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The Recovery Trial
type of antibody looked for (e.g, IgA, IgM or IgG) and the population characteristics. If the test was done between day 1-7, the sensitivity for a combination of IgG/IgM was 30.1%. It was 72.2% for day 8 to 14 and 91.4% for day 15 to 21. For day 21-35, the sensitivity was 96% but there was inadequate data for tests done beyond day 35.The sensitivity of the LFIA (which is the potential point of care test method) was lowest at 66%. Tests using ELISA had sensitivities of 84.3% and CLIA fared best at 97.8%. Specificities of all tests range from 92-98%.
The Randomized evaluation of COVID-19 therapy, the RECOVERY trial, has reiterated what many frontline workers had been experiencing. Steroids work! This was a 176 center, randomized control pragmatic trial comparing the effect of 6 mg dexamethasone for 10 days along with usual care to usual care alone in patients with COVID-19 infections. There were 2104 patients who received dexamethasone and 4321 got only usual care. Primary outcome measured was mortality at 28 days and secondary outcomes were need for oxygen or ventilation. Overall, the dexamethasone group had a significantly lower mortality of 21.6% compared to the non-dexamethasone group (24.6%).
The performance of the test also depends on the population being tested. For example, in healthcare workers with respiratory symptoms with an expected prevalence of 50%, in 1000 people tested, 43 would be missed and 7 would be falsely positive. In national surveys where one would expect a prevalence of 5%, of every 1000 people tested 4 would be missed and 12 would be falsely positive.
What was more striking was the reduction in mortality in those requiring oxygen or mechanical ventilation. Dexamethasone reduced deaths by one-third in patients receiving invasive mechanical ventilation (29.0% vs. 40.7%; P
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