ABSTRACT
Background: Diagnosis of SARS-CoV-2 plays an essential role for border screening to deter importation and transmission in the community. This study aims to compare the accuracy of various SARS-CoV-2 diagnostics in the general population and assess their potential utility as border screening for SARS-CoV-2 infection and immunity against SARS-CoV-2.Methods: Systematic literature searches were conducted in six electronic databases for studies reporting SARS-CoV-2 diagnostics. Meta-analysis and methodological assessment were conducted for all included studies. Performance of diagnostic tests was evaluated with pooled sensitivity, specificity and their respective 95% confidence intervals.Results: 5,416 unique studies were identified and 95 studies (at least 30,660 patients/samples) were included. Nuclei acid amplification tests (NAAT) consistently outperformed all other diagnostic methods regardless of geographical regions and selected viral genes with pooled sensitivity of 98% and pooled specificity of 99%. Point-of-care serology tests had reasonably high pooled sensitivity (69%), albeit lower than laboratory-based serology tests (89%), but both had high pooled specificity (96-98%). Diagnostic tests were consistently more sensitive among symptomatic patients than asymptomatic patients, while serology tests were more sensitive for later (≥7 days) than early stages (≤7 days) of the disease. Serology tests was less sensitive in American studies (64%, 95% CI 57%-70%) as compared to Chinese (98%, 95% CI: 95%-99%) and European studies (93%, 95% CI: 78%-99%).Conclusion: Point-of-care NAAT and serology tests are suitable for detecting SARS-CoV-2 infection and immunity against SARS-CoV-2, respectively as border screening.Funding Statement: Ministry of Defence (N-608-000-065-001)Declaration of Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.
Subject(s)
COVID-19ABSTRACT
Background: An understanding of key differences in epidemiological and clinical characteristics between geographical regions and populations is limited. This systematic review and meta-analysis aims to compare clinical presentation, outcomes, and care management of different COVID-19 patient groups globally. Methods: The search strategy involved peer-reviewed studies published between 1st January and 9th April 2020 in Pubmed, Google scholar, and Chinese Medical Journal database. Pooled prevalence and means with 95% confidence intervals were computed using a random effects model. Subgroup analyses were performed between different geographies, clinical severities, and age groups. Results: A total of 77 publications were identified after full-text screening. Subsequently, data from 40 non-overlapping studies, comprising 4,884 patients from seven countries, were summarized. Wuhan patients were older (mean age: 54·3) and had higher rates of dyspnea (39·5%), compared to patients in other cities of China (mean age: 43·6; dyspnea: 9·7%) and outside of China (mean age: 50·5; dyspnea: 13·4%). Myalgia, fatigue, acute respiratory distress syndrome (ARDS) and fatalities were also significantly more prevalent amongst Wuhan patients compared to other geographical subgroups (p<0·01). There was a significant dose-response increase in prevalence of diabetes, D-dimer, white blood cells, neutrophil levels and ARDS from non-severe to severe and fatal outcomes (p<0·01). A higher proportion of asymptomatic cases in children (20%) as compared to adults (2.4%) was observed in Chinese hospitals. Interpretation: COVID-19 patients had more severe clinical disease in Wuhan compared to patients outside of Wuhan and beyond China. Pediatric cases had less severe disease compared to adults. Biomarkers at admission may be useful for prognosis among COVID-19 patients.Funding Statement: Ministry of Defence, SingaporeDeclaration of Interests: The authors declare no competing interests.