Objectives The Coronavirus disease 2019 (COVID‐19) pandemic is straining healthcare resources. Molecular testing turnaround time precludes having results at the point‐of‐care (POC) thereby exposing COVID‐19/Non‐COVID‐19 patients while awaiting diagnosis. We evaluated the utility of a triage strategy including FebriDx, a 10‐minute POC finger‐stick blood test that differentiates viral from bacterial acute respiratory infection through detection of Myxovirus‐resistance protein A (MxA) and C‐reactive protein (CRP), to rapidly isolate viral cases requiring confirmatory testing. Methods This observational, prospective, single‐center study enrolled patients presenting to/within an acute care hospital in England with suspected COVID‐19 between March and April 2020. Immunocompetent patients ≥16 years requiring hospitalisation with pneumonia or acute respiratory distress syndrome or influenza‐like illness (fever and ≥1 respiratory symptom within 7 days of enrolment, or inpatients with new respiratory symptoms, fever of unknown cause or pre‐existing respiratory condition worsening). The primary endpoint was diagnostic performance of FebriDx to identify COVID‐19 as a viral infection; secondary endpoint was SARS‐CoV‐2 molecular test diagnostic performance compared with the reference standard COVID‐19 Case Definition (molecular or antibody detection of SARS‐CoV‐2). Results Valid results were available for 47 patients. By reference standard, 35 had viral infections (34/35 COVID‐19; 1/35 non‐COVID‐19; overall FebriDx viral sensitivity 97.1% (95%CI 83.3‐99.9)). Of the COVID‐19 cases, 34/34 were FebriDx viral positive (sensitivity 100%; 95%CI 87.4‐100); 29/34 had an initial SARS‐CoV‐2 positive molecular test (sensitivity 85.3%; 95%CI 68.2‐94.5). FebriDx was viral negative when the diagnosis was not COVID‐19 and SARS‐Cov‐2 molecular test was negative (negative predictive value (NPV) 100% (13/13; 95%CI 71.7‐100)) exceeding initial SARS‐CoV‐2 molecular test NPV 72.2% (13/19; 95%CI 46.4‐89.3). The diagnostic specificity of FebriDx and initial SARS‐CoV‐2 molecular test was 100% (13/13; 95%CI 70‐100 and 13/13; 95%CI 85.4‐100, respectively). Conclusions FebriDx could be deployed as part of a reliable triage strategy for identifying symptomatic cases as possible COVID‐19 in the pandemic.

Background Reliable differentiation between uncomplicated and self-limiting acute respiratory tract infections (ARIs) and more severe bacterial respiratory tract infections remains challenging, due to the non-specific clinical manifestations in both systemic bacterial or viral infections. The current COVID-19 pandemic is putting extraordinary strain on healthcare resources. To date, molecular testing is available but has a long turnaround time and therefore cannot provide results at the point-of-care, leading to a delay in results thereby exposing patients to cross-infection and delay in diagnosis (1-3). Methods We prospectively evaluated the utility of FebriDx®, a point-of-care fingerstick blood test that can differentiate viral from bacterial ARIs through simultaneous detection of both Myxovirus-resistance protein A (MxA) and C-reactive protein (CRP), in rapidly determining viral cases requiring immediate isolation and confirmatory molecular testing, from non-infectious patients or bacterial infections that require antibacterial therapy.Results 75 consecutive patients were assessed and 48 eligible cases were tested with FebriDx®. Overall, 35 patients had FebriDx® test viral positive. All 35 patients had either positive rt-PCR (n=30) for COVID-19 or clinical picture highly suggestive of COVID-19 infection (PPV of 100% in a pandemic situation)[AB1] . In the 13 cases it was viral negative, rRT-PCR was also negative in all cases. In one case of LRTI, it was not possible to determine the exact cause of infection and a viral infection couldn’t be excluded. Including this patient, the NPV was 12/13 (92%) exceeding the NPV of rRt-PCR at 71% (12/17). Sensitivity was conservatively calculated at 97% (35/36) compared to 85.7% (30[RS2] /35) for rRt-PCR. Similarly the specificity of both FebriDx®and rRt-PCR was 100% (12/12).Conclusions In the current COVID-19, FebriDx® shows potential as a reliable POC test and a proxy marker of COVID-19 infection amongst inpatients in a secondary care setting. [AB1]35/35 equates to a sensitivity and specificity of 100% for COVID, would you be willing to say that instead of ‘near 100% ppv)? [RS2]I believe PCR was 85.7% (30/35), because PCR only detects the COVID cases

Hepatitis C (HCV) infection elimination in low- and middle-income countries requires decentralised HCV services to increase testing and linkage to care. The CT2 Study investigated patients’ views of access to and acceptance of two community-based HCV care models in Myanmar using a mixed-methods approach. Point-of-care HCV testing and general practitioner-initiated HCV treatment were provided at two community clinics in Yangon, Myanmar–the Burnet Institute’s (BI) clinic focused on people who inject drugs (PWID), and the Myanmar Liver Foundation’s (MLF) clinic focused on people with liver-related diseases. Study staff administered quantitative questionnaires to 633 participants receiving anti-HCV antibody testing. Purposive sampling was used to recruit 29 participants receiving direct-acting antiviral treatment for qualitative interviews. Among participants completing quantitative questionnaires, almost all reported the clinic location was convenient (447/463, 97%), waiting time was acceptable (455/463, 98%), and HCV antibody and RNA testing methods were acceptable (617/632, 98% and 592/605, 97% respectively). Nearly all participants were satisfied with their clinic’s services (444/463, 96%) and preferred same-day test results (589/632, 93%). BI clinic participants were more confident that they understood HCV antibody and RNA results; MLF clinic participants were more comfortable disclosing their risk behaviour to staff and had slightly higher satisfaction with the overall care, privacy and secure storage of their information. In qualitative interviews, participants reported that flexible appointment scheduling, short wait times and rapid return of results increased the clinic’s accessibility. The simplified point-of-care testing and treatment procedures and supportive healthcare providers contributed to participants’ acceptance of the HCV care model. This decentralised community-based HCV testing and treatment model was highly accessible and acceptable to CT2 participants. Prioritizing patient-centred care, rapid provision of results, flexible appointments and convenient clinic locations can promote accessible and acceptable services which may in turn help accelerate progress in reaching HCV elimination targets.

Purpose. Optical coherence tomography (OCT) is a novel light-based intravascular imaging method with potential utility for quantifying vascular disease and the effect of therapy. OCT has been used to image vein grafts and neointima in clinical research studies but validity of OCT for vein graft imaging is limited by depth of field and tissue penetration. Experiments were carried out to validate the inhouse developed new software (Medipass-iScan) and OCT vendor software comparing with a gold standard, photomicroscopy. Methods. Seven synthetic phantom tubes with varying inner diameters and eight saphenous veins were imaged with OCT. Imaging was performed five times on each phantom/vessel and sections of each were measured by photomicroscopy. OCT images were analyzed by iScan to measure the inner diameters and then compared with corresponding microscopy sections. Results. A Bland-Altman plot of differences between photomicroscopy and OCT measurements of phantoms, demonstrated evidence of limited bias (104 μm) and 95% limits of agreement, −100 and 308 μm. The mean variation of iScan OCT measurements from microscopy was 3.02% and that of the OCT vendor software 3.03%. Conclusions. OCT has high measurement accuracy of lumen diameter. iScan measurements of saphenous veins imaged by OCT had similar accuracy to vendor software, supporting its validity. Potentially, OCT may be used to measure saphenous vein dimensions ex vivo.

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