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Burrow DT, Heggestad JT, Kinnamon DS, Chilkoti A. Engineering Innovative Interfaces for Point-of-Care Diagnostics. Curr Opin Colloid Interface Sci 2023; 66:101718. [PMID: 37359425 PMCID: PMC10247612 DOI: 10.1016/j.cocis.2023.101718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Revised: 05/31/2023] [Accepted: 06/05/2023] [Indexed: 06/28/2023]
Abstract
The ongoing Coronavirus disease 2019 (COVID-19) pandemic illustrates the need for sensitive and reliable tools to diagnose and monitor diseases. Traditional diagnostic approaches rely on centralized laboratory tests that result in long wait times to results and reduce the number of tests that can be given. Point-of-care tests (POCTs) are a group of technologies that miniaturize clinical assays into portable form factors that can be run both in clinical areas --in place of traditional tests-- and outside of traditional clinical settings --to enable new testing paradigms. Hallmark examples of POCTs are the pregnancy test lateral flow assay and the blood glucose meter. Other uses for POCTs include diagnostic assays for diseases like COVID-19, HIV, and malaria but despite some successes, there are still unsolved challenges for fully translating these lower cost and more versatile solutions. To overcome these challenges, researchers have exploited innovations in colloid and interface science to develop various designs of POCTs for clinical applications. Herein, we provide a review of recent advancements in lateral flow assays, other paper based POCTs, protein microarray assays, microbead flow assays, and nucleic acid amplification assays. Features that are desirable to integrate into future POCTs, including simplified sample collection, end-to-end connectivity, and machine learning, are also discussed in this review.
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Affiliation(s)
- Damon T Burrow
- Department of Biomedical Engineering, Pratt School of Engineering, Duke University, Durham, NC 27708 USA
| | - Jacob T Heggestad
- Department of Biomedical Engineering, Pratt School of Engineering, Duke University, Durham, NC 27708 USA
| | - David S Kinnamon
- Department of Biomedical Engineering, Pratt School of Engineering, Duke University, Durham, NC 27708 USA
| | - Ashutosh Chilkoti
- Department of Biomedical Engineering, Pratt School of Engineering, Duke University, Durham, NC 27708 USA
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2
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Han T, Cong H, Shen Y, Yu B. Recent advances in detection technologies for COVID-19. Talanta 2021; 233:122609. [PMID: 34215093 PMCID: PMC8196236 DOI: 10.1016/j.talanta.2021.122609] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 06/10/2021] [Indexed: 12/16/2022]
Abstract
Corona Virus Disease 2019 (COVID-19) is a highly infectious respiratory illness that was caused by the SARS-CoV-2. It spread around the world in just a few months and became a worldwide pandemic. Quick and accurate diagnosis of infected patients is very important for controlling transmission. In addition to the commonly used Real-time reverse-transcription polymerase chain reaction (RT-PCR) detection techniques, other diagnostic techniques are also emerging endlessly. This article reviews the current diagnostic methods for COVID-19 and discusses their advantages and disadvantages. It provides an important reference for the diagnosis of COVID-19.
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Affiliation(s)
- Tingting Han
- Institute of Biomedical Materials and Engineering, College of Chemistry and Chemical Engineering, College of Materials Science and Engineering, Qingdao University, Qingdao, 266071, China
| | - Hailin Cong
- Institute of Biomedical Materials and Engineering, College of Chemistry and Chemical Engineering, College of Materials Science and Engineering, Qingdao University, Qingdao, 266071, China; State Key Laboratory of Bio-Fibers and Eco-Textiles, Qingdao University, Qingdao, 266071, China
| | - Youqing Shen
- Institute of Biomedical Materials and Engineering, College of Chemistry and Chemical Engineering, College of Materials Science and Engineering, Qingdao University, Qingdao, 266071, China
| | - Bing Yu
- Institute of Biomedical Materials and Engineering, College of Chemistry and Chemical Engineering, College of Materials Science and Engineering, Qingdao University, Qingdao, 266071, China; State Key Laboratory of Bio-Fibers and Eco-Textiles, Qingdao University, Qingdao, 266071, China.
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3
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Dora AV, Winnett A, Fulcher JA, Sohn L, Calub F, Lee-Chang I, Ghadishah E, Schwartzman WA, Beenhouwer DO, Vallone J, Graber CJ, Goetz MB, Bhattacharya D. Using Serologic Testing to Assess the Effectiveness of Outbreak Control Efforts, Serial Polymerase Chain Reaction Testing, and Cohorting of Positive Severe Acute Respiratory Syndrome Coronavirus 2 Patients in a Skilled Nursing Facility. Clin Infect Dis 2021; 73:545-548. [PMID: 32857830 PMCID: PMC7499538 DOI: 10.1093/cid/ciaa1286] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Accepted: 08/27/2020] [Indexed: 11/13/2022] Open
Abstract
We characterized serology following a nursing home outbreak where residents were serially tested by RT-PCR and positive residents were cohorted. When tested 46-76 days later, 24/26 RT-PCR-positive residents were seropositive; none of the 124 RT-PCR-negative residents had confirmed seropositivity, supporting serial SARS-CoV-2 RT-PCR testing and cohorting in nursing homes.
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Affiliation(s)
- Amy V Dora
- Division of Infectious Diseases, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California, USA
| | - Alexander Winnett
- Division of Infectious Diseases, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California, USA
| | - Jennifer A Fulcher
- Division of Infectious Diseases, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California, USA.,Division of Infectious Disease, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California, USA
| | - Linda Sohn
- Division of Geriatrics and Extended Care, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California, USA
| | - Feliza Calub
- Division of Infectious Disease, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California, USA
| | - Ian Lee-Chang
- Division of Infectious Disease, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California, USA
| | - Elham Ghadishah
- Division of Geriatrics and Extended Care, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California, USA
| | - William A Schwartzman
- Division of Infectious Disease, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California, USA
| | - David O Beenhouwer
- Division of Infectious Disease, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California, USA
| | - John Vallone
- Division of Pathology and Laboratory Medicine, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California, USA
| | - Christopher J Graber
- Division of Infectious Disease, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California, USA
| | - Matthew Bidwell Goetz
- Division of Infectious Disease, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California, USA
| | - Debika Bhattacharya
- Division of Infectious Diseases, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California, USA.,Division of Infectious Disease, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California, USA
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4
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Savio A, Calza S, Guerrini G, Romano V, Marchina E. Rapid Point-Of-Care Serology and Clinical History Assessment Increase Protection Provided by RT-PCR Screening: A Pilot Study Involving Three Nursing Homes in Brescia, a Hotspot of Lombardy. Front Public Health 2021; 9:649524. [PMID: 34249831 PMCID: PMC8264443 DOI: 10.3389/fpubh.2021.649524] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Accepted: 05/27/2021] [Indexed: 12/21/2022] Open
Abstract
Background: COVID-19 outbursts have been registered worldwide within care homes with asymptomatic transmission combined with shortage/inaccuracy of diagnostic tests undermining the efforts at containment of the disease. Nursing facilities in Lombardy (Italy) were left with no, or limited, access to testing for 8 weeks after the outbreak of COVID-19. Methods: This study includes 246 residents and 286 workers of three different nursing homes in Brescia-Lombardy. Clinical questionnaires and rapid serology tests were devised to integrate the data of the first available RT-PCR screening. Follow-up serology after 60-days was performed on 67 of 86 workers with positive serology or clinically suspicious. Findings: Thirty-seven residents and 18 workers had previous positive RT-PCR. Thorough screening disclosed two additional RT-PCR-positive workers. Serology screening revealed antibodies in 59 residents and 48 workers, including 32/37 residents and all workers previously positive at RT-PCR. Follow up serology disclosed antibodies in two additional workers with recent symptoms at the time of screening. The professionals in close contact with residents had more infections (47/226–20.79% vs. 1/60–1.66%; p = 0.00013 Fisher exact-test). A suspicious clinical score was present in 44/64 residents and in 41/50 workers who tested positive with either method with totally asymptomatic disease more frequent among residents 28.1 vs. 10.0% (p = 0.019 Fisher exact-test). Interpretation: Based on the available RT-PCR ± results at the time of symptoms/contacts, our integrated clinical and serological screening demonstrated sensitivity 89% and specificity 87%. This multimodal assessment proved extremely useful in understanding the viral spread in nursing homes, in defining its stage and in implementing protective measures. Rapid serology tests demonstrated efficient and particularly suited for older people less able to move/cooperate.
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Affiliation(s)
- Antonella Savio
- Histopathology Department, The Royal Marsden Hospital, London, United Kingdom
| | - Stefano Calza
- Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy
| | | | | | - Eleonora Marchina
- Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy
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Sitjar J, Liao JD, Lee H, Tsai HP, Wang JR, Liu PY. Challenges of SERS technology as a non-nucleic acid or -antigen detection method for SARS-CoV-2 virus and its variants. Biosens Bioelectron 2021; 181:113153. [PMID: 33761416 PMCID: PMC7939978 DOI: 10.1016/j.bios.2021.113153] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 02/19/2021] [Accepted: 03/04/2021] [Indexed: 01/03/2023]
Abstract
The COVID-19 pandemic has caused a significant burden since December 2019 that has negatively impacted the global economy owing to the fact that the SARS-CoV-2 virus is fast-transmitting and highly contagious. Efforts have been taken to minimize the impact through strict screening measures in country borders in order to isolate potential virus carriers. Effective fast-screening methods are thus needed to identify infected individuals. The standard diagnostic methods for screening SARS-CoV-2 virus have always been to perform nucleic acid-based and serological tests. However, with each having drawbacks on producing false results at very early or later stage after symptoms onset, supplementary techniques are needed to back up these tests. Surface-enhanced Raman spectroscopy (SERS) as a detection technique has continuously advanced throughout the years in terms of sensitivity and capability to detect ultralow concentration of analytes ranging from single molecule to pathogens, to present as a highly potential alternative to known sensing methods. SERS technology as a candidate for an alternative and supplementary diagnostic method for the viral envelope of SARS-CoV-2 virus is presented, comparing its pros and cons to the standard methods and what other aspects it could offer that the other methods are not capable of. Factors that contribute to the detection effectivity of SERS is also discussed to show the advantages and limitations of this technique. Despite its promising capabilities, challenges like sources of SARS-CoV-2 virus and its variations, reliable SERS spectra, mass production of SERS-active substrates, and compliance to regulations for wide-scale testing scenario are highlighted.
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Affiliation(s)
- Jaya Sitjar
- Engineered Materials for Biomedical Applications Laboratory, Department of Materials Science and Engineering, National Cheng Kung University, Tainan, 701, Taiwan.
| | - Jiunn-Der Liao
- Engineered Materials for Biomedical Applications Laboratory, Department of Materials Science and Engineering, National Cheng Kung University, Tainan, 701, Taiwan; Medical Device Innovation Center, National Cheng Kung University, 1 University Road, Tainan, 701, Taiwan.
| | - Han Lee
- Engineered Materials for Biomedical Applications Laboratory, Department of Materials Science and Engineering, National Cheng Kung University, Tainan, 701, Taiwan.
| | - Huey-Pin Tsai
- Department of Pathology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, 704, Taiwan; Division of Cardiology, Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, 701, Tainan, Taiwan.
| | - Jen-Ren Wang
- Department of Medical Laboratory Science and Biotechnology, College of Medicine, National Cheng Kung University, Tainan, 701, Taiwan; Division of Cardiology, Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, 701, Tainan, Taiwan.
| | - Ping-Yen Liu
- Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, 701, Tainan, Taiwan; Division of Cardiology, Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, 701, Tainan, Taiwan.
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6
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Sitjar J, Liao JD, Lee H, Tsai HP, Wang JR, Liu PY. Challenges of SERS technology as a non-nucleic acid or -antigen detection method for SARS-CoV-2 virus and its variants. Biosens Bioelectron 2021. [PMID: 33761416 DOI: 10.1016/j.bios.2021.113153l] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/10/2023]
Abstract
The COVID-19 pandemic has caused a significant burden since December 2019 that has negatively impacted the global economy owing to the fact that the SARS-CoV-2 virus is fast-transmitting and highly contagious. Efforts have been taken to minimize the impact through strict screening measures in country borders in order to isolate potential virus carriers. Effective fast-screening methods are thus needed to identify infected individuals. The standard diagnostic methods for screening SARS-CoV-2 virus have always been to perform nucleic acid-based and serological tests. However, with each having drawbacks on producing false results at very early or later stage after symptoms onset, supplementary techniques are needed to back up these tests. Surface-enhanced Raman spectroscopy (SERS) as a detection technique has continuously advanced throughout the years in terms of sensitivity and capability to detect ultralow concentration of analytes ranging from single molecule to pathogens, to present as a highly potential alternative to known sensing methods. SERS technology as a candidate for an alternative and supplementary diagnostic method for the viral envelope of SARS-CoV-2 virus is presented, comparing its pros and cons to the standard methods and what other aspects it could offer that the other methods are not capable of. Factors that contribute to the detection effectivity of SERS is also discussed to show the advantages and limitations of this technique. Despite its promising capabilities, challenges like sources of SARS-CoV-2 virus and its variations, reliable SERS spectra, mass production of SERS-active substrates, and compliance to regulations for wide-scale testing scenario are highlighted.
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Affiliation(s)
- Jaya Sitjar
- Engineered Materials for Biomedical Applications Laboratory, Department of Materials Science and Engineering, National Cheng Kung University, Tainan, 701, Taiwan.
| | - Jiunn-Der Liao
- Engineered Materials for Biomedical Applications Laboratory, Department of Materials Science and Engineering, National Cheng Kung University, Tainan, 701, Taiwan; Medical Device Innovation Center, National Cheng Kung University, 1 University Road, Tainan, 701, Taiwan.
| | - Han Lee
- Engineered Materials for Biomedical Applications Laboratory, Department of Materials Science and Engineering, National Cheng Kung University, Tainan, 701, Taiwan.
| | - Huey-Pin Tsai
- Department of Pathology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, 704, Taiwan; Division of Cardiology, Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, 701, Tainan, Taiwan.
| | - Jen-Ren Wang
- Department of Medical Laboratory Science and Biotechnology, College of Medicine, National Cheng Kung University, Tainan, 701, Taiwan; Division of Cardiology, Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, 701, Tainan, Taiwan.
| | - Ping-Yen Liu
- Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, 701, Tainan, Taiwan; Division of Cardiology, Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, 701, Tainan, Taiwan.
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7
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Verkerke H, Saeedi BJ, Boyer D, Allen JW, Owens J, Shin S, Horwath M, Patel K, Paul A, Wu S, Wang J, Ho A, Maier CL, Zerra PE, Chonat S, Arthur CM, Roback JD, Neish AS, Lough C, Josephson CD, Stowell SR. Are We Forgetting About IgA? A Re-examination of Coronavirus Disease 2019 Convalescent Plasma. Transfusion 2021; 61:1740-1748. [PMID: 34041759 PMCID: PMC8242454 DOI: 10.1111/trf.16435] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2020] [Revised: 02/08/2021] [Accepted: 02/10/2021] [Indexed: 12/15/2022]
Abstract
BACKGROUND While convalescent plasma (CP) may benefit patients with COVID-19, fundamental questions remain regarding its efficacy, including the components of CP that may contribute to its therapeutic effect. Most current serological evaluation of CP relies on examination of total immunoglobulin or IgG-specific anti-SARS-CoV-2 antibody levels. However, IgA antibodies, which also circulate and are secreted along the respiratory mucosa, represent a relatively uncharacterized component of CP. STUDY DESIGN AND METHODS Residual samples from patients and CP donors were assessed for IgM, IgG, and IgA anti-SARS-CoV-2 antibody titers against the receptor-binding domain responsible for viral entry. Symptom onset was obtained by chart review. RESULTS Increased IgA anti-SARS-CoV-2 antibody levels correlated with clinical improvement and viral clearance in an infant with COVID-19, prompting a broader examination of IgA levels among CP donors and hospitalized patients. Significant heterogeneity in IgA levels was observed among CP donors, which correlated weakly with IgG levels or the results of a commonly employed serological test. Unlike IgG and IgM, IgA levels were also more likely to be variable in hospitalized patients and this variability persisted in some patients >14 days following symptom onset. IgA levels were also less likely to be sustained than IgG levels following subsequent CP donation. CONCLUSIONS IgA levels can be very heterogenous among CP donors and hospitalized patients and do not necessarily correlate with commonly employed testing platforms. Examining isotype levels in CP and COVID-19 patients may allow for a tailored approach when seeking to fill specific gaps in humoral immunity.
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Affiliation(s)
- Hans Verkerke
- Center for Transfusion Medicine and Cellular Therapies, Emory UniversityAtlantaGeorgiaUSA,Department of Pathology and Laboratory MedicineEmory University School of MedicineAtlantaGeorgiaUSA,Department of PathologyBrigham and Women's Hospital, Harvard Medical SchoolBostonMassachusettsUSA
| | - Bejan J. Saeedi
- Department of Pathology and Laboratory MedicineEmory University School of MedicineAtlantaGeorgiaUSA
| | - Darra Boyer
- Department of Pathology and Laboratory MedicineEmory University School of MedicineAtlantaGeorgiaUSA
| | - Jerry W. Allen
- Center for Transfusion Medicine and Cellular Therapies, Emory UniversityAtlantaGeorgiaUSA,Department of Pathology and Laboratory MedicineEmory University School of MedicineAtlantaGeorgiaUSA,Department of PathologyBrigham and Women's Hospital, Harvard Medical SchoolBostonMassachusettsUSA
| | - Joshua Owens
- Department of Pathology and Laboratory MedicineEmory University School of MedicineAtlantaGeorgiaUSA
| | - Sooncheon Shin
- Center for Transfusion Medicine and Cellular Therapies, Emory UniversityAtlantaGeorgiaUSA,Department of Pathology and Laboratory MedicineEmory University School of MedicineAtlantaGeorgiaUSA
| | - Michael Horwath
- Department of Pathology and Laboratory MedicineEmory University School of MedicineAtlantaGeorgiaUSA
| | - Kashyap Patel
- Department of PathologyBrigham and Women's Hospital, Harvard Medical SchoolBostonMassachusettsUSA
| | - Anu Paul
- Department of PathologyBrigham and Women's Hospital, Harvard Medical SchoolBostonMassachusettsUSA
| | - Shang‐Chuen Wu
- Department of PathologyBrigham and Women's Hospital, Harvard Medical SchoolBostonMassachusettsUSA
| | - Jianmei Wang
- Center for Transfusion Medicine and Cellular Therapies, Emory UniversityAtlantaGeorgiaUSA,Department of Pathology and Laboratory MedicineEmory University School of MedicineAtlantaGeorgiaUSA
| | - Alex Ho
- Center for Transfusion Medicine and Cellular Therapies, Emory UniversityAtlantaGeorgiaUSA,Department of Pathology and Laboratory MedicineEmory University School of MedicineAtlantaGeorgiaUSA,Department of PathologyBrigham and Women's Hospital, Harvard Medical SchoolBostonMassachusettsUSA
| | - Cheryl L. Maier
- Center for Transfusion Medicine and Cellular Therapies, Emory UniversityAtlantaGeorgiaUSA,Department of Pathology and Laboratory MedicineEmory University School of MedicineAtlantaGeorgiaUSA
| | - Patricia E. Zerra
- Center for Transfusion Medicine and Cellular Therapies, Emory UniversityAtlantaGeorgiaUSA,Department of Pathology and Laboratory MedicineEmory University School of MedicineAtlantaGeorgiaUSA
| | - Satheesh Chonat
- Center for Transfusion Medicine and Cellular Therapies, Emory UniversityAtlantaGeorgiaUSA,Department of Pathology and Laboratory MedicineEmory University School of MedicineAtlantaGeorgiaUSA
| | - Connie M. Arthur
- Center for Transfusion Medicine and Cellular Therapies, Emory UniversityAtlantaGeorgiaUSA,Department of Pathology and Laboratory MedicineEmory University School of MedicineAtlantaGeorgiaUSA
| | - John D. Roback
- Center for Transfusion Medicine and Cellular Therapies, Emory UniversityAtlantaGeorgiaUSA,Department of Pathology and Laboratory MedicineEmory University School of MedicineAtlantaGeorgiaUSA
| | - Andrew S. Neish
- Department of Pathology and Laboratory MedicineEmory University School of MedicineAtlantaGeorgiaUSA
| | | | - Cassandra D. Josephson
- Center for Transfusion Medicine and Cellular Therapies, Emory UniversityAtlantaGeorgiaUSA,Department of Pathology and Laboratory MedicineEmory University School of MedicineAtlantaGeorgiaUSA
| | - Sean R. Stowell
- Center for Transfusion Medicine and Cellular Therapies, Emory UniversityAtlantaGeorgiaUSA,Department of Pathology and Laboratory MedicineEmory University School of MedicineAtlantaGeorgiaUSA,Department of PathologyBrigham and Women's Hospital, Harvard Medical SchoolBostonMassachusettsUSA
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8
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Different Laboratory Diagnosis Methods of COVID-19: A Systematic Review. ARCHIVES OF CLINICAL INFECTIOUS DISEASES 2021. [DOI: 10.5812/archcid.110667] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
: The virus causing COVID-19 disease is known as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The disease spread rapidly and was transmitted like a contagious disease throughout China, and then it gradually spread in other parts of the world. Accordingly, the rapid and accurate detection of the SARS-CoV-2 virus plays an essential role in selecting timely treatments, saving lives, and preventing the spread of the disease. This study summarizes the methods used to identify coronavirus nucleic acid. The effectiveness of coronavirus nucleic acid detection kits by different samples and the performance of other diagnostic techniques are also addressed in this study. We searched Embase, Google Scholar, MEDLINE, Web of Science, Scopus, and PubMed databases as well as the references of all relevant articles in English published during 2019 - 2020 using keywords related to COVID-19, detection kits, and respiratory failure and proceedings from relevant conferences and congresses. The authors collected the relevant reports, and each of the authors independently reviewed the data published in different studies. The results of previous studies indicated that the diagnosis methods of the COVID-19 disease are the RT-PCR method, ELISA kits, quick tests, white blood cell count, C-reactive protein (CRP) levels, other laboratory factors and antigenic detection methods. Given the sensitivity and specificity of these methods at different periods using different samples, the disease interpretation can be performed accurately. The findings showed that proper laboratory equipment and appropriate laboratory kits are necessary for the rapid and precise identification of COVID-19.
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9
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Kierkegaard P, McLister A, Buckle P. Rapid point-of-care testing for COVID-19: quality of supportive information for lateral flow serology assays. BMJ Open 2021; 11:e047163. [PMID: 33741675 PMCID: PMC7985936 DOI: 10.1136/bmjopen-2020-047163] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2020] [Revised: 02/16/2021] [Accepted: 02/18/2021] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVE There is a lack of evidence addressing several important human factors questions pertaining to the quality of supportive information provided by commercial manufacturers that can affect the adoption and use of lateral flow serology assays in practice. We aimed to: (1) identify and assess the quality of information that commercial manufacturers provided for their point-of-care tests (POCTs) and (2) examine the implications of these findings on real-world settings. DESIGN We used a content analysis methodology in two stages to systematically, code and analyse textual data from documents of commercial manufacturers. A deductive approach was applied using a coding guide based on the validated Point-of-Care Key Evidence Tool (POCKET) multidimensional checklist. An inductive approach was used to identify new patterns or themes generated from our textual analysis. SETTING Publicly available supportive information documents by commercial manufacturers for lateral flow serology, were identified and gathered from online searches. PARTICIPANTS Supportive information documents retrieved from online searches over 3 months (March 2020 to June 2020). RESULTS A total of 79 POCTs were identified that met the study inclusion criteria. Using the POCKET coding guide, we found that the quality of information varied significantly between the manufacturers and was often lacking in detail. Our inductive approach further examined these topics and found that several statements were vague and that significant variations in the level of details existed between manufacturers. CONCLUSIONS This study revealed significant concerns surrounding the supportive information reported by manufacturers for lateral flow serology assays. Information transparency was poor and human factor issues were not properly addressed to mitigate the risk of improper device use, although it should be noted that the results of our study are limited by the data that manufactures were prepared to disclose. Overall, commercial manufacturers should improve the quality and value of information presented in their supporting documentation.
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Affiliation(s)
- Patrick Kierkegaard
- NIHR London In Vitro Diagnostics Co-operative, Department of Surgery and Cancer, Imperial College London, London, UK
- CRUK Convergence Science Centre, Institute of Cancer Research & Imperial College London, London, UK
| | - Anna McLister
- NIHR London In Vitro Diagnostics Co-operative, Department of Surgery and Cancer, Imperial College London, London, UK
| | - Peter Buckle
- NIHR London In Vitro Diagnostics Co-operative, Department of Surgery and Cancer, Imperial College London, London, UK
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10
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Ho AD, Verkerke H, Allen JW, Saeedi BJ, Boyer D, Owens J, Shin S, Horwath M, Patel K, Paul A, Wu SC, Chonat S, Zerra P, Lough C, Roback JD, Neish A, Josephson CD, Arthur CM, Stowell SR. An automated approach to determine antibody endpoint titers for COVID-19 by an enzyme-linked immunosorbent assay. Immunohematology 2021; 37:33-43. [PMID: 33962490 DOI: 10.21307/immunohematology-2021-007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
While a variety of therapeutic options continue to emerge for COVID-19 treatment, convalescent plasma (CP) has been used as a possible treatment option early in the pandemic. One of the most significant challenges with CP therapy, however, both when defining its efficacy and implementing its approach clinically, is accurately and efficiently characterizing an otherwise heterogenous therapeutic treatment. Given current limitations, our goal is to leverage a SARS antibody testing platform with a newly developed automated endpoint titer analysis program to rapidly define SARS-CoV-2 antibody levels in CP donors and hospitalized patients. A newly developed antibody detection platform was used to perform a serial dilution enzyme-linked immunosorbent assay (ELISA) for immunoglobulin (Ig)G, IgM, and IgA SARS-CoV-2 antibodies. Data were then analyzed using commercially available software, GraphPad Prism, or a newly developed program developed in Python called TiterScape, to analyze endpoint titers. Endpoint titer calculations and analysis times were then compared between the two analysis approaches. Serial dilution analysis of SARS-CoV-2 antibody levels revealed a high level of heterogeneity between individuals. Commercial platform analysis required significant time for manual data input and extrapolated endpoint titer values when the last serial dilution was above the endpoint cutoff, occasionally producing erroneously high results. By contrast, TiterScape processed 1008 samples for endpoint titer results in roughly 14 minutes compared with the 8 hours required for the commercial software program analysis. Equally important, results generated by TiterScape and Prism were highly similar, with differences averaging 1.26 ± 0.2 percent (mean ± SD). The pandemic has created unprecedented challenges when seeking to accurately test large numbers of individuals for SARS-CoV-2 antibody levels with a rapid turnaround time. ELISA platforms capable of serial dilution analysis coupled with a highly flexible software interface may provide a useful tool when seeking to define endpoint titers in a high-throughput manner. Immunohematology 2021;37:33-43. While a variety of therapeutic options continue to emerge for COVID-19 treatment, convalescent plasma (CP) has been used as a possible treatment option early in the pandemic. One of the most significant challenges with CP therapy, however, both when defining its efficacy and implementing its approach clinically, is accurately and efficiently characterizing an otherwise heterogenous therapeutic treatment. Given current limitations, our goal is to leverage a SARS antibody testing platform with a newly developed automated endpoint titer analysis program to rapidly define SARS-CoV-2 antibody levels in CP donors and hospitalized patients. A newly developed antibody detection platform was used to perform a serial dilution enzyme-linked immunosorbent assay (ELISA) for immunoglobulin (Ig)G, IgM, and IgA SARS-CoV-2 antibodies. Data were then analyzed using commercially available software, GraphPad Prism, or a newly developed program developed in Python called TiterScape, to analyze endpoint titers. Endpoint titer calculations and analysis times were then compared between the two analysis approaches. Serial dilution analysis of SARS-CoV-2 antibody levels revealed a high level of heterogeneity between individuals. Commercial platform analysis required significant time for manual data input and extrapolated endpoint titer values when the last serial dilution was above the endpoint cutoff, occasionally producing erroneously high results. By contrast, TiterScape processed 1008 samples for endpoint titer results in roughly 14 minutes compared with the 8 hours required for the commercial software program analysis. Equally important, results generated by TiterScape and Prism were highly similar, with differences averaging 1.26 ± 0.2 percent (mean ± SD). The pandemic has created unprecedented challenges when seeking to accurately test large numbers of individuals for SARS-CoV-2 antibody levels with a rapid turnaround time. ELISA platforms capable of serial dilution analysis coupled with a highly flexible software interface may provide a useful tool when seeking to define endpoint titers in a high-throughput manner. Immunohematology 2021;37:33–43.
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Affiliation(s)
- A D Ho
- Center for Transfusion Medicine and Cellular Therapies, and Department of Pathology and Laboratory Medicine, Emory University School of Medicine , Atlanta, GA , and Joint Program in Transfusion Medicine, Department of Pathology, Brigham and Women's Hospital, Harvard Medical School , Boston, MA
| | - H Verkerke
- Center for Transfusion Medicine and Cellular Therapies, and Department of Pathology and Laboratory Medicine, Emory University School of Medicine , Atlanta, GA , and Joint Program in Transfusion Medicine, Department of Pathology, Brigham and Women's Hospital, Harvard Medical School , Boston, MA
| | - J W Allen
- Center for Transfusion Medicine and Cellular Therapies, and Department of Pathology and Laboratory Medicine, Emory University School of Medicine , Atlanta, GA , and Joint Program in Transfusion Medicine, Department of Pathology, Brigham and Women's Hospital, Harvard Medical School , Boston, MA
| | - B J Saeedi
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine , Atlanta, GA
| | - D Boyer
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine , Atlanta, GA
| | - J Owens
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine , Atlanta, GA
| | - S Shin
- Center for Transfusion Medicine and Cellular Therapies, and Department of Pathology and Laboratory Medicine, Emory University School of Medicine , Atlanta, GA
| | - M Horwath
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine , Atlanta, GA
| | - K Patel
- Joint Program in Transfusion Medicine, Department of Pathology, Brigham and Women's Hospital, Harvard Medical School , Boston, MA
| | - A Paul
- Joint Program in Transfusion Medicine, Department of Pathology, Brigham and Women's Hospital, Harvard Medical School , Boston, MA
| | - S-C Wu
- Joint Program in Transfusion Medicine, Department of Pathology, Brigham and Women's Hospital, Harvard Medical School , Boston, MA
| | - S Chonat
- Department of Pediatrics, Emory University School of Medicine , Atlanta, GA
| | - P Zerra
- Center for Transfusion Medicine and Cellular Therapies, and Department of Pathology and Laboratory Medicine, Emory University School of Medicine , Atlanta, GA
| | - C Lough
- Lifesouth Blood Donation Services , Gainesville, FL
| | - J D Roback
- Center for Transfusion Medicine and Cellular Therapies, and Department of Pathology and Laboratory Medicine, Emory University School of Medicine , Atlanta, GA
| | - A Neish
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine , Atlanta, GA
| | - C D Josephson
- Center for Transfusion Medicine and Cellular Therapies, and Department of Pathology and Laboratory Medicine, Emory University School of Medicine , Atlanta, GA
| | - C M Arthur
- Center for Transfusion Medicine and Cellular Therapies, and Department of Pathology and Laboratory Medicine, Emory University School of Medicine , Atlanta, GA
| | - S R Stowell
- Center for Transfusion Medicine and Cellular Therapies, and Department of Pathology and Laboratory Medicine, Emory University School of Medicine , 201 Dowman Drive, Atlanta, GA 30322 , and Joint Program in Transfusion Medicine, Department of Pathology, Brigham and Women's Hospital, Harvard Medical School , 630E New Research Building, 77 Avenue Louis Pasteur, Boston, MA 02115
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11
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Tešija Kuna A, Hanžek M, Vukasović I, Nikolac Gabaj N, Vidranski V, Ćelap I, Miler M, Stančin N, Šimac B, Živković M, Žarak M, Kmet M, Jovanović M, Tadinac S, Šupraha Goreta S, Periša J, Šamija I, Štefanović M. Comparison of diagnostic accuracy for eight SARS-CoV-2 serological assays. Biochem Med (Zagreb) 2021; 31:010708. [PMID: 33594297 PMCID: PMC7852303 DOI: 10.11613/bm.2021.010708] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Accepted: 11/23/2020] [Indexed: 12/28/2022] Open
Abstract
Introduction Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) serological tests have been suggested as an additional diagnostic tool in highly suspected cases with a negative molecular test and determination of seroprevalence in population. We compared the diagnostic performance of eight commercial serological assays for IgA, IgM, and IgG antibodies to the SARS-CoV-2 virus. Materials and methods The comparison study was performed on a total of 76 serum samples: 30 SARS-CoV-2 polymerase chain reaction (PCR)-negative and 46 SARS-CoV-2 PCR-positive patients with asymptomatic to severe disease and symptoms duration from 3-30 days. The study included: three rapid lateral flow immunochromatographic assays (LFIC), two enzyme-linked immunosorbent assays (ELISA), and three chemiluminescence immunoassays (CLIA). Results Agreement between IgM assays were minimal to moderate (kappa 0.26 to 0.63) and for IgG moderate to excellent (kappa 0.72 to 0.92). Sensitivities improved with > 10 days of symptoms and were: 30% to 89% for IgM; 89% to 100% for IgG; 96% for IgA; 100% for IgA/IgM combination; 96% for total antibodies. Overall specificities were: 90% to 100% for IgM; 85% to 100% for IgG; 90% for IgA; 70% for IgA/IgM combination; 100% for total antibodies. Diagnostic accuracy for IgG ELISA and CIA assays were excellent (AUC ≥ 0.90), without significant difference. IgA showed significantly better diagnostic accuracy than IgM (P < 0.001). Conclusion There is high variability between IgM assays independently of the assay format, while IgG assays showed moderate to perfect agreement. The appropriate time for testing is crucial for the proper immunity investigation.
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Affiliation(s)
- Andrea Tešija Kuna
- Department of Clinical Chemistry, Sestre milosrdnice University Hospital Center, Zagreb, Croatia
| | - Milena Hanžek
- Department of Clinical Chemistry, Sestre milosrdnice University Hospital Center, Zagreb, Croatia
| | - Ines Vukasović
- Department of Clinical Chemistry, Sestre milosrdnice University Hospital Center, Zagreb, Croatia
| | - Nora Nikolac Gabaj
- Department of Clinical Chemistry, Sestre milosrdnice University Hospital Center, Zagreb, Croatia
| | - Valentina Vidranski
- Department of Oncology and Nuclear Medicine, Sestre milosrdnice University Hospital Center, Zagreb, Croatia
| | - Ivana Ćelap
- Department of Clinical Chemistry, Sestre milosrdnice University Hospital Center, Zagreb, Croatia
| | - Marijana Miler
- Department of Clinical Chemistry, Sestre milosrdnice University Hospital Center, Zagreb, Croatia
| | - Nevenka Stančin
- Clinical Department of Laboratory Diagnostics, University Hospital Dubrava, Zagreb, Croatia
| | - Brankica Šimac
- Clinical Department of Laboratory Diagnostics, University Hospital Dubrava, Zagreb, Croatia
| | - Marcela Živković
- Clinical Department of Laboratory Diagnostics, University Hospital Dubrava, Zagreb, Croatia
| | - Marko Žarak
- Clinical Department of Laboratory Diagnostics, University Hospital Dubrava, Zagreb, Croatia
| | - Marta Kmet
- Clinical Department of Laboratory Diagnostics, University Hospital Dubrava, Zagreb, Croatia
| | - Marijana Jovanović
- Clinical Department of Laboratory Diagnostics, University Hospital Dubrava, Zagreb, Croatia
| | - Sanja Tadinac
- Department of Oncology and Nuclear Medicine, Sestre milosrdnice University Hospital Center, Zagreb, Croatia
| | - Sandra Šupraha Goreta
- Department of Biochemistry and Molecular Biology, Faculty of Pharmacy and Biochemistry, University of Zagreb, Zagreb, Croatia
| | - Josipa Periša
- Department of Oncology and Nuclear Medicine, Sestre milosrdnice University Hospital Center, Zagreb, Croatia
| | - Ivan Šamija
- Department of Oncology and Nuclear Medicine, Sestre milosrdnice University Hospital Center, Zagreb, Croatia
| | - Mario Štefanović
- Department of Clinical Chemistry, Sestre milosrdnice University Hospital Center, Zagreb, Croatia
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12
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Rapid seroconversion and persistent functional IgG antibodies in severe COVID-19 patients correlates with an IL-12p70 and IL-33 signature. Sci Rep 2021; 11:3461. [PMID: 33568715 PMCID: PMC7876035 DOI: 10.1038/s41598-021-83019-0] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2020] [Accepted: 01/13/2021] [Indexed: 12/14/2022] Open
Abstract
Despite ongoing efforts to characterize the host response toward SARS-CoV-2, a major gap in our knowledge still exists regarding the magnitude and duration of the humoral response. Analysis of the antibody response in mild versus moderate/severe patients, using our new developed quantitative electrochemiluminescent assay for detecting IgM/IgA/IgG antibodies toward SARS-CoV-2 antigens, revealed a rapid onset of IgG/IgA antibodies, specifically in moderate/severe patients. IgM antibodies against the viral receptor binding domain, but not against nucleocapsid protein, were detected at early stages of the disease. Furthermore, we observed a marked reduction in IgM/IgA antibodies over-time. Adapting our assay for ACE2 binding-competition, demonstrated that the presence of potentially neutralizing antibodies is corelated with IgG/IgA. Finally, analysis of the cytokine profile in COVID-19 patients revealed unique correlation of an IL-12p70/IL33 and IgG seroconversion, which correlated with disease severity. In summary, our comprehensive analysis has major implications on the understanding and monitoring of SARS-CoV-2 infections.
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Abstract
Much of our current understanding about novel coronavirus disease 2019 (COVID-19) comes from hospitalised patients. However, the spectrum of mild and subclinical disease has implications for population-level screening and control. Forty-nine participants were recruited from a group of 99 adults repatriated from a cruise ship with a high incidence of COVID-19. Respiratory and rectal swabs were tested by polymerase chain reaction (PCR) for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Sera were tested for anti-SARS-CoV-2 antibodies by enzyme-linked immunosorbent assay (ELISA) and microneutralisation assay. Symptoms, viral shedding and antibody response were examined. Forty-five participants (92%) were considered cases based on either positive PCR or positive ELISA for immunoglobulin G. Forty-two percent of cases were asymptomatic. Only 15% of symptomatic cases reported fever. Serial respiratory and rectal swabs were positive for 10% and 5% of participants respectively about 3 weeks after median symptom onset. Cycle threshold values were high (range 31–45). Attempts to isolate live virus were unsuccessful. The presence of symptoms was not associated with demographics, comorbidities or antibody response. In closed settings, incidence of COVID-19 could be almost double that suggested by symptom-based screening. Serology may be useful in diagnosis of mild disease and in aiding public health investigations.
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14
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Characteristics of Three Different Chemiluminescence Assays for Testing for SARS-CoV-2 Antibodies. DISEASE MARKERS 2021; 2021:8810196. [PMID: 33532006 PMCID: PMC7834819 DOI: 10.1155/2021/8810196] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 11/03/2020] [Accepted: 12/24/2020] [Indexed: 01/08/2023]
Abstract
Several tests based on chemiluminescence immunoassay techniques have become available to test for SARS-CoV-2 antibodies. There is currently insufficient data on serology assay performance beyond 35 days after symptoms onset. We aimed to evaluate SARS-CoV-2 antibody tests on three widely used platforms. A chemiluminescent microparticle immunoassay (CMIA; Abbott Diagnostics, USA), a luminescence immunoassay (LIA; Diasorin, Italy), and an electrochemiluminescence immunoassay (ECLIA; Roche Diagnostics, Switzerland) were investigated. In a multigroup study, sensitivity was assessed in a group of participants with confirmed SARS-CoV-2 (n = 145), whereas specificity was determined in two groups of participants without evidence of COVID-19 (i.e., healthy blood donors, n = 191, and healthcare workers, n = 1002). Receiver operating characteristic (ROC) curves, multilevel likelihood ratios (LR), and positive (PPV) and negative (NPV) predictive values were characterized. Finally, analytical specificity was characterized in samples with evidence of the Epstein–Barr virus (EBV) (n = 9), cytomegalovirus (CMV) (n = 7), and endemic common-cold coronavirus infections (n = 12) taken prior to the current SARS-CoV-2 pandemic. The diagnostic accuracy was comparable in all three assays (AUC 0.98). Using the manufacturers' cut-offs, the sensitivities were 90%, 95% confidence interval [84,94] (LIA), 93% [88,96] (CMIA), and 96% [91,98] (ECLIA). The specificities were 99.5% [98.9,99.8] (CMIA), 99.7% [99.3,99.9] (LIA), and 99.9% [99.5,99.98] (ECLIA). The LR at half of the manufacturers' cut-offs were 60 (CMIA), 82 (LIA), and 575 (ECLIA) for positive and 0.043 (CMIA) and 0.035 (LIA, ECLIA) for negative results. ECLIA had higher PPV at low pretest probabilities than CMIA and LIA. No interference with EBV or CMV infection was observed, whereas endemic coronavirus in some cases provided signals in LIA and/or CMIA. Although the diagnostic accuracy of the three investigated assays is comparable, their performance in low-prevalence settings is different. Introducing gray zones at half of the manufacturers' cut-offs is suggested, especially for orthogonal testing approaches that use a second assay for confirmation.
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15
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Baron RC, Risch L, Weber M, Thiel S, Grossmann K, Wohlwend N, Lung T, Hillmann D, Ritzler M, Bigler S, Egli K, Ferrara F, Bodmer T, Imperiali M, Heer S, Renz H, Flatz L, Kohler P, Vernazza P, Kahlert CR, Paprotny M, Risch M. Frequency of serological non-responders and false-negative RT-PCR results in SARS-CoV-2 testing: a population-based study. Clin Chem Lab Med 2020; 58:2131-2140. [PMID: 32866113 DOI: 10.1515/cclm-2020-0978] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Accepted: 08/12/2020] [Indexed: 12/17/2022]
Abstract
Objectives The sensitivity of molecular and serological methods for COVID-19 testing in an epidemiological setting is not well described. The aim of the study was to determine the frequency of negative RT-PCR results at first clinical presentation as well as negative serological results after a follow-up of at least 3 weeks. Methods Among all patients seen for suspected COVID-19 in Liechtenstein (n=1921), we included initially RT-PCR positive index patients (n=85) as well as initially RT-PCR negative (n=66) for follow-up with SARS-CoV-2 antibody testing. Antibodies were detected with seven different commercially available immunoassays. Frequencies of negative RT-PCR and serology results in individuals with COVID-19 were determined and compared to those observed in a validation cohort of Swiss patients (n=211). Results Among COVID-19 patients in Liechtenstein, false-negative RT-PCR at initial presentation was seen in 18% (12/66), whereas negative serology in COVID-19 patients was 4% (3/85). The validation cohort showed similar frequencies: 2/66 (3%) for negative serology, and 16/155 (10%) for false negative RT-PCR. COVID-19 patients with negative follow-up serology tended to have a longer disease duration (p=0.05) and more clinical symptoms than other patients with COVID-19 (p<0.05). The antibody titer from quantitative immunoassays was positively associated with the number of disease symptoms and disease duration (p<0.001). Conclusions RT-PCR at initial presentation in patients with suspected COVID-19 can miss infected patients. Antibody titers of SARS-CoV-2 assays are linked to the number of disease symptoms and the duration of disease. One in 25 patients with RT-PCR-positive COVID-19 does not develop antibodies detectable with frequently employed and commercially available immunoassays.
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Affiliation(s)
| | - Lorenz Risch
- Labormedizinisches zentrum Dr. Risch, Buchs, Switzerland.,Private Universität im Fürstentum Liechtenstein, Triesen, Liechtenstein.,Center of Laboratory Medicine, University Institute of Clinical Chemistry, University of Bern, Bern, Switzerland
| | - Myriam Weber
- Liechtensteinisches Landesspital, Heiligkreuz, Vaduz, Liechtenstein
| | - Sarah Thiel
- Liechtensteinisches Landesspital, Heiligkreuz, Vaduz, Liechtenstein
| | - Kirsten Grossmann
- Private Universität im Fürstentum Liechtenstein, Triesen, Liechtenstein
| | - Nadia Wohlwend
- Labormedizinisches zentrum Dr. Risch, Buchs, Switzerland
| | - Thomas Lung
- Labormedizinisches zentrum Dr. Risch, Buchs, Switzerland
| | | | | | - Susanna Bigler
- Labormedizinisches zentrum Dr. Risch, Liebefeld, Switzerland
| | - Konrad Egli
- Labormedizinisches zentrum Dr. Risch, Liebefeld, Switzerland
| | | | - Thomas Bodmer
- Labormedizinisches zentrum Dr. Risch, Liebefeld, Switzerland
| | - Mauro Imperiali
- Centro medicina di laboratorio Dr. Risch, Pregassona, Switzerland
| | - Sonja Heer
- Blutspendedienst Graubünden, Chur, Switzerland
| | - Harald Renz
- Institute of Laboratory Medicine and Pathobiochemistry, Molecular Diagnostics, Philipps University Marburg, Marburg, Germany.,University Hospital Giessen and Marburg, Marburg, Germany
| | - Lukas Flatz
- Institute of Immunobiology, Kantonsspital St Gallen, St Gallen, Switzerland
| | - Philipp Kohler
- Cantonal Hospital St Gallen, Department of Infectious Diseases and Hospital Epidemiology, St Gallen, Switzerland
| | - Pietro Vernazza
- Cantonal Hospital St Gallen, Department of Infectious Diseases and Hospital Epidemiology, St Gallen, Switzerland
| | - Christian R Kahlert
- Cantonal Hospital St Gallen, Department of Infectious Diseases and Hospital Epidemiology, St Gallen, Switzerland.,Children's Hospital of Eastern Switzerland, Departments of Infectious Diseases and Hospital Epidemiology, St Gallen, Switzerland
| | | | - Martin Risch
- Zentrallabor, Kantonsspital Graubünden, Chur, Switzerland
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EDTA-Anticoagulated Whole Blood for SARS-CoV-2 Antibody Testing by Electrochemiluminescence Immunoassay (ECLIA) and Enzyme-Linked Immunosorbent Assay (ELISA). Diagnostics (Basel) 2020; 10:diagnostics10080593. [PMID: 32823852 PMCID: PMC7460437 DOI: 10.3390/diagnostics10080593] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Accepted: 08/11/2020] [Indexed: 12/25/2022] Open
Abstract
While lateral flow test formats can be utilized with whole blood and low sample volumes, their diagnostic characteristics are inferior to immunoassays based on chemiluminescence immunoassay (CLIA) or enzyme-linked immunosorbent assay (ELISA) technology. CLIAs and ELISAs can be automated to a high degree but commonly require larger serum or plasma volumes for sample processing. We addressed the suitability of EDTA-anticoagulated whole blood as an alternative sample material for antibody testing against SARS-CoV-2 by electro-CLIA (ECLIA; Roche, Rotkreuz, Switzerland) and ELISA (IgG and IgA; Euroimmun, Germany). Simultaneously drawn venous serum and EDTA-anticoagulated whole blood samples from 223 individuals were included. Correction of the whole blood results for hematocrit led to a good agreement with the serum results for weakly to moderately positive antibody signals. In receiver-operating characteristic curve analysis, all three assays displayed comparable diagnostic accuracy (area under the curve (AUC)) using corrected whole blood and serum (AUCs: 0.97 for ECLIA and IgG ELISA; 0.84 for IgA ELISA). In conclusion, our results suggest that the investigated assays can reliably detect antibodies against SARS-CoV-2 in hemolyzed whole blood anticoagulated with EDTA. Correction of these results for hematocrit is suggested. This study demonstrates that the automated processing of whole blood for identification of SARS-CoV-2 antibodies with common ECLIA and ELISA methods is accurate and feasible.
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17
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Contini C, Caselli E, Martini F, Maritati M, Torreggiani E, Seraceni S, Vesce F, Perri P, Rizzo L, Tognon M. COVID-19 Is a Multifaceted Challenging Pandemic Which Needs Urgent Public Health Interventions. Microorganisms 2020; 8:E1228. [PMID: 32806657 PMCID: PMC7464234 DOI: 10.3390/microorganisms8081228] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Revised: 07/27/2020] [Accepted: 08/08/2020] [Indexed: 02/06/2023] Open
Abstract
Until less than two decades ago, all known human coronaviruses (CoV) caused diseases so mild that they did not stimulate further advanced CoV research. In 2002 and following years, the scenario changed dramatically with the advent of the new more pathogenic CoVs, including Severe Acute Respiratory Syndome (SARS-CoV-1), Middle Eastern respiratory syndrome (MERS)-CoV, and the new zoonotic SARS-CoV-2, likely originated from bat species and responsible for the present coronavirus disease (COVID-19), which to date has caused 15,581,007 confirmed cases and 635,173 deaths in 208 countries, including Italy. SARS-CoV-2 transmission is mainly airborne via droplets generated by symptomatic patients, and possibly asymptomatic individuals during incubation of the disease, although for the latter, there are no certain data yet. However, research on asymptomatic viral infection is currently ongoing worldwide to elucidate the real prevalence and mortality of the disease. From a clinical point of view, COVID-19 would be defined as "COVID Planet " because it presents as a multifaceted disease, due to the large number of organs and tissues infected by the virus. Overall, based on the available published data, 80.9% of patients infected by SARS-CoV-2 develop a mild disease/infection, 13.8% severe pneumonia, 4.7% respiratory failure, septic shock, or multi-organ failure, and 3% of these cases are fatal, but mortality parameter is highly variable in different countries. Clinically, SARS-CoV-2 causes severe primary interstitial viral pneumonia and a "cytokine storm syndrome", characterized by a severe and fatal uncontrolled systemic inflammatory response triggered by the activation of interleukin 6 (IL-6) with development of endothelitis and generalized thrombosis that can lead to organ failure and death. Risk factors include advanced age and comorbidities including hypertension, diabetes, and cardiovascular disease. Virus entry occurs via binding the angiotensin-converting enzyme 2 (ACE2) receptor present in almost all tissues and organs through the Spike (S) protein. Currently, SARS-CoV-2 infection is prevented by the use of masks, social distancing, and improved hand hygiene measures. This review summarizes the current knowledge on the main biological and clinical features of the SARS-CoV-2 pandemic, also focusing on the principal measures taken in some Italian regions to face the emergency and on the most important treatments used to manage the COVID-19 pandemic.
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Affiliation(s)
- Carlo Contini
- Infectious Diseases and Dermatology Section, Pathology, Oncology and Experimental Biology Section, Department of Medical Sciences, University of Ferrara, 44124 Ferrara, Italy; (F.M.); (E.T.); (M.T.)
| | - Elisabetta Caselli
- Department of Chemical and Pharmaceutical Sciences, Microbiology Section, University of Ferrara, 44124 Ferrara, Italy;
| | - Fernanda Martini
- Infectious Diseases and Dermatology Section, Pathology, Oncology and Experimental Biology Section, Department of Medical Sciences, University of Ferrara, 44124 Ferrara, Italy; (F.M.); (E.T.); (M.T.)
| | - Martina Maritati
- Department of Morphology, Surgery and Experimental Medicine, University of Ferrara, 44124 Ferrara, Italy;
| | - Elena Torreggiani
- Infectious Diseases and Dermatology Section, Pathology, Oncology and Experimental Biology Section, Department of Medical Sciences, University of Ferrara, 44124 Ferrara, Italy; (F.M.); (E.T.); (M.T.)
| | - Silva Seraceni
- RDI, Rete Diagnostica Italiana s.r.l, Lifebrain Group, Limena, 35010 Padova, Italy;
| | - Fortunato Vesce
- Department of Morphology, Surgery and Experimental Medicine, Obstetrics and Gynecology Section, University of Ferrara, 44124 Ferrara, Italy;
| | - Paolo Perri
- Department of Biomedical Sciences and Surgical Specialties; Ophthalmology Section, University of Ferrara, 44124 Ferrara, Italy;
| | - Leonzio Rizzo
- Department of Economy and Management; University of Ferrara, 44124 Ferrara, Italy;
| | - Mauro Tognon
- Infectious Diseases and Dermatology Section, Pathology, Oncology and Experimental Biology Section, Department of Medical Sciences, University of Ferrara, 44124 Ferrara, Italy; (F.M.); (E.T.); (M.T.)
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Lakkireddy DR, Chung MK, Deering TF, Gopinathannair R, Albert CM, Epstein LM, Harding CV, Hurwitz JL, Jeffery CC, Krahn AD, Kusumoto FM, Lampert R, Mansour M, Natale A, Patton KK, Seiler A, Shah MJ, Wang PJ, Russo AM. Guidance for Rebooting Electrophysiology Through the COVID-19 Pandemic From the Heart Rhythm Society and the American Heart Association Electrocardiography and Arrhythmias Committee of the Council on Clinical Cardiology: Endorsed by the American College of Cardiology. JACC Clin Electrophysiol 2020; 6:1053-1066. [PMID: 32819525 PMCID: PMC7291987 DOI: 10.1016/j.jacep.2020.06.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Coronavirus disease 2019 (COVID-19) has presented substantial challenges to patient care and impacted health care delivery, including cardiac electrophysiology practice throughout the globe. Based upon the undetermined course and regional variability of the pandemic, there is uncertainty as to how and when to resume and deliver electrophysiology services for arrhythmia patients. This joint document from representatives of the Heart Rhythm Society, American Heart Association, and American College of Cardiology seeks to provide guidance for clinicians and institutions reestablishing safe electrophysiological care. To achieve this aim, we address regional and local COVID-19 disease status, the role of viral screening and serologic testing, return-to-work considerations for exposed or infected health care workers, risk stratification and management strategies based on COVID-19 disease burden, institutional preparedness for resumption of elective procedures, patient preparation and communication, prioritization of procedures, and development of outpatient and periprocedural care pathways.
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Affiliation(s)
| | - Mina K Chung
- Heart, Vascular, and Thoracic Institute and Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | | | - Rakesh Gopinathannair
- Kansas City Heart Rhythm Institute and Research Foundation, Overland Park, Kansas, USA
| | - Christine M Albert
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | | | | | | | - Courtney C Jeffery
- Kansas City Heart Rhythm Institute and Research Foundation, Overland Park, Kansas, USA
| | - Andrew D Krahn
- University of British Columbia, Vancouver, British Columbia, Canada
| | | | | | - Moussa Mansour
- Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Andrea Natale
- Texas Cardiac Arrhythmia Institute, Austin, Texas, USA
| | | | | | - Maully J Shah
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Paul J Wang
- Stanford University, Palo Alto, California, USA
| | - Andrea M Russo
- Cooper Medical School of Rowan University, Camden, New Jersey, USA
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19
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Shaylor R, Verenkin V, Matot I. Anesthesia for Patients Undergoing Anesthesia for Elective Thoracic Surgery During the COVID-19 Pandemic: A Consensus Statement From the Israeli Society of Anesthesiologists. J Cardiothorac Vasc Anesth 2020; 34:3211-3217. [PMID: 32798170 PMCID: PMC7373002 DOI: 10.1053/j.jvca.2020.07.049] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Revised: 07/13/2020] [Accepted: 07/15/2020] [Indexed: 02/08/2023]
Abstract
Anesthesia for thoracic surgery requires specialist intervention to provide adequate operating conditions and one-lung ventilation. The pandemic caused by severe acute respiratory syndrome–associated coronavirus 2 (SARS-CoV-2) is transmitted by aerosol and droplet spread. Because of its virulence, there is a risk of transmission to healthcare workers if appropriate preventive measures are not taken. Coronavirus disease 2019 (COVID-19) patients may show no clinical signs at the early stages of the disease or even remain asymptomatic for the whole course of the disease. Despite the lack of symptoms, they may be able to transfer the virus. Unfortunately, during current COVID-19 testing procedures, about 30% of tests are associated with a false-negative result. For these reasons, standard practice is to assume all patients are COVID-19 positive regardless of swab results. Here, the authors present the recommendations produced by the Israeli Society of Anesthesiologists for use in thoracic anesthesia for elective surgery during the COVID-19 pandemic for both the general population and COVID-19–confirmed patients. The objective of these recommendations is to make changes to some routine techniques in thoracic anesthesia to augment patients’ and the medical staff's safety.
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Affiliation(s)
- Ruth Shaylor
- Division of Anesthesia, Pain and Intensive Care, Tel Aviv Sourasky Medical Center, Tel Aviv University, the Sackler Faculty of Medicine, Tel Aviv, Israel.
| | - Vladimir Verenkin
- Division of Anesthesia, Pain and Intensive Care, Tel Aviv Sourasky Medical Center, Tel Aviv University, the Sackler Faculty of Medicine, Tel Aviv, Israel
| | - Idit Matot
- Division of Anesthesia, Pain and Intensive Care, Tel Aviv Sourasky Medical Center, Tel Aviv University, the Sackler Faculty of Medicine, Tel Aviv, Israel
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20
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Li Y, Tahamtani Y, Totonchi M, Chen CH, Hashemian SMR, Amoozegar F, Zhang JS, Gholampour Y, Li X. Challenges of Iranian Clinicians in Dealing with COVID-19: Taking Advantages of The Experiences in Wenzhou. CELL JOURNAL 2020; 22:155-165. [PMID: 32779447 PMCID: PMC7481903 DOI: 10.22074/cellj.2020.7604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Accepted: 06/12/2020] [Indexed: 11/23/2022]
Abstract
The novel coronavirus has been spreading since December 2019. It was initially reported in Wuhan, Hubei province of China. Coronavirus disease 2019 (COVID-19) has currently become a pandemic affecting over seven million people worldwide, and the number is still rising. Wenzhou, as the first hit city out of Hubei Province, achieved a remarkable success in effectively containing the disease. A great record was also observed in Wenzhou for the clinical management of COVID-19 patients, leading to one of the lowest death rates in China. Researchers and clinical specialists proposed and formulated combined approaches such as computerized tomography (CT)- scans and molecular assays, as well as using both allopathic and traditional medications to mitigate its effects. Iranian and Chinese specialists and scientists had a communication in clinical, molecular and pharmaceutical aspects of COVID-19. A proper guideline was prepared according to the experiences of Chinese clinicians in managing the full spectrum of COVID-19 patients, from relatively mild to highly complex cases. The purpose of this guideline is to serve a reference in the hospital for specialists so that they may better diagnose cases and provide effective therapies and proposed antiviral and anti-inflammatory drugs for patients.
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Affiliation(s)
- Yuping Li
- Department of Pulmonary and Critical Care Medicine, The Firs t Affiliated Hospital of Wenzhou Medical University, China
| | - Yaser Tahamtani
- Department of Diabetes, Obesity and Metabolism, Cell Science Research Center, Royan Institute for Stem Cell Biology and Technology, ACECR, Tehran, Iran
- Department of Stem Cells and Developmental Biology, Cell Science Research Center, Royan Institute for Stem Cell Biology and Technology, ACECR, Tehran, Iran
| | - Mehdi Totonchi
- Department of Stem Cells and Developmental Biology, Cell Science Research Center, Royan Institute for Stem Cell Biology and Technology, ACECR, Tehran, Iran
- Department of Genetics, Reproductive Biomedicine Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran
| | - C Hengshui Chen
- Department of Pulmonary and Critical Care Medicine, The Firs t Affiliated Hospital of Wenzhou Medical University, China
| | - Seyed Mohammad Reza Hashemian
- Chronic Respiratory Diseases Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Fatemeh Amoozegar
- Noncommunicable diseases research center, Fasa University of Medical Sciences, Fasa, Iran
| | - Jin San Zhang
- Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Wenzhou Medical University, China. Electronic Address:
- International Collaborative Center on Growth Factor Research, and School of Pharmaceutical Sciences, Wenzhou Medical University, China
| | - Yousef Gholampour
- Department of Internal Medicine, School of Medicine, Fasa University of Medical Sciences, Fasa, Iran. Electronic Address: Electronic Address:
| | - Xiaokun Li
- Department of Pulmonary and Critical Care Medicine, The Firs t Affiliated Hospital of Wenzhou Medical University, China
- School of Pharmaceutical Sciences, Wenzhou Medical University, and Wenzhou Biomedicine Collaborative Innovation Center, Wenzhou, China. Electronic Address:
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21
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Lim TK. The Facts, Fallacies and Uncertainties about Coronavirus Disease 2019 (COVID-19). ANNALS ACADEMY OF MEDICINE SINGAPORE 2020. [DOI: 10.47102/annals-acadmedsg.2020217] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Affiliation(s)
- Tow Keang Lim
- Department of Medicine, National University Hospital, Singapore
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22
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Lakkireddy DR, Chung MK, Deering TF, Gopinathannair R, Albert CM, Epstein LM, Harding CV, Hurwitz JL, Jeffery CC, Krahn AD, Kusumoto FM, Lampert R, Mansour M, Natale A, Patton KK, Seiler A, Shah MJ, Wang PJ, Russo AM. Guidance for Rebooting Electrophysiology Through the COVID-19 Pandemic From the Heart Rhythm Society and the American Heart Association Electrocardiography and Arrhythmias Committee of the Council on Clinical Cardiology. Circ Arrhythm Electrophysiol 2020; 13:e008999. [PMID: 32530306 PMCID: PMC7368851 DOI: 10.1161/circep.120.008999] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Coronavirus disease 2019 (COVID-19) has presented substantial challenges to patient care and impacted healthcare delivery, including cardiac electrophysiology practice throughout the globe. Based upon the undetermined course and regional variability of the pandemic, there is uncertainty as to how and when to resume and deliver electrophysiology services for patients with arrhythmia. This joint document from representatives of the Heart Rhythm Society, American Heart Association, and American College of Cardiology seeks to provide guidance for clinicians and institutions reestablishing safe electrophysiological care. To achieve this aim, we address regional and local COVID-19 disease status, the role of viral screening and serological testing, return-to-work considerations for exposed or infected health care workers, risk stratification and management strategies based on COVID-19 disease burden, institutional preparedness for resumption of elective procedures, patient preparation and communication, prioritization of procedures, and development of outpatient and periprocedural care pathways.
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Affiliation(s)
- Dhanunjaya R Lakkireddy
- Kansas City Heart Rhythm Institute and Research Foundation, Overland Park (D.R.L., R.G., C.C.J.)
| | - Mina K Chung
- Heart, Vascular, and Thoracic Institute and Lerner Research Institute, Cleveland Clinic, OH (M.K.C.)
| | | | - Rakesh Gopinathannair
- Kansas City Heart Rhythm Institute and Research Foundation, Overland Park (D.R.L., R.G., C.C.J.)
| | - Christine M Albert
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA (C.M.A.)
| | | | | | | | - Courtney C Jeffery
- Kansas City Heart Rhythm Institute and Research Foundation, Overland Park (D.R.L., R.G., C.C.J.)
| | - Andrew D Krahn
- University of British Columbia, Vancouver, Canada (A.D.K.)
| | | | | | | | | | | | | | | | | | - Andrea M Russo
- Cooper Medical School of Rowan University, Camden, NJ (A.M.R.)
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23
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Lakkireddy DR, Chung MK, Deering TF, Gopinathannair R, Albert CM, Epstein LM, Harding CV, Hurwitz JL, Jeffery CC, Krahn AD, Kusumoto FM, Lampert R, Mansour M, Natale A, Patton KK, Seiler A, Shah MJ, Wang PJ, Russo AM. Guidance for rebooting electrophysiology through the COVID-19 pandemic from the Heart Rhythm Society and the American Heart Association Electrocardiography and Arrhythmias Committee of the Council on Clinical Cardiology: Endorsed by the American College of Cardiology. Heart Rhythm 2020; 17:e242-e254. [PMID: 32540298 PMCID: PMC7291964 DOI: 10.1016/j.hrthm.2020.06.012] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 06/09/2020] [Indexed: 01/12/2023]
Abstract
Coronavirus disease 2019 (COVID-19) has presented substantial challenges to patient care and impacted health care delivery, including cardiac electrophysiology practice throughout the globe. Based upon the undetermined course and regional variability of the pandemic, there is uncertainty as to how and when to resume and deliver electrophysiology services for arrhythmia patients. This joint document from representatives of the Heart Rhythm Society, American Heart Association, and American College of Cardiology seeks to provide guidance for clinicians and institutions reestablishing safe electrophysiological care. To achieve this aim, we address regional and local COVID-19 disease status, the role of viral screening and serologic testing, return-to-work considerations for exposed or infected health care workers, risk stratification and management strategies based on COVID-19 disease burden, institutional preparedness for resumption of elective procedures, patient preparation and communication, prioritization of procedures, and development of outpatient and periprocedural care pathways.
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Affiliation(s)
| | - Mina K Chung
- Heart, Vascular, and Thoracic Institute and Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio
| | | | | | - Christine M Albert
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California
| | | | | | | | - Courtney C Jeffery
- Kansas City Heart Rhythm Institute and Research Foundation, Overland Park, Kansas
| | - Andrew D Krahn
- University of British Columbia, Vancouver, British Columbia, Canada
| | | | | | | | | | | | | | - Maully J Shah
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | | | - Andrea M Russo
- Cooper Medical School of Rowan University, Camden, New Jersey
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