Potential drawbacks of frequent asymptomatic coronavirus disease 2019 (COVID-19) testing

• Published in: Infection control and hospital epidemiology Vol. 42; no. 11; pp. 1405 - 1406
• Main Authors: Lippi, Giuseppe, Henry, Brandon M., Sanchis-Gomar, Fabian
• Format: Journal Article
• Language: English
• Published: United States Cambridge University Press 01.11.2021
• Subjects: Asymptomatic; Asymptomatic Diseases; Asymptomatic Infections; Coronaviruses; COVID-19; COVID-19 diagnostic tests; Disease transmission; Humans; Infections; Letter to the Editor; Medical supplies; Pandemics; Quarantine; Radiation; Reagents; Respiratory tract; SARS-CoV-2; Severe acute respiratory syndrome coronavirus 2; Shortages; Social distancing
• ISSN: 0899-823X; 1559-6834; 1559-6834
• DOI: 10.1017/ice.2020.1305

A recent survey of the American Association of Clinical Chemistry (AACC) has revealed that >50% of worldwide clinical laboratories were still facing dramatic shortages of test kits and reagents at the end of September 2020, with >70% of respondents emphasizing substantial challenges to increase their testing capacity.3 The gold standard for diagnosing COVID-19 is identification of viral RNA in upper respiratory tract samples, collected and tested by skilled and trained healthcare personnel. [...]staff shortages will further complicate the possibility of amplifying the actual testing volume, which remains now insufficient for even testing all suspect and symptomatic subjects in many worldwide regions. [...]specimen collection and reagent shortages have inhibited rapid increases in testing capacity, representing a bottleneck and critical limitation in intensifying SARS-CoV-2 diagnostic testing. [...]diagnosing asymptomatic COVID-19 people, who are unlikely to develop medium- or long-term consequences from this infection, could expose these people to further invasive and potentially harmful testing (eg, radiation) and even unnecessary treatments, which may be associated with undesirable side effects that could be worse than the disease itself.8,9 Rates of false-negative swab tests between 2% and 33% in repeat sample testing have been reported, while rates of false positives have been estimated between 0.8% and 4.0%, probably due to technical problems such as contamination during sampling, contamination of amplicons or reagents, and cross reactions with other viruses or genetic material.10 Assuming a false-positive rate of only 1%, for every 1 million tests run per day, 10,000 false-positive results would occur.