What is the role of imaging and biomarkers within the current testing strategy for the diagnosis of Covid-19?

Abstract

BACKGROUND: The current standard for testing and direct identification of infection with SARS-CoV-2 is RT-PCR, but it has been observed that high false negative rates may be common. A number of factors could contribute to a false negative result, such as the technique of sample collection, poor quality/low sample volume of respiratory samples collected, time when the sample was collected in the course of disease, handling and storage of the sample or technical limitations of the test. This implies a high level of uncertainty in clinical decisions linked to single isolation, cohort isolation as well as de-isolation of the patients and healthcare professionals. It also leads to uncertainty regarding the diagnosis and can mean that antibiotics are not reviewed and stopped in patients with initial negative RT-PCR. CURRENT EVIDENCE: We described the approaches to clinical investigations following a negative RT-PCR results as described in guidelines from China, Italy, Spain, UK and US. Then we looked at possible strategies to understand how to increase the accuracy of the current testing pathway to identify patients with COVID -19, while focusing on the role of imaging and of additional tests, including blood biomarkers.