Acceptance of a Symptom-Based Approach for COVID-19 rtRT-PCR Testing to Conserve Resources in a Lower Middle-Income Setting

• Published in: Journal of primary care & community health 2021, Vol.12, p.2150132720987711
• Main Authors: Islam, S. M. Rashed Ul, Akther, Tahmina, Nasif, Md. Abdullah Omar, Sultana, Sharmin, Munshi, Saif Ullah
• Format: Article
• Language: English
• Subjects: Adult; Asymptomatic; Caring for the Caregivers during the COVID-19 Pandemic; Chemical analysis; Coronaviruses; COVID-19; COVID-19 - complications; COVID-19 - diagnosis; COVID-19 diagnostic tests; COVID-19 Testing - methods; COVID-19 Testing - statistics & numerical data; Developing Countries; Disease transmission; Disruption; Female; Health Care Rationing - methods; Humans; Laboratories; Laboratories - statistics & numerical data; Male; Pandemics; Patient Isolation - statistics & numerical data; Polymerase chain reaction; Precautions; Reverse Transcriptase Polymerase Chain Reaction; RNA, Viral - isolation & purification; SARS-CoV-2 - genetics; SARS-CoV-2 - isolation & purification; Severe acute respiratory syndrome; Severe acute respiratory syndrome coronavirus 2; Symptom Assessment; Young Adult
• ISSN: 2150-1319; 2150-1327; 2150-1327
• DOI: 10.1177/2150132720987711

SARS-CoV-2 initially emerged in Wuhan, China in late 2019. It has since been recognized as a pandemic and has led to great social and economic disruption globally. The Reverse Transcriptase Real-Time Polymerase Chain Reaction (rtRT-PCR) has become the primary method for COVID-19 testing worldwide. The method requires a specialized laboratory set up. Long-term persistence of SARS-CoV-2 RNA in nasopharyngeal secretion after full clinical recovery of the patient is regularly observed nowadays. This forces the patients to spend a longer period in isolation and test repeatedly to obtain evidence of viral clearance. Repeated COVID-19 testing in asymptomatic or mildly symptomatic cases often leads to extra workload for laboratories that are already struggling with a high specimen turnover. Here, we present 5 purposively selected cases with different patterns of clinical presentations in which nasopharyngeal shedding of SARS-CoV-2 RNA was observed in patients for a long time. From these case studies, we emphasized the adoption of a symptom-based approach for discontinuing transmission-based precautions over a test-based strategy to reduce the time spent by asymptomatic and mildly symptomatic COVID-19 patients in isolation. A symptom-based approach will also help reduce laboratory burden for COVID-19 testing as well as conserve valuable resources and supplies utilized for rtRT-PCR testing in an emerging lower-middle-income setting. Most importantly, it will also make room for critically ill COVID-19 patients to visit or avail COVID-19 testing at their convenience.