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In conditions of high diagnostic demand, as will be inevitable during the influenza virus circulation next autumn-winter, while some laboratories will be equipped to handle large quantities, most of the Italian territory will be in difficulties and will not be able to produce the reports. in acceptable times (24 hours).
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The challenge of rapid tests: “This is how we will save the school”
Of course, the swab system is also what has made the difference in recent months, which has allowed us to identify the positive, symptomatic and others, and to carry out that follow-up that has been a clear success in the strategic management of the pandemic . But in recent months, many companies and researchers have been working to create an easier and faster diagnostic method. Now, with schools and universities reopening, it is time to use them.
The first step towards simplification is represented by the molecular test in saliva (1,2), already validated and approved by the US Food & Drug Administration (FDA), which allows you to skip the entire procedure related to sampling. Test subjects simply collect saliva in a container: no operator, less invasiveness, no glue for collection And even the later phases, thanks to changes in the molecular analysis protocol, are faster and much cheaper, another factor to consider in the management of a pandemic.
The low cost of the test, estimated at less than $ 10, therefore low, would allow for widespread use in schools and universities, allowing for the rapid health check that teachers and families expect.
The second step is based instead on the use of rapid tests that instead of recognizing the RNA of the virus identify its proteins, the so-called “antigenic tests” (the antigen is the portion of protein or other viral component recognized by an antibody).
Currently, the FDA has approved 4 tests, all based on the nasal swab. These tests have the clear advantage of a quick response (a few minutes), but the disadvantage of collecting samples, as illustrated above. In Italy, the rapid antigen test is used in Fiumicino, it seems to have satisfactory results, and it is not clear why a suitable test to identify potential positives at the airport may not be adequate to monitor students and school or university staff at the long of the time.
But the final definitive step for the rapid diagnosis of SARS-CoV2 will be a low-cost antigenic saliva test, sensitive and specific enough to be repeated periodically, with minimal discomfort for the individual and without the need for specialized personnel. Tests for the identification of proteins in saliva have shown a good sensitivity, which, however, is lower than that of classical “molecular” swabs.
The lower sensitivity may not identify subjects with low viral load as positive (“false negative” subjects) and therefore cause them to escape the identification system. However, given the modest cost of these tests, the speed of response and their repeatability in a short period of time (for example, once a week), we believe that the time has come to seriously consider these new rapid diagnostic tools. and economical. live with the SARS-Cov2 virus during the reopening of schools and universities and be prepared for the arrival of the flu epidemic
Sergio Abrignani
Adriana albini
Franco Buonaguro
Francesco Cecconi
Guido Poli
Alessandro quattrone
Luca scorrano
Stefano Vella
Elisa Vicenzi
Antonella Viola
