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Clinicians should use coronavirus symptoms for treatment, not just RT-PCR tests, new Rutgers study says

In the event that real-time reverse transcription PCR (RT-PCR) tests continue to come back with negative results, clinical symptoms of the coronavirus disease (COVID-19) should be trusted over test results, a recent Rutgers study says. – Photo by Guido Hofmann / Unsplash

A Rutgers study recently concluded that clinical coronavirus disease (COVID-19) symptoms should be trusted over real-time reverse transcription PCR (RT-PCR) tests, in the case that the patient repeatedly tests negative despite displaying symptoms, according to a press release.

The study tested four groups of participants between April and October 2020, including patients who tested positive on RT-PCR tests and patients who displayed symptoms or chest imaging indicative of COVID-19 but continued to test negative on RT-PCR tests.

In addition, the study also tested individuals who repeatedly tested negative on RT-PCR tests but displayed COVID-19 symptoms and patients who tested negative on RT-PCR tests but had symptoms that were not compatible with COVID-19. 

David Alland, director of the Center for COVID-19 Response and Pandemic Preparedness and co-senior author of the study, said the study results show that the patients who tested negative in an RT-PCR test but displayed clinical COVID-19 symptoms had almost the same antibody levels as patients who tested RT-PCR positive, according to the study.

Specifically, this demonstrates that clinical COVID-19 symptoms should sometimes be trusted over RT-PCR tests, in the event that these tests continue to come back with negative results, he said, according to the release.

Yingda Xie, an assistant professor at Rutgers New Jersey Medical School and senior author of the study, said that clinicians should always take COVID-19 symptoms into account by not solely utilizing RT-PCR test results. 

She said that although the study’s findings aligned with the researchers’ original hypothesis, the extent of the results were unexpected.

“What surprised us was the extent of these findings, which indicated a high likelihood of PCR-negative COVID-19 based on clinical signs (and) symptoms and the disappearance of this likelihood when a potential alternative diagnosis was present,” Xie said.

Jack Knapp, a School of Environmental and Biological Sciences sophomore, said that he was not surprised by the results of the study and felt that the University has sufficiently communicated the seriousness of the pandemic to the community. 

“(The result) doesn’t surprise me as Rutgers has taken a very safe approach to (COVID-19) and would rather play it safe than take any risks,” he said.

J. Alston-Frye, a first-year in the Mason Gross School of the Arts, said that when their mom contracted COVID-19, her experience aligned with results of the study.

“When my mom had (COVID-19) over break, she didn't have any symptoms until about a week and a half into it. So that's not too shocking,” they said. “I think that we should all be super vigilant in still wearing our masks ... people are asymptomatic a lot of the time, but that doesn't mean we should get lenient with (COVID-19) protocols.”

The study also found that patients with similar rates of disease progression received treatment based on their RT-PCR results, despite showing similar levels of sickness. 

Specifically, 43.8 percent of severely ill patients, those with extreme clinical COVID-19 symptoms, who tested RT-PCR negative received treatment, according to the study. In comparison, 79.2 percent of severely ill patients who tested RT-PCR positive received treatment.

Xie said that she believes this portion of the results will be significant in encouraging medical professionals to take clinical symptoms heavily into account when treating a patient. 

“The costs of missed COVID-19 diagnosis increases as more evidence-based therapies and interventions are developed,” she said. “For severely ill or high-risk patients, a missed diagnosis can translate to disease progression and even mortality that may have been avoided with treatment.”

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