Performance and feasibility of universal PCR admission screening for SARS‐CoV‐2 in a German tertiary care hospital

Abstract

Anamnestic screening of symptoms and contact history is applied to identify coronavirus disease 2019 (COVID-19) patients on admission. However, asymptomatic and presymptomatic patients remain undetected although the viral load may be high. In this retrospective cohort study, all hospitalized patients who received polymerase chain reaction (PCR) admission testing from March 26th until May 24th, 2020 were included. Data on COVID-19-specific symptoms and contact history to COVID-19 cases were retrospectively extracted from patient files and from contact tracing notes. The compliance to the universal testing protocol was high with 90%.Out of 6940 tested patients, 27 new severe acute respiratory syndrome coronavirus-2 infections (0.4%) were detected. Seven of those COVID-19 cases (26% of all new cases) were asymptomatic and had no positive contact history, but were identified through a positive PCR test. The number needed to identify an asymptomatic patient was 425 in the first wave of the epidemic, 1218 in the low incidence phase. The specificity of the method was above 99.9%. Universal PCR testing was highly accepted by staff as demonstrated by high compliance. The costs to detect one asymptomatic case in future studies need to be traded off against the costs and damage caused by potential outbreaks of COVID-19.

Clinical performance evaluation of SARS-CoV-2 rapid antigen testing in point of care usage in comparison to RT-qPCR

“…For more than a year, the COVID-19 pandemic has been a worldwide public health challenge. As well as contact tracing, contact reduction, quarantine, and vaccination, the early testing and detection of infectious persons is key in mitigating the spread of disease [1] .…”

Universal Polymerase Chain Reaction Screening for Severe Acute Respiratory Syndrome Coronavirus 2 in Asymptomatic Patients Before Hospital Admission in Tokyo, Japan

“…In this study, 0.07% of the asymptomatic patients and attendants tested positive for SARS-CoV-2 RNA by PCR before the scheduled admission. Regarding universal SARS-CoV-2 PCR screening before admission, Krüger et al [1] reported that 27 of 6,940 patients (0.4%) were positive at a tertiary care hospital in Germany, and Scheier et al [2] demonstrated similar results at four hospitals in Zurich (8 of 2,278 positive patients, 0.4%). These studies were conducted in areas where the COVID-19 prevalence was higher than in Tokyo.…”

“…Universal severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) polymerase chain reaction (PCR) screening before admission has been adopted in several hospitals to prevent nosocomial SARS-CoV-2 transmission from asymptomatic and pre-symptomatic patients. However, the usefulness of this type of screening remains unclear as it depends on the regional COVID-19 prevalence, and, to date, only a few large-scale studies have been conducted [1] , [2] , [3] . Here, we report the universal COVID-19 PCR screening results for over 12,000 asymptomatic patients and their attendants before admission to a hospital in Tokyo, Japan, to evaluate the universal screening benefits.…”

Performance of Three SARS-CoV-2 Immunoassays, Three Rapid Lateral Flow Tests, and a Novel Bead-Based Affinity Surrogate Test for the Detection of SARS-CoV-2 Antibodies in Human Serum

“…However, antibody testing is useful in determining exposure to SARS-CoV-2, especially in patients with potential post-COVID-19-symptoms, as well as for epidemiological investigations. In patients with low viral RNA load detected by PCR, antibody testing helps to distinguish between the beginning of a SARS-CoV-2 infection, when no antibodies are detectable and infectivity is expected to increase, and the persistent PCR positivity after an undiagnosed SARS-CoV-2 infection, when antibodies should be detectable and no further infectivity is expected (6). Antibody testing also allows the identification of suitable convalescent plasma donors and may become important for the determination of post-vaccination immunity.…”