COVID-19 Diagnosis in Asymptomatic: RT-qPCR or any other Cost-Effective Method?

Mayank Agarwal,Yogesh Arvind Bahurupi,Prasan Kumar Panda

doi:10.3844/ajidsp.2021.97.100

Abstract

On January 30th, 2020, the World Health Organization announced the COVID-19 outbreak as a Public Health Emergency of International Concern. In the view of this pandemic, early diagnosis is the mainstay for halting the disease progression. Quantitative real-time Reverse Transcriptase-Polymerase Chain Reaction (RT-qPCR) has been established as the cornerstone for the diagnosis of COVID-19. However, the significance of RT-qPCR positivity in asymptomatic cases with travel history, mass screening purposes, or close contact tracing remains debatable as their period of infectivity is unknown. We present a case series of 42 asymptomatic patients, who tested positive for COVID-19 and were subjected to hospitalization until they tested negative as per Government guidelines. Through our case series, we have tried to establish that RT-qPCR testing as a diagnostic criterion for asymptomatic patients with no known contact history can lead to increased psychological and economic burden on the Government, the patient as well as his family. It also overburdens the health care resources and therefore, raises the question about its necessity among this cohort of asymptomatic cases and thus the possible role of other methods in the diagnosis and isolation of such cases.

Highlights

In late 2019, a novel coronavirus, designated as SARSCoV-2, was identified as the cause of an outbreak of acute respiratory illness in Wuhan, a city in Hubei, China. It was renamed ‘COVID-19’ by the World Health Organization (WHO) and by March 2020 the outbreak was characterised as a pandemic (Güner et al, 2020)
A recent study reported a positive retest in an asymptomatic, discharged and possibly non-infectious patient when tested by RT-qPCR for SARS-CoV-2 (Zhang et al, 2020)
As per our case series, we suggest that the 27 asymptomatic patients with a travel history or no documented records of contact history could have been subjected to other cheaper diagnostic methods instead of RT-qPCR tests, leading to the conservation of resources

Summary

Introduction

In late 2019, a novel coronavirus, designated as SARSCoV-2, was identified as the cause of an outbreak of acute respiratory illness in Wuhan, a city in Hubei, China Later, it was renamed ‘COVID-19’ by the World Health Organization (WHO) and by March 2020 the outbreak was characterised as a pandemic (Güner et al, 2020). The detection of viral RNA does not necessarily indicate the presence of an infectious or viable virus. The virus could not be isolated or cultured after day 11 of the illness. This indicated that while viral RNA detection may persist in some patients, such persistent RNA detection represents a non-viable virus and such patients are non-infectious. The current criteria for hospital discharge or discontinuation of quarantine need to be re-evaluated (NCIDS, 2020)

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