Misuse of SARS-CoV-2 testing in symptomatic health-care staff in the UK
Authors: Bernard Freudenthal
Journal: The Lancet (2020)

An initiative to screen asymptomatic health-care workers for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was timely and logical,1Black JRM Bailey C Przewrocka J Dijkstra KK Swanton C COVID-19: the case for health-care worker screening to prevent hospital transmission.Lancet. 2020; 395: 1418-1420Summary Full Text Full Text PDF PubMed Scopus (302) Google Scholar and contrasted markedly with the UK Government's testing strategy of National Health Service (NHS) staff during the epidemic. The NHS staff testing policy was only to test symptomatic staff, precisely to reduce absenteeism by encouraging staff with negative results back to work, thus intentionally reducing their time in self-isolation. The Secretary of State for Health and Social Care, Matt Hancock, himself stated that "we want to get [NHS staff absences] down, and the way to do that is to get the amount of testing up".2Booth R Number of NHS doctors off sick 'may be nearly triple the official estimate'.https://www.theguardian.com/world/2020/apr/05/number-nhs-doctors-off-sick-may-be-three-times-more-than-thoughtDate: April 5, 2020Date accessed: April 19, 2020Google Scholar This testing approach was then also applied to other groups of public sector workers.3The GuardianUK Covid-19 testing expanded to police, fire service and judiciary.https://www.theguardian.com/world/2020/apr/17/uk-covid-19-testing-expanded-to-police-fire-service-and-judiciaryDate: April 17, 2020Date accessed: April 19, 2020Google Scholar The UK Government's approach of using SARS-CoV-2 testing as a strategy to reduce absenteeism rather than to increase the detection of otherwise asymptomatic spreaders was surely symptomatic of flawed analysis and misunderstanding of the utility of the SARS-CoV-2 pharyngeal swab RT-PCR test. WHO expressly advises against using this test as a rule-out in the event of negative results.4WHOLaboratory testing for coronavirus disease (COVID-19) in suspected human cases.https://www.who.int/publications-detail/laboratory-testing-for-2019-novel-coronavirus-in-suspected-human-cases-20200117Date: March 19, 2020Date accessed: April 19, 2020Google Scholar Sensitivity of the test might be as low as 83%,5Long C Xu H Shen Q et al.Diagnosis of the Coronavirus disease (COVID-19): rRT-PCR or CT?.Eur J Radiol. 2020; 126108961Summary Full Text Full Text PDF PubMed Scopus (663) Google Scholar and in our practice many colleagues believe it to be lower still. Overzealous redirection of self-isolating staff back to work before they had completed sufficient self-isolation to exclude infectivity was therefore likely to increase spread of the virus to other staff and to patients or care-receivers in a substantial number of cases, especially given the high prevalence and likelihood of SARS-CoV-2 infection among exposed health-care workers during the epidemic. Surely the only defensible policy would have been national opportunistic and frequent testing of NHS and social care sector staff regardless of symptomology, and the test should be used exclusively as a rule-in and not a rule-out test as per existing WHO guidance.4WHOLaboratory testing for coronavirus disease (COVID-19) in suspected human cases.https://www.who.int/publications-detail/laboratory-testing-for-2019-novel-coronavirus-in-suspected-human-cases-20200117Date: March 19, 2020Date accessed: April 19, 2020Google Scholar I declare no competing interests. COVID-19: the case for health-care worker screening to prevent hospital transmissionThe outbreak of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has placed unprecedented strain on health-care services worldwide, leading to more than 100 000 deaths worldwide, as of April 15, 2020.1 Full-Text PDF Misuse of SARS-CoV-2 testing in symptomatic health-care staff in the UK – Authors' replyWe thank Bernard Freudenthal for his response to our previous Correspondence.1 We agree that use of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) testing among health-care workers (HCWs) solely to reduce absenteeism is inappropriate. Freudenthal correctly outlines the risks, posed by false-negative results, of advising potentially infectious HCWs to return to work. Moreover, staffing levels are currently far less problematic within UK health-care settings than during the peak of the pandemic. Full-Text PDF