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CORRESPONDENCE
Year : 2020  |  Volume : 152  |  Issue : 1  |  Page : 134

Effect of quantitative real-time RT-PCR reaction sensitivity in determining the efficacy of HCQ prophylaxis for COVID-19


1 Rowan University School of Osteopathic Medicine, Stratford, NJ, USA
2 Department of Anesthesiology & Critical Care Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA

Date of Submission03-Jun-2020
Date of Web Publication17-Sep-2020

Correspondence Address:
Basavana Goudra
Department of Anesthesiology & Critical Care Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
USA
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijmr.IJMR_2368_20

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How to cite this article:
Gouda D, Goudra B. Effect of quantitative real-time RT-PCR reaction sensitivity in determining the efficacy of HCQ prophylaxis for COVID-19. Indian J Med Res 2020;152:134

How to cite this URL:
Gouda D, Goudra B. Effect of quantitative real-time RT-PCR reaction sensitivity in determining the efficacy of HCQ prophylaxis for COVID-19. Indian J Med Res [serial online] 2020 [cited 2021 Apr 19];152:134. Available from: https://www.ijmr.org.in/text.asp?2020/152/1/134/291339



Sir,

We read the article by Chatterjee et al[1] published recently on HCQ prophylaxis for COVID-19. We congratulate the authors for this successful study, but make a comment on the research methodology.

In this case-control study, the authors designated symptomatic healthcare workers (HCWs) testing positive on the quantitative real-time reverse transcription-polymerase chain reaction (qRT-PCR) for SARS-CoV-2 as cases and symptomatic HCWs who tested negative on qRT-PCR for SARS-CoV-2 as controls. The differentiating factor of the two groups is the result of the qRT-PCR test. Other population characteristics have been appropriately matched. However, previous research shows very low sensitivity of the qRT-PCR for SARS-CoV-2.

Ai et al[2] found that initial qRT-PCR pharyngeal swab sensitivity ranged from 66 to 80 per cent. Fang et al[3] found qRT-PCR sensitivity of 71 per cent compared to chest computed tomography (CT) sensitivity of

98 per cent. Many suspected cases with typical clinical features and identical specific CT images have elicited false negatives by qRT-PCR[4]. As a result, many national public health institutes and hospital systems have detailed multifactored diagnostic approaches to diagnose symptomatic patients suspected of having SARS-CoV-2. The Centers for Disease Control and Prevention, USA, for example, in the guidance to clinicians includes laboratory and radiographic findings alongside viral testing as diagnostic procedures to be used in conjunction to diagnose SARS-CoV-2[5].

Thus, given this background, it is inaccurate to use the qRT-PCR test as a standalone diagnostic procedure to designate the studied healthcare worker population into case and control groups. It introduces the likelihood of diagnostic error and as a result, undermines the subsequent analysis on occupational exposure, personal protective equipment (PPE) and prophylactic HCQ.

Conflicts of Interest: None.



 
   References Top

1.
Chatterjee P, Anand T, Singh KJ, Rasaily R, Singh R, Das S, et al. Healthcare workers & SARS-CoV-2 infection in India: A case-control investigation in the time of COVID-19. Indian J Med Res 2020; 151 : 459-67.  Back to cited text no. 1
    
2.
Ai T, Yang Z, Hou H, Zhan C, Chen C, Lv W, et al. Correlation of chest CT and RT-PCR testing in coronavirus disease 2019 (COVID-19) in China: A report of 1014 cases. Radiology 2020; 296 : E32-40.  Back to cited text no. 2
    
3.
Fang Y, Zhang H, Xie J, Lin M, Ying L, Pang P, et al. Sensitivity of chest CT for COVID-19: Comparison to RT-PCR. Radiology 2020; 296 : E115-7.  Back to cited text no. 3
    
4.
Wang Y, Kang H, Liu X, Tong Z. Combination of RT-qPCR testing and clinical features for diagnosis of COVID-19 facilitates management of SARS-CoV-2 outbreak. J Med Virol 2020; 92 : 538-9.  Back to cited text no. 4
    
5.
Centers for Disease Control and Prevention. Coronavirus Disease 2019 (COVID-19). Available from: https://www.cdc.gov/coronavirus/2019-ncov/hcp/clinical-guidance-management-patients.html, accessed on May 9, 2020.  Back to cited text no. 5
    




 

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