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COVID-19 testing

Volume of testing
Country or territory Total tests As of Tests per million
South Korea South Korea[1] 234,998 March 11 3,800
China China, Guangdong[2] 320,000 February 20 2,820
Iceland Iceland[3] 710 March 10 1,947
Italy Italy[4] 73,154 March 11 1,212
Malta Malta[5] 550 March 9 1,114
Slovenia Slovenia[6] 2,270 March 11 1092
Taiwan Taiwan[7] 15,413 March 11 648
Alberta Canada, Alberta[8] 2,619 March 11 599
Austria Austria[9] 5,026 March 10 565
British Columbia Canada, British Columbia[10] 2,803 March 6 560
Russia Russia[11] 70,601 March 10 481
Switzerland Switzerland[12] 4,000 March 7 467
United Kingdom United Kingdom[13][14] 27,020 March 10 456
Israel Israel[15] 3,872 March 9 445
Denmark Denmark[16] 2,263 March 11 385
Republic of Ireland Ireland[17] 1,784 March 9 369
Netherlands The Netherlands[18] 6,000 March 7 340
State of Palestine Palestine[19] 1609 March 11 328
Belgium Belgium[20] 3,128 March 9 272
Canada Canada[21][22][23][24][25] 7,695 March 10 208
Finland Finland[26][27] 900 March 11 163
Slovakia Slovakia[28] 713 March 11 128
France France[29] 6,700 March 6 100
Croatia Croatia[30] 344 March 9 84
Czech Republic Czech Republic[31] 928 March 9 75
Thailand Thailand[32] 5,232 March 11 79
Japan Japan[33] 9,195 March 11 73
Armenia Armenia[34] 211 March 9 71
Hungary Hungary[35] 609 March 11 62
New Zealand New Zealand[36] 286 March 9 60
Poland Poland[37] 2,024 March 11 52
Turkey Turkey[38] 2,900 March 10 35
Panama Panama[39] 121 March 10 33
United States United States[40] 8,554 March 9 26
Vietnam Vietnam[41] 4,471 March 12 46
South Africa South Africa[42] 645 March 11 11
Philippines Philippines[43] 663 March 10 7
India India[44] 4,058 March 6 3

Testing for the respiratory illness COVID-19 and the associated SARS-CoV-2 virus can be done by polymerase chain reaction (PCR) testing, nucleic acid tests and ELISA antibody test kits. One study published in February 2020 claims that chest CT scans perform better than PCR tests[45].

Test methods

As of 6 March 2020, WHO listed the development laboratories and protocols[46]
Country Institute Gene targets
China China CDC ORF1ab and Nucleoprotein (N)
Germany Charité RdRP, E, N
Hong Kong HKU ORF1b-nsp14, N
Japan National Institute of Infectious Diseases Spike protein (Peplomer)
Thailand National Institute of Health N
US US CDC Three targets in N gene
France Pasteur Institute Two targets in RdRP

PCR

One of the early PCR tests was developed at Charité in Berlin in January 2020 using real-time polymerase chain reaction (RT-PCR) and formed the basis of 250,000 kits that the WHO is distributing.[47]

A South Korean company called Kogenebiotech[48] developed a clinical grade, PCR-based SARS-CoV-2 detection kit called PowerChek Coronavirus on Jan. 28, 2020.[citation needed] It looks for the "E" gene shared by all beta coronaviruses, and the RdRp gene specific to SARS-CoV-2.[49] Other companies in the country like Solgent and Seegene also developed their versions of clinical grade detection kits called DiaPlexQ and Allplex 2019-nCoV Assay respectively in Feb of 2020.

In China, BGI were one of the first companies to receive emergency use approval from China's National Medical Products Administration for a PCR-based SARS-CoV-2 detection kit.[50]

In the United States, the US Centers for Disease Control is distributing the CDC 2019-Novel Coronavirus (2019-nCoV) Real-Time RT-PCR Diagnostic Panel to public health labs through its International Reagent Resource.[51] One of three genetic tests in older versions of the test kits caused inconclusive results, and a bottleneck of testing at the CDC in Atlanta; tests using two components were determined to be reliable on February 28, 2020, allowing state and local laboratories to complete testing quickly.[52] The test was approved by the Food and Drug Administration under an Emergency Use Authorization.

Antibody

COVID-19 testing can also be done with antibody test kits. Antibody assays use a blood serum sample and can provide a positive result even if the person has recovered and the virus is no longer present. The first antibody test was demonstrated by a team at the Wuhan Institute of Virology on 17 February 2020.[53][54]

On 25 February, a team from Duke–NUS Medical School in Singapore announced another antibody test for COVID-19 that can provide a result within a few days.[54][55]

On Feb. 28th of 2020, another South Korean company called PCL filed a Fast Track Designation Request to Ministry of Food and Drug Safety of South Korea for their antibody-based detection kit, COVID-19 Ag GICA Rapid. Unlike a real-time RT-PCR based detection kit, PCL claims that their antibody-based kit could make a diagnosis within 10 min.

Nucleic acid

The 'Explify Respiratory' test by IDbyDNA is a metagenomic nucleic acid analysis test that can identify over 900 respiratory pathogens, including the SARS-CoV-2 virus strain. The actual data analysis takes less than an hour; the turnaround time from receipt of sample to test result is 36 hours. It is more expensive than PCR testing.[47]

Chest CT scan

Chest CT scan, an imaging tool for pneumonia, is fast and relatively easy to perform. One research found that the sensitivity of CT for COVID-19 infection was 98% compared to RT-PCR sensitivity of 71%.[56][45] Most common CT scan findings were bilateral groundglass attenuation (patchy or diffuse) with subpleural dominance, crazy paving and consolidations at later stages. However, these findings are nonspecific and found as well in other types of pneumonia. No study yet has validated the accuracy and discriminatory value of CT scans to distinguish COVID from other viral pneumonia. Therefore, the CDC - does not recommend CT for initial screening, as emphasized in the COCA call on Thursday, 5 March. People with suspected COVID should be tested with RT - PCR -which is the most specific test.

Sample collection

Using real time reverse transcription polymerase chain reaction (rRT-PCR)[57] the test can be done on respiratory samples obtained by various methods, including nasopharyngeal swab or sputum sample.[58] Results are generally available within a few hours to 2 days.[59]

Hong Kong has set up a scheme where suspected patients can stay home, "emergency department will give a specimen tube to the patient", they spit into it, send it back and get a test result a while after.[60]

The British NHS has announced that it will start testing suspected cases at home which saves the risk of infecting others if they come to a hospital and having to disinfect the ambulance if one is used.[61]

Production and volume of testing

Number of tests done per day in the United States

In China, BGI were one of the first companies to receive emergency use approval from China's National Medical Products Administration for a PCR-based 2019-nCoV detection kit.[62] To then scale up testing capacity, BGI-founder Wang Jian oversaw the construction in 5 days of a 10,000 samples a day testing lab in Wuhan termed the Huo-Yan or “Fire Eye Lab”.[63]

China announced it was making 1.7 million nucleic acid-based tests and 350,000 antibody test kits each day as of 25 February 2020.[64]

As of 4 March 2020 BGI have set up 12 Huo-Yan laboratories across China, which have completed a total of 360,000 test samples and have a testing capacity of 50,000 samples a day.[65] Outside of China the kit has now received European CE-IVD certification,[66] allowing it to be commercially available in markets recognising CE marking.


References

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External links

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