Reflections on COVID-19: A Literature Review of SARS-CoV-2 Testing

Although the Coronavirus disease 2019 (COVID-19) pandemic has ended, there are still many important lessons we can learn, as the pandemic profoundly affected every area of laboratory practice. During the pandemic, extensive changes to laboratory staffing had to be implemented, as many healthcare institutions required regular screening of all healthcare staff. Several studies examined the effectiveness of different screening regimens and concluded that repeated testing, even with lower sensitivity tests, could rival the performance of gold-standard RT-PCR testing in the detection of new cases. Many assay evaluations were performed both in the earlier and later periods of the pandemic. They included both nucleocapsid/spike antibodies and automated antigen assays. Early in the pandemic, it was generally agreed that the initial nucleocapsid antibody assays had poor sensitivity when used before 14 days of disease onset, with total or IgG antibodies being preferred over the use of IgM. Spike antibody assays gradually replaced nucleocapsid antibody assays, as most people were vaccinated. Spike antibodies tracked the rise in antibodies after vaccination with mRNA vaccines and became invaluable in the assessment of vaccine response. Studies demonstrated robust antibody secretion with each vaccine dose and could last for several months post-vaccination. When antigen testing was introduced, they became effective tools to identify affected patients when used serially or in an orthogonal fashion with RT-PCR testing. Despite the numerous findings during the pandemic period, research in COVID-19 has slowed. To this day it is difficult to identify a true neutralizing antibody test for the virus. An appropriate antibody level that would confer protective immunity against the plethora of new variants remains elusive. We hope that a summary of events during the pandemic could provide important insights to consider in planning for the next viral pandemic.