Scaled testing for COVID-19 needs community involvement

With limited vaccine coverage and in the absence of specific therapeutics, the options to curb the COVID-19 pandemic today are mostly infection prevention measures and diagnostic tests to identify infected individuals rapidly, followed by isolation and contact tracing. The past months have seen significant worldwide scale-up of testing through quantitative PCR (qPCR) detecting nucleic acid of SARS-CoV-2. However, with the current resurgence of cases in Europe and elsewhere, qPCR demand far exceeds capacity. Moreover, qPCR is expensive, requires sophisticated laboratories, well-trained staff, and extensive logistics. Capacity deficits are aggravated in LMICs (Lower and Middle-Income Countries) with rampant shortages of tests kits, qualified staff, and laboratories, compromising clinical utility. Africa CDC reports 23 countries with proxy PCR coverage of <5000 tests/million population [1]. Alternative novel molecular diagnostics such as LAMP, DNAnudge and LAMPore remain widely unscalable. Moreover, even qPCR has its limitations in detecting non-infectious traces of viral RNA [2] and false negativity issues [3]. We conclude that molecular testing for COVID-19 is unfit for reaching scale at the community level.