Background Understanding the false negative rates of SARS-CoV-2 RT-PCR testing is pivotal for the management of the COVID-19 pandemic and it has implications for patient management. Our aim was to determine the real-life clinical sensitivity of SARS-CoV-2 RT-PCR. Methods This population-based retrospective study was conducted in March–April 2020 in the Helsinki Capital Region, Finland. Adults who were clinically suspected of SARS-CoV-2 infection and underwent SARS-CoV-2 RT-PCR testing, with sufficient data in their medical records for grading of clinical suspicion were eligible. In addition to examining the first RT-PCR test of repeat-tested individuals, we also used high clinical suspicion for COVID-19 as the reference standard for calculating the sensitivity of SARS-CoV-2 RT-PCR. Results All 1,194 inpatients (mean [SD] age, 63.2 [18.3] years; 45.2% women) admitted to COVID-19 cohort wards during the study period were included. The outpatient cohort of 1,814 individuals (mean [SD] age, 45.4 [17.2] years; 69.1% women) was sampled from epidemiological line lists by systematic quasi-random sampling. The sensitivity (95% CI) for laboratory confirmed cases (repeat-tested patients) was 85.7% (81.5–89.1%) inpatients; 95.5% (92.2–97.5%) outpatients, 89.9% (88.2–92.1%) all. When also patients that were graded as high suspicion but never tested positive were included in the denominator, the sensitivity (95% CI) was: 67.5% (62.9–71.9%) inpatients; 34.9% (31.4–38.5%) outpatients; 47.3% (44.4–50.3%) all. Conclusions The clinical sensitivity of SARS-CoV-2 RT-PCR testing was only moderate at best. The relatively high false negative rates of SARS-CoV-2 RT-PCR testing need to be accounted for in clinical decision making, epidemiological interpretations, and when using RT-PCR as a reference for other tests.

Background: Upper airway side effects are common during nasal continuous positive airway pressure (nCPAP) treatment and may affect the use of nCPAP. Objectives: It was our aim to evaluate the prevalence of upper airway symptoms in obstructive sleep apnea syndrome (OSAS) patients before and during nCPAP treatment and to assess the possible association between the symptoms and long-term adherence to the treatment. Methods: We examined 385 consecutive OSAS patients (79% men, mean age ± SD 52 ± 10 years and apnea-hypopnea index 33 ± 23) by means of a prospective questionnaire-based survey. The patients filled in questionnaires about upper airway symptoms before starting nCPAP and after 2 months of treatment. Results: Upper airway symptoms were common before starting nCPAP: 61% of the patients reported dryness of mouth, 54% dryness of throat, 52% nasal stuffiness, 51% dryness of nose, 30% sneezing, 24% mucus in throat, 17% rhinorrhea, and 6% nose bleeds daily or almost daily. In CPAP users there was a significant decline in the number of patients with frequent mouth (37%), throat (34%), nose (28%) dryness and nasal stuffiness (24%). There was no difference in upper airway symptoms before nCPAP treatment between those who continued the treatment after 1 year and those who terminated the treatment. Conclusions: The most common upper airway symptoms in patients with untreated OSAS seem to be associated with mucosal dryness. These symptoms improved during nCPAP treatment probably due to the change in breathing pattern. The occurrence of upper airway symptoms before nCPAP start did not predict long-term adherence to the treatment.

Frequent upper airway symptoms among study subjects were common: 56% of the patients reported throat dryness, 55% mouth dryness, 54% nasal stuffiness, 52% nose dryness, 33% sneezing, 33% postnasal drip, and 24% rhinorrhea. The patients with moderate or severe OSAS (AHI ≥15 and Epworth sleepiness score ≥10) suffered from mouth dryness more often (71% vs 40%, p < 0.01) than those with mild or no OSAS.

We report the first long-term follow-up of a randomized trial (NCT04978259) addressing the effects of remdesivir on recovery (primary outcome) and other patient-important outcomes one year after hospitalization resulting from COVID-19. Of the 208 patients recruited from 11 Finnish hospitals, 198 survived, of whom 181 (92%) completed follow-up. At one year, self-reported recovery occurred in 85% in remdesivir and 86% in standard of care (SoC) (RR 0.94, 95% CI 0.47-1.90). We infer no convincing difference between remdesivir and SoC in quality of life or symptom outcomes (p > 0.05). Of the 21 potential long-COVID symptoms, patients reported moderate/major bother from fatigue (26%), joint pain (22%), and problems with memory (19%) and attention/concentration (18%). In conclusion, after a one-year follow-up of hospitalized patients, one in six reported they had not recovered well from COVID-19. Our results provide no convincing evidence of remdesivir benefit, but wide confidence intervals included possible benefit and harm.