What is the most appropriate test to diagnose COVID-19 in an individual presenting with suggestive symptoms?

09 Feb 2021

What the research says:

Diagnostic testing for COVID-19 includes:

Clinical Situation	Appropriate Test	Testing for	Sensitivity (to identify disease)	Specificity (to identify no disease	Clinical sample	Time to result
Symptomatic individual	Laboratory-based DNA amplification	Presence of viral RNA	High	High	Nasopharyngeal/ oropharyngeal swab	15 minutes to >2 days*
	Laboratory-based antigen testing	Presence of viral antigens	Moderate	High	Nasopharyngeal/ oropharyngeal swab	15 minutes to >2 days*
	Lateral flow (point-of-care) test	Presence of viral antigens	Low to moderate**	High	Nasopharyngeal/ oropharyngeal swab or finger prick blood sample	15–30 minutes

*Dependent on local laboratory capacity

**Dependent on factors such as for how long somebody has been infected

Antibody testing can be used to indicate past infection, but is not an indicator of current infection.

What this means for your clinical practice:

Confirmation of a suspected diagnosis of COVID-19 infection requires a positive laboratory-based DNA- or antigen-based test. Where laboratory testing is not an option, point-of-care testing can be utilised using a lateral flow test although there is a higher risk of a false negative result.

Supporting references and databases:

Centers for Disease Control and Prevention. Using Antigen Tests. December 2020. Available at: https://www.cdc.gov/coronavirus/2019-ncov/lab/resources/antigen-tests-guidelines.html#table1. Accessed January 2021.

European Centre for Disease Prevention and Control. Diagnostic testing and screening for SARS-CoV-2. Available at: https://www.ecdc.europa.eu/en/covid-19/latest-evidence/diagnostic-testing. Accessed October 2020.

Green K, et al. What tests could potentially be used for the screening, diagnosis and monitoring of COVID-19 and what are their advantages and disadvantages. Available at: https://www.cebm.net/covid-19/what-tests-could-potentially-be-used-for-the-screening-diagnosis-and-monitoring-of-covid-19-and-what-are-their-advantages-and-disadvantages/#:~:text=PCR%20is%20a%20very%20common,the%20virus%20causing%20COVID%2D19. Accessed October 2020.

WHO. Advice on the use of point-of-care immunodiagnostic tests for COVID-19. Available at: https://www.who.int/news-room/commentaries/detail/advice-on-the-use-of-point-of-care-immunodiagnostic-tests-for-covid-19. Accessed October 2020.

Resource information

Respiratory conditions

COVID-19

Respiratory topics

Diagnosis

Type of resource

IPCRG COVID-19 and respiratory Q&A

Disclaimer

Page last reviewed on the date shown above.

The content is drawn from the references listed above. Wording has been adapted for clarity and applicability for the primary care context. The content does not imply direction by the IPCRG nor does it form a position of the IPCRG on this subject. The content may be adapted as new evidence arises. This content is advisory; it is intended for general use and should not be regarded as applicable to a speciﬁc case.

The International Primary Care Respiratory Group produces a range of answers to questions raised by our Sentinel Network for clinicians working in community settings. These are called the IPCRG Questions and Answers. Where possible, these are published using Creative Commons licences under the Attribution-NonCommercial-ShareAlike CC BY-NC-SA licence. This licence lets others remix, tweak, and build upon our work non-commercially, as long as they credit IPCRG and license their new creations under the identical terms. This enables member countries to adapt and translate for use in their country. Further information on the fine print can be found by reading the Legal Code. We would appreciate it if you would ask your colleagues to visit our site to obtain documents, rather than you sending them copies. By doing this they will be better able to understand and accept the CCL. The IPCRG Answer Review Group coordinates the views of primary care colleagues with specific regard to these answers. The views expressed in these answers are not necessarily those of the International Primary Care Respiratory Group. Should any author have a conflict of interest in regard to an answer, then this will be clearly stated in the answer document.

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What is the most appropriate test to diagnose COVID-19 in an individual presenting with suggestive symptoms?

What the research says:

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For a person accessing primary care, how can I decide which symptoms are more likely to suggest a current COVID-19 infection in order to decide further which of them should be tested in preparation for a face to face consultation?

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