Beyond COVID-19-will self-sampling and testing become the norm?
Beyond COVID-19-will self-sampling and testing become the norm?
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超越COVID-19-自我采样和检测会成为常态吗？
DOI：
10.1016/s1473-3099(21)00197-3
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发表时间：
2021-09
期刊：
影响因子：
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通讯作者：
Okomo MC
中科院分区：
文献类型：
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作者：
Boum Y;Eyangoh S;Okomo MC
在抗击COVID-19的斗争中，许多国家的普通民众没有获得进行诊断检测的能力，而是经常受到令人沮丧和检测能力不足的影响。诊断一直是全球应对COVID-19的基石，因为遏制和应对疫情的策略主要依赖病例数。虽然RT-PCR仍然是检测SARS-CoV-2的金标准，但高检测需求已使分子实验室的能力不堪重负。在大流行的早期尤其如此，特别是在低收入和中等收入国家。诊断检测能力不足是COVID-19的影响在全球被低估的主要原因，而在诊断能力比高收入国家更稀缺的低收入国家，情况更是如此。[1]当2020年3月疫情蔓延至非洲时，只有塞内加尔和南非拥有能够使用RT-PCR检测SARS-CoV-2的实验室。由于非洲疾病控制和预防中心、世卫组织非洲区域办事处和世界粮食计划署采取行动提高实验室能力，到2020年5月，拥有RT-PCR能力实验室的非洲国家数量已增加到43个。1尽管这些实验室大多位于大城市，但喀麦隆在10个地区中的9个地区建立了17个RT-PCR检测点，以分散COVID-19国家应对措施。[2]建立分子实验室虽然必要，但并不能解决大规模检测的挑战。专门的检测点增加了检测能力，但也使感染状况不明的人靠近，并通过他们的旅行和等待采样和结果，增加了COVID-19的暴露风险。SARS-CoV-2抗原快速诊断检测试剂盒（RDTs;例如，SD Biosensor SARS-CoV-2 Rapid Antigen Test [Roche Diagnostics]）的验证已在全球范围内显著改变了检测策略。3 RDT结果可在30分钟内获得，缩短了周转时间，从而降低了暴露风险。在喀麦隆，国家算法建议对有症状的患者进行快速诊断试验，并对检测呈阳性的患者立即进行隔离和医疗护理。因此，只有RDT结果为阴性的个体才接受RT-PCR检测，从而缩短了周转时间和患者流量。通过这一策略，喀麦隆超过40%的有症状的SARS-CoV-2感染被RDT检测到并得到及时管理。4然而，尽管补充PCR检测，特别是随着新出现的变异带来的威胁增加，RDT不能完全取代SARS-CoV-2 RT-PCR。对一定比例的阳性样本进行RT-PCR检测对于检测新的变异仍然至关重要，并且通常需要在集中检测设施进行亲自采样。Nicole Ngai Yung Tsang及其同事5在《柳叶刀传染病》杂志上发表的荟萃分析中，比较了不同临床标本的诊断性能，包括鼻咽、鼻、喉和口咽拭子以及唾液。以鼻咽拭子为金标准，他们发现病人合并的鼻腔和咽喉拭子的灵敏度最高（97%，95%CI 93-100），而唾液中达到中度敏感性（85%，75-93）和鼻拭子（86%，77-93），咽喉拭子（68%，35-94）的敏感性低得多。因此，作者得出结论，唾液和鼻拭子是临床上可接受的常用鼻咽拭子替代品。更重要的是，他们还发现，汇集自我收集的鼻拭子和咽拭子具有诊断性能，...
In the fight against COVID-19, the general population in many countries has not been empowered to pursue diagnostic testing, but rather has been a subject to often frustrating and inadequate testing capacity. Diagnostics have been a cornerstone of the COVID-19 response globally, because strategies to contain and respond to the pandemic rely primarily on case counts. Although RT-PCR remains the gold standard for detecting SARS-CoV-2, high testing demand has overwhelmed molecular laboratory capacities. This was especially true early in the pandemic, and particularly in low-income and middleincome countries (LMICs). Inadequate diagnostic testing capacity is a primary reason why the impact of COVID-19 has been underestimated globally, and woefully so in LMICs, where diagnostic capacity has been even more scarce than in high-income countries. 1 When the pandemic spread to Africa in March, 2020, only Senegal and South Africa had laboratories capable of detecting SARS-CoV-2 using RT-PCR. Owing to actions taken by the Africa Centers for Disease Control and Prevention, WHO AFRO, and World Food Program to increase laboratory capacity, the number of African countries with RT-PCR-capable laboratories had increased to 43 by May, 2020. 1 Although most of these laboratories are in major cities, Cameroon implemented 17 RT-PCR testing sites in nine of ten regions to decentralise the COVID-19 national response. 2 Although necessary, establishing molecular laboratories does not solve the challenge of mass testing. Dedicated testing sites increased testing capacity, but also brought people of unknown infection status into proximity and, through their travelling and awaiting sampling and results, increased COVID-19 exposure risk. The validation of SARS-CoV-2 antigen rapid diagnostic tests (RDTs; eg, SD Biosensor SARS-CoV-2 Rapid Antigen Test [Roche Diagnostics]) has substantially changed testing strategies globally. 3 RDT results are available within 30 min, reducing turnaround time and therefore exposure risk. In Cameroon, the national algorithm recommended RDTs for symptomatic patients, and immediate isolation and medical care for those testing positive. Thus, only individuals with a negative RDT result underwent RT-PCR testing, improving turnaround time and patient flow.Through this strategy, more than 40% of symptomatic SARS-CoV-2 infections were detected by RDT and managed promptly in Cameroon. 4 However, despite complementing PCR testing, especially with the increased threat presented by emerging variants, RDTs cannot entirely replace SARS-CoV-2 RT-PCR. RT-PCR testing of a proportion of positive samples will remain crucial for the detection of new variants, and often requires in-person sampling at centralised testing facilities. In their meta-analysis reported in The Lancet Infectious Diseases, Nicole Ngai Yung Tsang and colleagues5 compared the diagnostic performance of different clinical specimens, including nasopharyngeal, nasal, throat, and oropharyngeal swabs and saliva. Using nasopharyngeal swabs as the gold standard, they found that patients’ pooled nasal and throat swabs gave the highest sensitivity (97%, 95% CI 93–100) among alternative sampling approaches, whereas moderate sensitivities were achieved by saliva (85%, 75–93) and nasal swabs (86%, 77–93) and a much lower sensitivity by throat swabs (68%, 35–94). The authors thus concluded that saliva and nasal swabs are clinically acceptable alternatives to commonly used nasopharyngeal swabs. More importantly, they also found that pooled self-collected nasal and throat swabs had a diagnostic performance that …