A simplified alternative diagnostic algorithm for SARS-CoV-2 suspected symptomatic patients and confirmed close contacts (asymptomatic): A consensus of Latin American experts

Fay, Fabian F.; Alvarez-Moreno, Carlos Arturo; Bonvehi, Pablo E.; Espinoza, Carolina Cucho; Hidalgo, Marco Luis Herrera; Marcano-Lozada, Marcel; Perez, Carlos M.; Pulchinelli Jr, Alvaro; Sáenz-Flor, Klever Vinicio; Condino-Neto, Antonio

Introduction Latin America accounts for one-quarter of global COVID-19 cases and one-third of deaths. Inequalities in the region lead to barriers regarding the best use of diagnostic tests during the pandemic. There is a need for a simplified guideline, considering the region's health resources’ low availability, international guidelines, medical literature, and local expertise. Methods Nine experts from Latin American countries developed a simplified algorithm for COVID-19 diagnosis, using a modified Delphi method. Twenty-four questions related to diagnostic settings were proposed, followed by discussion of the literature and experts’ experience. Results The algorithm considers three timeframes (≤7 days, 8-13 days, and ≥ 14 days) and discusses diagnostic options for each one. SARS-CoV-2 rRT-PCR is the test of choice from day 1 to day 14 after symptom onset or close contact, although antigen testing may be used in particular situations, from days 5 to 7. Antibody assays may be used for confirmation, mainly after day 14. If the clinical suspicion is very high, but other tests are negative, these assays may be used as an adjunct to decision-making from day 8 to day 13. Conclusion The proposed algorithm aims to support COVID-19 diagnosis decision-making in Latin America.