A Two-stage Diagnosis Strategy for COVID-19 and Similar Pandemics

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Türkiye Klinikleri Biyoistatistik Dergisi, vol.13, no.1, pp.82-90, 2021 (Peer-Reviewed Journal) identifier


Objective: Coronavirus disease-2019 (COVID-19) outbreak emerged in Wuhan-China in December-2019, and has covered the world by rapidly becoming a pandemic, infecting >4.5 million by mid-May 2020, killing >300,000 globally, and >90 million people tested. Several rapid test kits based on antibody response have been developed but the reverse transcriptionpolymerase chain reaction (RT-PCR) approach for its superior sensitivity and specificity. As rapid detection of the virus is vital, we propose a two-stage testing framework that utilizes antibodydiagnostic kits and refers to RT-PCR only when a decision cannot be made. Material and Methods: In this study, using the Bayes formula and independent tests assumption, we developed several “repeat-testing” strategies to increase the overall sensitivity and specificity of both tests. We compared the false negatives, false positive, burden on the testing centres, and predicted cost among strategies. Results: We have shown that it is possible to increase the diagnostic capabilities of poor tests, “repeat” testing strategies. The primary advantage of such approaches is the faster diagnosis of cases, which allows for timely isolation, quarantine, and affiliation work. Also such strategies reduce the burden on the RT-PCR testing laboratories, thus, allowing them to focus their efforts to individuals that are more difficult to diagnose. The cost-comparison we conducted also suggests that this proposed is more cost-effective. Conclusion: The two-stage diagnostic strategy for COVID-19 is more efficient regarding pandemic management as it provides the testing results more quickly for the majority of suspected cases, allowing for timely isolation and affiliation work, and more cost-effective, reducing the burden on the healthcare system.