Declining SARS-CoV-2 PCR sensitivity with time and dependence on clinical features: consequences for control

Bergmans, B. J. M.; Reusken, C. B. E. M.; Van Oudheusden, A. J. G.; Godeke, G.-J.; Bonacic Marinovic, A. A.; de Vries, E.; Kluiters-de Hingh, Y. C. M.; Vingerhoets, R.; Berrevoets, M. A. H.; Verweij, J. J.; Nieman, A.-E.; Reimerink, J.; Murk, J.-L.; Swart, A. N.

Real-time reverse transcription-polymerase chain reaction (RT-PCR) on upper respiratory tract (URT) samples is the primary method to diagnose SARS-CoV-2 infections and guide public health measures, with a supportive role for serology. However, the clinical sensitivity of RT-PCR remains uncertain. In the present study, Bayesian statistical modeling was used to retrospectively determine the sensitivity of RT-PCR using SARS-CoV-2 serology in 644 COVID-19-suspected patients with varying degrees of disease severity and duration. The sensitivity of RT-PCR ranged between 79-95%; while increasing with disease severity, it decreased rapidly over time in mild COVID-19 cases. Negative URT RT-PCR results should therefore be interpreted in the context of clinical characteristics, especially with regard to containment of viral transmission based on the 'test, trace and isolate' principle.