moderate illness who may present late, beyond the first 2 weeks of illness onset. The most sensitive and earliest serological marker is total antibodies, levels of which begin to increase from the second week of symptom onset. For example, IgM and IgG seroconversion occurred in all patients between the third and fourth week of clinical illness onset as measured in 23 patients by To et al 7 and 85 patients by Xiang et al.

During the first 5. Testing of paired serum samples with the initial PCR and the second 2 weeks later can further increase diagnostic accuracy. Typically, the majority of antibodies are produced against the most abundant protein of the virus, which is the NC. Therefore, tests that detect antibodies to NC would be the most sensitive.

However, the receptor-binding domain of S RBD-S protein is the host attachment protein, and antibodies to RBD-S would be more specific and are expected to be neutralizing. Therefore, using one or both antigens for detecting IgG and IgM would result in high sensitivity.

Rapid point-of-care tests for detection of antibodies have been widely developed and marketed and are of variable quality. Many manufacturers do not reveal the nature of antigens used. The presence of neutralizing antibodies can only be confirmed by a plaque reduction neutralization test. Using available evidence, a clinically useful timeline of diagnostic markers for detection of COVID has been devised Figure.

Most of the available data are for adult populations who are not immunocompromised. The time course of PCR positivity and seroconversion may vary in children and other groups, including the large population of asymptomatic individuals who go undiagnosed without active surveillance.

Many questions remain, particularly how long potential immunity lasts in individuals, both asymptomatic and symptomatic, who are infected with SARS-CoV Published Online: May 6, Conflict of Interest Disclosures: None reported.

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When should rt pcr test be done – none:

May 12,  · Well, the good news is that many COVID experts now suggest that after 14 days of quarantine, people who have mild or moderate COVID infection, do not need to get a repeated RT-PCR test for a. May 03,  · Laboratory tests can take days to complete and include RT-PCR and other types of NAATs. play circle light icon Watch Video: Viral Test for COVID [] Antibody tests should not be used to diagnose a current infection, but they may indicate if you had a past infection. Antibody tests help learn about how human immune systems defend Estimated Reading Time: 5 mins. To face the new Covid‐19 pandemic, the need for early and accurate diagnosis of the disease among suspected cases quickly became obvious for effective management, and for better control of the spread of the disease in the population. Since the beginning of this disease epidemic caused by the severe Author: Moustapha Dramé, Maturin Tabue Teguo, Emeline Proye, Fanny Hequet, Maxime Hentzien, Lukshe Kanagarat.



May 12,  · Well, the good news is that many COVID experts now suggest that after 14 days of quarantine, people who have mild or moderate COVID infection, do not need to get a repeated RT-PCR test for a. Aug 18,  · In areas of higher disease burden (prevalence of 25%), the false negative rate after four RT-PCR tests is below 1%. Even with a very high prevalence of 50%, the false negative rate is low (%) after four negative tests, suggesting that alternative diagnoses should be strongly considered. Go to:Author: Masis Isikbay, Travis S. Henry, James A. Frank, Michael D. Hope, Michael D. Hope. Aug 17,  · One should take the test within the first week to ensure the accuracy of the results. Also, the faster one starts the treatment, the greater are the chances of avoiding complications. Always Follow Up The Test Results. If one tests negative for Covid RT PCR Test once but the symptoms persist for a longer period, it is better to take a follow-up test.