A Systematic Analysis of Laboratory-Guided Diagnosis and Management of Covid-19: Challenges and Recommendations

Abstract

We conducted a comprehensive analysis of patient demographics and laboratory tests encompassing Real Time PCR (RT-qPCR) and serology for SARS-CoV-2 in addition to blood components and clinical blood markers for COVID-19 disease. All relevant literature was included up to 15 July 2020 and multiple studies were analysed in tandem to correlate findings. For RT-qPCR, nasopharyngeal swabs are the most suitable samples based on detection rates by sample, but may require repeat testing. One-week post-symptom onset, serological testing is a more stable marker. Antibody titers have been linked to disease severity. Several clinical blood components and markers have been reported to be prognostically useful; however, care is needed when making interpretation owing to the association between raised levels of these being found for the co-morbidities that predispose to worse prognosis in COVID-19. Challenges in the current study when finding the information presented in this paper suggest the need for a quality assured database that outlines the complete set of results, anonymised patient data for each entry and a set of internationally-agreed guidelines for complete laboratory testing, documentation and open-access reporting. We suggest that such information would be useful to help with patient diagnosis and management, worldwide. Contribution/Originality: This review compiles a large set of data on the efficacy of different laboratory tests in predicting severity of sequelae post COVID-19 infection and it recommends that anonymized patient results might be added to an international database from the time a pandemic is announced to help with patient management, worldwide. 1. INTRODUCTION There have been significant pandemics already in the first two decades of the 21 st century. For example, by July 2003, the severe acute respiratory syndrome (SARS) pandemic had resulted in 8,096 reported cases, including 774 deaths in 27 countries [1]. Certain severe acute respiratory syndrome coronavirus (SARS-CoV)-like viruses found in bats have recently been shown to be able to infect human cells without adaptation, suggesting the potential for SARS to re-emerge [2]. In May 2015, a single person returning from the Middle East started a nosocomial outbreak of Middle East respiratory syndrome coronavirus (MERS-CoV) in South Korea that involved 16 hospitals and 186 patients [3]. By July 2017, 2,040 MERS-CoV laboratory-confirmed cases, resulting in 712 deaths, were reported globally.