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Utility of the FebriDx point-of-care test for rapid triage and identification of possible coronavirus disease 2019 (COVID-19)
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  • Nawazish Karim,
  • Srikumar Mallik,
  • Muhammad Zubair ashraf,
  • Tahir Anwar,
  • Hnin Wint Wint Aung,
  • Muhammad Naeem,
  • Georgios Tsaknis,
  • Sareesh Bandapaati,
  • Sidra Kiran,
  • Eleni Avraam,
  • Faisal Khan,
  • Raja Reddy
Nawazish Karim
Kettering General Hospital NHS Foundation Trust
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Srikumar Mallik
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Muhammad Zubair ashraf
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Tahir Anwar
Kettering General Hospital NHS Foundation Trust
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Hnin Wint Wint Aung
Kettering General Hospital NHS Foundation Trust
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Muhammad Naeem
Kettering General Hospital NHS Foundation Trust
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Georgios Tsaknis
Kettering General Hospital NHS Foundation Trust
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Sareesh Bandapaati
Kettering General Hospital NHS Foundation Trust
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Sidra Kiran
Kettering General Hospital NHS Foundation Trust
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Eleni Avraam
Kettering General Hospital NHS Foundation Trust
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Faisal Khan
Kettering General Hospital NHS Foundation Trust
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Raja Reddy
Kettering General Hospital NHS Foundation Trust
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Peer review status:UNDER REVIEW

01 Jul 2020Submitted to International Journal of Clinical Practice
01 Jul 2020Submission Checks Completed
01 Jul 2020Assigned to Editor
01 Jul 2020Reviewer(s) Assigned
06 Jul 2020Review(s) Completed, Editorial Evaluation Pending
17 Jul 20201st Revision Received
18 Jul 2020Reviewer(s) Assigned
18 Jul 2020Submission Checks Completed
18 Jul 2020Assigned to Editor
02 Aug 2020Review(s) Completed, Editorial Evaluation Pending

Abstract

Abstract Background Differentiating viral from bacterial acute respiratory infections (ARIs) remains challenging, due to the non-specific clinical manifestations. The COVID-19 pandemic is putting extraordinary strain on healthcare resources. To date, molecular testing is available but has a long turnaround time and therefore cannot provide results at the point-of-care (POC) thereby exposing COVID-19/Non-COVID-19 patients to each other while awaiting diagnosis. Methods This observational study prospectively evaluated the utility of a triage strategy including FebriDx, a POC fingerstick blood test that differentiates viral from bacterial ARIs through simultaneous detection of Myxovirus-resistance protein A (MxA) and C-reactive protein (CRP), in rapidly determining viral cases requiring immediate isolation and confirmatory molecular testing, from non-infectious patients or bacterial infections requiring antibiotics. Results 75 consecutive patients were screened, 48 eligible cases were tested with FebriDx, 36 were confirmed viral infection and 35/36 had COVID-19. 31/35 COVID-19 cases tested positive for SARS-CoV-2 via rRT-PCR and (4/35) had a clinical diagnosis of probable COVID-19 based on symptoms, epidemiological history, and chest imaging (PPV 100% (35/35)). 13 cases were FebriDx viral negative and rRT-PCR was also negative. In one case, it was not possible to determine the exact cause of infection, although a viral infection could not be excluded. Including this patient, FebriDx NPV was 92.3% (12/13), exceeding the NPV of rRT-PCR a 68.3% (13/19), and diagnostic sensitivity was conservatively calculated at 97% (35/36) compared to 82.9% (29/35) for initial rRT-PCR. The diagnostic specificity of both FebriDx and rRT-PCR was 100%. Conclusions: FebriDx could be deployed as part of a reliable triage strategy for identifying possible COVID-19 patients with symptomatic ARI in the COVID-19 pandemic. Key words: Pandemic; COVID-19; SARS-CoV-2; pneumonia; viral; point of care; infection