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COVID-19: The CIDRAP Viewpoint - Part 3: "Smart testing for COVID-19 virus and antibodies" (May 20, 2020)

Shiloh

Editor, Senior Moderator
Source: https://www.cidrap.umn.edu/covid-19/covid-19-cidrap-viewpoint


COVID-19: The CIDRAP Viewpoint

Part 3: "Smart testing for COVID-19 virus and antibodies" (May 20, 2020)
Part 2: "Effective COVID-19 crisis communication" (May 6, 2020)
Part 1: "The future of the COVID-19 pandemic: lessons learned from pandemic influenza" (Apr 30, 2020)
Welcome to "COVID-19: The CIDRAP Viewpoint." Our intent with the Viewpoint series is to add key information regarding the pandemic, address issues that haven't garnered the attention they deserve, and reflect the unique expertise among the CIDRAP team and our expert consultants.
In this series of reports we will address timely issues with straight talk and clarity. And the steps we recommend will be based on our current reality and the best available data. Our goal is to help planners envision some of the situations that might present themselves later this year or next year so that they can take key steps now, while there’s still time.
Upcoming reports will address contact tracing, surveillance, supply chains, epidemiologic issues, key areas for research, and other pressing topics. We will release reports every 1 to 2 weeks.
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In the third Viewpoint report, published May 20, 2020, "Smart testing for COVID-19 virus and antibodies"," CIDRAP and non-CIDRAP experts note that, while SARS-CoV-2 testing plays a critical role in responding to the COVID-19 pandemic, tests alone are just one element of a cascade of events that must occur for an effective testing strategy.
For the role of testing to be optimized, other elements of the cascade—including infrastructure, processes, people, other essential components, and an action plan—must be in place, operational, and continually monitored.
The experts propose a SARS-CoV-2 smart testing framework that helps ensure that the right test is available to the right person at the right time, with timely test results guiding actions that minimize illness, deaths, and disease spread. Key elements of the "smart testing" framework:
  • Right Infrastructure: Factors such as institutional support and supply chain availability must be in place.
  • Right Population: Testing must be targeted based on the goals of testing.
  • Right Test: Different types of tests (e.g., molecular, antigen, antibody) are appropriate in different settings.
  • Right Interpretation: The test sensitivity and specificity—and how well it performs at low versus higher levels of disease in the population—must be considered.
  • Right Action: Based on test results, what actions are needed to minimize illness, deaths, and disease spread?
The report also outlines some of the most important, but often overlooked components in the testing cascade that must be considered by policy makers, public health agencies, hospital administrators, and the public. These are material capacity, instrument capacity, skilled labor availability, instrument use and availability, and result reporting and action steps.
Because of the complexities involved in the SARS-CoV-2 testing cascade, the authors recommend that the US secretary of Health and Human Services (HHS) appoint by July 1, 2020, a blue-ribbon panel of national experts to begin a reality-based testing strategy for the country.
”If we don’t do smart testing for SARS-CoC-2, we unnecessarily limit the clinical and public health impact we can have in responding to this pandemic,” said Michael Osterholm, PhD, MPH, CIDRAP director. “We believe that a ‘test, test, test mantra approach’ is actually counterproductive to using most effectively testing as one of our critical public health tools.”
 
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