Abstract
BackgroundChile has one of the highest incidences of COVID-19 infection in the world. Primary care can play a key role in early detection and containment of the disease. There is a lack of information on the clinical profile of patients with suspected COVID-19 in primary care, and controversy on the effectiveness of rapid serologic tests in the diagnosis and surveillance of the disease.AimTo assess the effectiveness of rapid serologic testing in detection and surveillance of COVID-19 cases in primary care.Design & settingA longitudinal study was undertaken, which was based on a non-random sample of 522 participants, including 304 symptomatic patients and 218 high-risk asymptomatic individuals. They were receiving care at four primary health clinics in an underserved area in Santiago, Chile.MethodThe participants were systematically assessed and tested for COVID-19 with reverse transcriptase-polymerase chain reaction (RT-PCR) and serology at baseline, and were followed clinically and serologically for 3 weeks.ResultsThe prevalence rate of RT-PCR confirmed COVID-19 cases were 3.5 times higher in symptomatic patients (27.5%; 95% confidence interval [CI] = 22.1 to 32.8) compared with asymptomatic participants (7.9%; 95% CI = 4.3 to 11.6). Similarly, the immune response was significantly different between both groups. Sensitivity of serologic testing was 57.8% (95% CI = 44.8 to 70.1) during the third week of follow-up and specificity was 98.4% (95% CI = 95.5 to 99.7).ConclusionRapid serologic testing is ineffective for detecting asymptomatic or non-severe cases of COVID-19 at early stages of the disease, but can be of value for surveillance of immunity response in primary care. The clinical profile and immune response of patients with COVID-19 in primary care differs from those in hospital-based populations.
Highlights
The pandemic of COVID-19 emerged strongly in Latin America; by mid-J uly 2020 the number of new daily cases surpassed that of the US and Europe with Brazil, Peru, and Chile leading the incidence rates
Rapid serologic testing is ineffective for detecting asymptomatic or non-severe cases of COVID-19 at early stages of the disease, but can be of value for surveillance of immunity response in primary care
Primary care can play a key role in early detection of cases and containment of the epidemic
Summary
The pandemic of COVID-19 emerged strongly in Latin America; by mid-J uly 2020 the number of new daily cases surpassed that of the US and Europe with Brazil, Peru, and Chile leading the incidence rates. Chile has one of the highest prevalence rates of COVID-19 in the world; higher than Brazil, the US, or the UK as of 31 August 2020.1 The stabilisation of incidence rates reported in Chile and in other countries highlights the relevance of finding effective early diagnostic and surveillance strategies at the community level to contain the epidemic, and start a safe unlock process. As lockdown strategies are reduced, because of a decrease in cases or social exhaustion, the role of primary care services could be essential for effective detection and containment of new outbreaks. There is a lack of information on the clinical profile of patients with suspected COVID-19 in primary care, and controversy on the effectiveness of rapid serologic tests in the diagnosis and surveillance of the disease
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