COVID-19: in the uncertainty, do not try this at home
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CE - LETTER TO THE EDITOR
COVID‑19: in the uncertainty, do not try this at home Tommaso Lupia1 · Silvia Corcione1,2 · Francesco Giuseppe De Rosa1 Received: 31 May 2020 / Accepted: 5 August 2020 © Società Italiana di Medicina Interna (SIMI) 2020
Keywords COVID-19 · Pneumonia · SARS-CoV-2 Dear Editor, Seventeen years after the SARS epidemic, the current SARSCoV-2 outbreak has plunged the scientific community into uncertainty once again. In December 2019, the uncertainty began with nomenclature. Initially, the new virus was called 2019-nCOV, was immediately renamed SARS-CoV-2 due to its similarities to the previous pandemic and was ultimately condensed into COVID-19. In January 2020, this apparent instability began to involve surveillance as various public health agencies worldwide told frontline healthcare providers to be vigilant against potential imported cases using numerous approaches that differed from country to country. Uncertainty quickly emerged at the suspected source of the contagion, the Huanan Seafood Market in Wuhan, where the virus was initially isolated, which has become a theatre of covert international schemes and conspiracy theories. Incongruities have been identified over the direct link between the Wuhan seafood market and the COVID-19 outbreak, such as by Li et al. [1], whose paper in the New England Journal of Medicine (NEJM) in late January describes a cluster of precocious laboratory-confirmed COVID-19 cases and their transmission dynamics. Of these, 45% had no direct connections to the Huanan Seafood Market, which obscures the role of this location in the outbreak. What has occurred since then is all too clear; at the time of writing, appalling estimates point to approximately 10,400,000 confirmed cases and 508,000 deaths, and uncertainty reigns within several machine gears, including
* Tommaso Lupia [email protected] 1
Department of Medical Sciences, Infectious Diseases, University of Turin, Turin, Italy
Tufts University School of Medicine, Boston, USA
2
diagnostic, preventive and therapeutic approaches for COVID-19. The 7 months into the pandemic have not yet allowed for clarifying which test could potentially be used as a gold standard for the screening, diagnosis and monitoring of COVID-19 subjects. The real-time polymerase chain reaction (RT-PCR) is able to amplify the genetic material of SARS-CoV-2, although it is possible to miss patients who have cleared the virus and have recovered from the disease. Moreover, the sensitivity of the RT-PCR swab is operator dependent and is affected by the volatility of the virus’ distribution across the respiratory tract. On the other hand, common tests, such as antibody lateral flow immunoassays and ELISA antigens, are new promising technologies but are characterised by an accuracy yet to be defined. Antibodies determine whether a patient has at some point been infected with SARS-CoV-2 and whether further testing is needed to clarify the presence of an active coronavirus infection. At this time, each test type has its own dis
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