Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa.
Communicable Disease Control, Department of Health, Western Cape, South Africa.
Pan Afr Med J. 2020 Dec 16;37(Suppl 1):48. doi: 10.11604/pamj.supp.2020.37.48.26881. eCollection 2020.
coronavirus disease 2019 (COVID-19) is caused by the novel coronavirus, severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). Most people infected with SARS-CoV-2 have mild disease with non-specific symptoms, although a few becoming critically ill with septic shock and multiple organ failure. There is an unknown proportion of infected individuals who remain asymptomatic and infectious. Universal screening for COVID-19 infections to detect individuals who are infected before they present clinically could therefore be an important measure to contain the spread of the disease. We highlight a Cochrane rapid review which assessed the effectiveness and accuracy of universal screening for COVID-19 infection.
the authors of the Cochrane review searched multiple electronic databases to identify studies reporting on the effectiveness of universal screening and reporting on screening test accuracy. Eligible participants for the review included people who had not sought care for potential COVID-19 symptoms.
the authors included 22 publications, with none of them conducted in Africa. Two modelling studies reported on the beneficial and negative effects of screening; and 20 studies (cohort and modelling) reported data on the accuracy of screening tests. The included studies had wide variability in the baseline prevalence of COVID-19 infection as well as study settings and methods. All cohort studies compared screening strategies to reverse transcriptase-polymerase chain reaction (RT-PCR) as the gold standard. The rapid review suggests that there is low certainty of evidence that screening at travel hubs may slow the importation of infected cases. Furthermore, the review highlights the uncertainty and variation in the accuracy of screening.
given the low accuracy of the tests included in this review, a high proportion of COVID-19 infected individuals may be missed and go on to infect others. In addition, some healthy individuals may be falsely identified as positive, requiring confirmatory testing and potentially leading to the unnecessary isolation of these individuals.
新型冠状病毒病（COVID-19）由新型冠状病毒，即严重急性呼吸综合征冠状病毒-2（SARS-CoV-2）引起。大多数感染 SARS-CoV-2 的人患有轻度疾病，症状不具特异性，尽管少数人会发展为感染性休克和多器官衰竭的重症患者。还有一部分感染个体无症状且具有传染性，未知比例。对 COVID-19 感染进行普遍筛查，以发现临床前感染的个体，因此可能是控制疾病传播的重要措施。我们强调了 Cochrane 快速评价，该评价评估了对 COVID-19 感染进行普遍筛查的效果和准确性。
Cochrane 评价的作者检索了多个电子数据库，以确定报告普遍筛查效果和报告筛查检测准确性的研究。该评价的合格参与者包括未因潜在 COVID-19 症状而寻求治疗的人。
作者纳入了 22 篇出版物，没有一篇在非洲进行。两项建模研究报告了筛查的有益和负面影响；20 项研究（队列和建模）报告了筛查检测准确性的数据。纳入的研究在 COVID-19 感染的基线患病率以及研究环境和方法方面存在很大差异。所有队列研究都将筛查策略与逆转录-聚合酶链反应（RT-PCR）作为金标准进行了比较。快速评价表明，有低确定性证据表明，在旅行枢纽进行筛查可能会减缓感染病例的输入。此外，该评价强调了筛查准确性的不确定性和差异。
鉴于本评价中包含的检测方法准确性较低，可能会错过大量 COVID-19 感染个体，并继续感染其他人。此外，一些健康个体可能被错误地识别为阳性，需要进行确认性检测，并且可能导致这些个体不必要的隔离。
