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COVID-19 testing

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CDC 2019-nCoV Laboratory Test Kit.jpg
The US CDC's COVID-19 laboratory test kit

COVID-19 testing involves analyzing samples to assess the current or past presence of SARS-CoV-2. The two main branches detect either the presence of the virus or of antibodies produced in response to infection.[1][2] Tests for viral presence are used to diagnose individual cases and to allow public health authorities to trace and contain outbreaks. Antibody tests instead show whether someone once had the disease. They are less useful for diagnosing current infections because antibodies may not develop for weeks after infection.[3] It is used to assess disease prevalence, which aids the estimation of the infection fatality rate.[4]

Individual jurisdictions have adopted varied testing protocols, including whom to test, how often to test, analysis protocols, sample collection and the uses of test results.[5][6][7] This variation has likely significantly impacted reported statistics, including case and test numbers, case fatality rates and case demographics.[8][9][10][11] Because SARS-CoV-2 transmission occurs days after exposure (and before onset of symptoms) there is an urgent need for frequent surveillance and rapid availability of results.[12]

Test analysis is often performed in automated, high-throughput, medical laboratories by medical laboratory scientists. Alternatively, point-of-care testing can be done in physician's offices and parking lots, workplaces, institutional settings or transit hubs.


Explanation of the underlying pathophysiology pertaining to diagnosis of COVID-19[13]

Positive viral tests indicate a current infection, while positive antibody tests indicate a prior infection.[14] Other techniques include a CT scan, checking for elevated body temperature, checking for low blood oxygen level, and the deployment of detection dogs at airports.[15][16][17]

Detection of the virus

Reverse transcription polymerase chain reaction

Polymerase chain reaction (PCR) is a process that amplifies (replicates) a small, well-defined segment of DNA many hundreds of thousands of times, creating enough of it for analysis. Test samples are treated with certain chemicals[18][19] that allow DNA to be extracted. Reverse transcription converts RNA into DNA.

Reverse transcription polymerase chain reaction (RT-PCR) first uses reverse transcription to obtain DNA, followed by PCR to amplify that DNA, creating enough to be analyzed.[19] RT-PCR can thereby detect SARS-CoV-2, which contains only RNA. The RT-PCR process generally requires a few hours.[20]

Real-time PCR (qPCR)[21] provides advantages including automation, higher-throughput and more reliable instrumentation. It has become the preferred method.[22][23]

The combined technique has been described as real-time RT-PCR[24] or quantitative RT-PCR[25] and is sometimes abbreviated qRT-PCR,[26] rRT-PCR[27] or RT-qPCR,[28] although sometimes RT-PCR or PCR are used. The Minimum Information for Publication of Quantitative Real-Time PCR Experiments (MIQE) guidelines propose the term RT-qPCR,[29] but not all authors adhere to this.

Average sensitivity for rapid molecular tests were 95.2% (ranging from 68% to 100%) and average specificity was 98.9% (ranging from 92% to 100%) between test results of different company brands and sampling methods.[30]

Samples can be obtained by various methods, including a nasopharyngeal swab, sputum (coughed up material),[31] throat swabs,[32] deep airway material collected via suction catheter[32] or saliva.[33][34] Drosten et al. remarked that for 2003 SARS, "from a diagnostic point of view, it is important to note that nasal and throat swabs seem less suitable for diagnosis, since these materials contain considerably less viral RNA than sputum, and the virus may escape detection if only these materials are tested."[35]

Sensitivity of clinical samples by RT-PCR is 63% for nasal swab, 32% for pharyngeal swab, 48% for feces, 72–75% for sputum, and 93–95% for bronchoalveolar lavage.[36]

The likelihood of detecting the virus depends on collection method and how much time has passed since infection. According to Drosten tests performed with throat swabs are reliable only in the first week. Thereafter the virus may abandon the throat and multiply in the lungs. In the second week, sputum or deep airways collection is preferred.[32]

Collecting saliva may be as effective as nasal and throat swabs,[33] although this is not certain.[37][34] Sampling saliva may reduce the risk for health care professionals by eliminating close physical interaction.[38] It is also more comfortable for the patient.[39] Quarantined people can collect their own samples.[38] A saliva test's diagnostic value depends on sample site (deep throat, oral cavity, or salivary glands).[34] Some studies have found that saliva yielded greater sensitivity and consistency when compared with swab samples.[40][41][42]

On 15 August 2020, the US FDA granted an emergency use authorization for a saliva test developed at Yale University that gives results in hours.[43][44]

On 4 January 2021, the US FDA issued an alert about the risk of false results, particularly false negative results, with the Curative SARS-Cov-2 Assay real-time RT-PCR test.[45]

Viral burden measured in upper respiratory specimens declines after symptom onset.[46]

Isothermal amplification assays

Isothermal nucleic acid amplification tests also amplify the virus's genome. They are faster than PCR because they don't involve repeated heating and cooling cycles. These tests typically detect DNA using fluorescent tags, which are read out with specialized machines. CRISPR gene editing technology was modified to perform the detection: if the CRISPR enzyme attaches to the sequence, it colors a paper strip. The researchers expect the resulting test to be cheap and easy to use in point-of-care settings.[47][48] The test amplifies RNA directly, without the RNA-to-DNA conversion step of RT-PCR.[49]


An antigen is the part of a pathogen that elicits an immune response. Antigen tests look for antigen proteins from the viral surface. In the case of a coronavirus, these are usually proteins from the surface spikes.[50] SARS-CoV-2 antigens can be detected before onset of COVID-19 symptoms (as soon as SARS-CoV-2 virus particles) with more rapid test results, but with less sensitivity than PCR tests for the virus.[51]

Antigen tests may be one way to scale up testing to much greater levels.[50] Isothermal nucleic acid amplification tests can process only one sample at a time per machine. RT-PCR tests are accurate but require too much time, energy and trained personnel to run the tests.[50] "There will never be the ability on a [PCR] test to do 300 million tests a day or to test everybody before they go to work or to school," Deborah Birx, head of the White House Coronavirus Task Force, said on 17 April 2020. "But there might be with the antigen test."[52]

Samples may be collected via nasopharyngeal swab, a swab of the anterior nares, or from saliva. The sample is then exposed to paper strips containing artificial antibodies designed to bind to coronavirus antigens. Antigens bind to the strips and give a visual readout. The process takes less than 30 minutes, can deliver results at point of care, and does not require expensive equipment or extensive training.[50]

Swabs of respiratory viruses often lack enough antigen material to be detectable.[53] This is especially true for asymptomatic patients who have little if any nasal discharge. Viral proteins are not amplified in an antigen test.[50][54] According to the WHO the sensitivity of similar antigen tests for respiratory diseases like the flu ranges between 34% and 80%. "Based on this information, half or more of COVID-19 infected patients might be missed by such tests, depending on the group of patients tested," the WHO said. While some scientists doubt whether an antigen test can be useful against COVID-19,[54] others have argued that antigen tests are highly sensitive when viral load is high and people are contagious, making them suitable for public health screening.[55][56] Routine antigen tests can quickly identify when asymptomatic people are contagious, while follow-up PCR can be used if confirmatory diagnosis is needed.[57]

Sniff tests

Sudden loss of smell can be used to screen people on a daily basis for COVID-19. A study by the National Institutes of Health showed that those infected with SARS-CoV-2 could not smell a 25% mixture of ethanol and water.[58] Because various conditions can lead to the loss of the sense of smell, a sniff test would not be definitive but indicate the need for a PCR test. Because the loss of the sense of smell shows up before other symptoms, there has been a call for widespread sniff testing. Health care bureaucracies have generally ignored sniff tests even though they are quick, easy and capable of being self-administered daily. This has led some medical journals to write editorials supporting the adoption of sniff testing.[59]


Typical visible features on CT initially include bilateral multilobar ground-glass opacities with a peripheral or posterior distribution.[60] COVID-19 can be identified with higher precision using CT than with RT-PCR.[61]

Subpleural dominance, crazy paving, and consolidation may develop as the disease evolves.[60][62] Chest CT scans and chest x-rays are not recommended for diagnosing COVID-19. Radiologic findings in COVID-19 lack specificity.[63][60]

Antibody tests

Machine used to analyze blood samples
Table showing amounts of IgG and IgM antibodies detected in sample
Left: Automated analyzer for immunoassays, used, for example, to find SARS-CoV-2 antibodies. Right: Example of quantitative results for SARS-CoV-2 antibody test.

The body responds to a viral infection by producing antibodies that help neutralize the virus. Blood tests (serology tests) can detect the presence of such antibodies.[64] Antibody tests can be used to assess what fraction of a population has once been infected, which can then be used to calculate the disease's mortality rate.[4]

SARS-CoV-2 antibodies' potency and protective period have not been established.[4][65] Therefore, a positive antibody test may not imply immunity to a future infection. Further, whether mild or asymptomatic infections produce sufficient antibodies for a test to detect has not been established.[66] Antibodies for some diseases persist in the bloodstream for many years, while others fade away.[50]

The most notable antibodies are IgM and IgG. IgM antibodies are generally detectable several days after initial infection, although levels over the course of infection and beyond are not well characterized.[67] IgG antibodies generally become detectable 10–14 days after infection and normally peak around 28 days after infection.[68][69] This pattern of antibody development seen with other infections, often does not apply to SARS-CoV-2, however, with IgM sometimes occurring after IgG, together with IgG or not occurring at all.[70] Generally, however, median IgM detection occurs 5 days after symptom onset, whereas IgG is detected a median 14 days after symptom onset.[71] IgG levels significantly decline after two or three months.[72]

Average specificity of antigen tests is 99.5%, and average sensitivity is 56.8%, but there is extreme variation in sensitivity results (ranging from 0 to 94%) between test results of different company brands.[30]

Genetic tests verify infection earlier than antibody tests. Only 30% of those with a positive genetic test produced a positive antibody test on day 7 of their infection.[66]


Rapid diagnostic test (RDT)

RDTs typically use a small, portable, positive/negative lateral flow assay that can be executed at point of care. RDTs may process blood samples, saliva samples, or nasal swab fluids. RDTs produce colored lines to indicate positive or negative results.[73]

COVID-19 Antigen Rapid Test Kit
Mucus from nose or throat in a test liquid is placed onto a COVID-19 rapid antigen diagnostic test device
Enzyme-linked immunosorbent assay (ELISA)

ELISAs can be qualitative or quantitative and generally require a lab. These tests usually use whole blood, plasma, or serum samples. A plate is coated with a viral protein, such as a SARS-CoV-2 spike protein. Samples are incubated with the protein, allowing any antibodies to bind to it. The antibody-protein complex can then be detected with another wash of antibodies that produce a color/fluorescent readout.[73]

Neutralization assay

Neutralization assays assess whether sample antibodies prevent viral infection in test cells. These tests sample blood, plasma or serum. The test cultures cells that allow viral reproduction (e.g., VeroE6 cells). By varying antibody concentrations, researchers can visualize and quantify how many test antibodies block virus replication.[73]

Chemiluminescent immunoassay

Chemiluminescent immunoassays are quantitative lab tests. They sample blood, plasma, or serum. Samples are mixed with a known viral protein, buffer reagents and specific, enzyme-labeled antibodies. The result is luminescent. A chemiluminescent microparticle immunoassay uses magnetic, protein-coated microparticles. Antibodies react to the viral protein, forming a complex. Secondary enzyme-labeled antibodies are added and bind to these complexes. The resulting chemical reaction produces light. The radiance is used to calculate the number of antibodies. This test can identify multiple types of antibodies, including IgG, IgM, and IgA.[73]

Neutralizing vis-à-vis binding antibodies

Most if not all large scale COVID-19 antibody testing looks for binding antibodies only and does not measure the more important neutralizing antibodies (NAb).[74][75][76] A NAb is an antibody that defends a cell from an infectious particle by neutralizing its biological effects. Neutralization renders the particle no longer infectious or pathogenic.[77] A binding antibody binds to the pathogen but the pathogen remains infective; the purpose can be to flag the pathogen for destruction by the immune system.[78] It may even enhance infectivity by interacting with receptors on macrophages.[79] Since most COVID-19 antibody tests return a positive result if they find only binding antibodies, these tests cannot indicate that the subject has generated protective NAbs that protect against re-infection.[75][76]

It is expected that binding antibodies imply the presence of NAbs[76] and for many viral diseases total antibody responses correlate somewhat with NAb responses[80] but this is not established for COVID-19. A study of 175 recovered patients in China who experienced mild symptoms reported that 10 individuals had no detectable NAbs at discharge, or thereafter. How these patients recovered without the help of NAbs and whether they were at risk of re-infection was not addressed.[75] An additional source of uncertainty is that even if NAbs are present, viruses such as HIV can evade NAb responses.[74]

Studies have indicated that NAbs to the original SARS virus (the predecessor to the current SARS-CoV-2) can remain active for two years[81] and are gone after six years.[82] Nevertheless, memory cells including Memory B cells and Memory T cells[83] can last much longer and may have the ability to reduce reinfection severity.[82]

Other tests

Following recovery, many patients no longer have detectable viral RNA in upper respiratory specimens. Among those who do, RNA concentrations three days following recovery are generally below the range in which replication-competent virus has been reliably isolated.[84]

No clear correlation has been described between length of illness and duration of post-recovery shedding of viral RNA in upper respiratory specimens.[85]


Infectivity is indicated by the basic reproduction number (R0, pronounced "R naught") of the disease.[86] SARS-CoV-2 is estimated to have an R0 of 2.2 to 2.5.[87][88] This means that in a population where all individuals are susceptible to infection, each infected person is expected to infect 2.2 to 2.5 others in the absence of interventions.[89] R0 can vary according factors such as geography, population demographics and density.[90] In New York state R0 was estimated to be 3.4 to 3.8.[91]

On average, an infected person begins showing symptoms five days after infection (the "incubation period") and can infect others beginning two to three days before that.[87][92] One study reported that 44% of viral transmissions occur within this period.[87][93] According to the CDC, a significant number of infected people who never show symptoms are nevertheless contagious.[93][88] In vitro studies have not found replication-competent virus after 9 days from infection.[94] The statistically estimated likelihood of recovering replication-competent virus approaches zero by 10 days.[95]

Infectious virus has not been cultured from urine or reliably cultured from feces;[96] these potential sources pose minimal if any risk of transmitting infection and any risk can be sufficiently mitigated by good hand hygiene.

Patterns and duration of illness and infectivity have not been fully described. However, available data indicate that SARS-CoV-2 RNA shedding in upper respiratory specimens declines after symptom onset. At 10 days recovery of replication-competent virus in viral culture (as a proxy of the presence of infectious virus) approaches zero. Although patients may produce PCR-positive specimens for up to six weeks,[97] it remains unknown whether these samples hold infectious virus. After clinical recovery, many patients do not continue to shed. Among recovered patients with detectable RNA in upper respiratory specimens, concentrations after three days are generally below levels where virus has been reliably cultured. These data were generated from adults across a variety of age groups and with varying severity of illness. Data from children and infants were not available.[94]


Timeline of total number of tests in different countries[98]



Public Health England announced a test on the 10th,[99] using a real-time RT-PCR (RdRp gene) assay based on oral swabs.[100] The test detected the presence of any type of coronavirus, including specifically identifying SARS-CoV-2. It was rolled out to twelve laboratories across the United Kingdom on 10 February.[101]

Scientists from China first released information on the viral genome on 11 January 2020,[102][103] sending multiple genomic sequences to GISAID, an indispensable mechanism for sharing influenza genetic sequence data.[104] That day the Malaysian Institute for Medical Research (IMR) produced "primers and probes" specific to a SARS-CoV-2 RT-PCR test.[105] The IMR's materials were used to diagnose Malaysia's first patient on 24 January.[106] BGI Group was one of the first companies to receive emergency use approval from China's National Medical Products Administration for a nucleic acid test.[107]

The German nucleic acid testing protocol was published on the 17th. Another early PCR test was developed by Charité University hospital in Berlin, working with academic collaborators in Europe and Hong Kong, and published on the 23rd. It used rtRT-PCR, and formed the basis of 250,000 kits distributed by the World Health Organization (WHO).[108]

The first case in South Korea was confirmed on 19 January.[109]

In Russia, the first COVID‑19 test was developed by the State Research Center of Virology and Biotechnology VECTOR. Production began on 24 January.[110]

In the US, the Centers for Disease Control and Prevention (CDC) developed its SARS-CoV-2 Real Time PCR Diagnostic Panel.[111] The protocol became available on the 28th.[112] One of three tests in early kits failed due to faulty reagents.[citation needed]


South Korean company Kogenebiotech's clinical grade, nucleic acid test (PowerChek Coronavirus) was approved by Korea Centers for Disease Control and Prevention (KCDC) on 4 February.[113]

In Wuhan, BGI opened a makeshift 2000-sq-meter emergency detection laboratory named "Huo-Yan" (Chinese: 火眼, "Fire Eye") on the 5th.[114][115] It processed more than 10,000 samples/day.[116][115] Construction required 5 days.[117] The Wuhan Laboratory was followed by Huo-Yan labs in Shenzhen, Tianjin, Beijing, and Shanghai, in a total of 12 cities across China.[citation needed]

On 11 February, the test was approved by the Federal Service for Surveillance in Healthcare in Russia.[118]

In the United States, the CDC refused to let other labs process tests that month, allowing an average of fewer than 100 samples/day to be processed.[citation needed] Tests using two components were not determined to be reliable until the 28th, and only then were state and local laboratories permitted to begin testing.[119] The test was approved by the FDA under an EUA.[citation needed]


Due to limited testing, no countries had reliable data on the prevalence of the virus in their population.[120] Testing variability distorts reported case fatality rates, which were probably overestimated in many countries due to sampling bias.[8][121] Shortages of reagent and other supplies became a bottleneck for mass testing in the EU and UK[122] and the US.[123][124]

By 4 March, China reached 50,000 tests per day.[125] Early in March, China reported accuracy problems with its PCR tests.[126] A study examined 1070 samples from 205 Wuhan patients and reported varied sensitivity according to the methods and location of sample collection. Samples from bronchoalveolar lavage fluid specimens returned the highest sensitivity.[127] The authors argued that CT scans showed even higher sensitivity.[128]

US commercial labs began testing in early March. As of the 5th, LabCorp announced nationwide availability of COVID‑19 testing based on RT-PCR.[129] Quest Diagnostics made nationwide testing available as of 9 March.[130] US testing demand grew rapidly, causing backlogs of hundreds of thousands of tests at private US labs. Supplies of swabs and chemical reagents continued strained.[131] On 25 May, the US required each state to take responsibility for meeting its testing needs.[132] In March, the FDA issued EUAs for nucleic acid tests to Hologic (3/16),[133] Abbott Laboratories (3/18),[134] Thermo Fisher Scientific (3/19)[135] Cepheid (3/21)[136][137] and LabCorp (4/30).[134]

On 12 March, Mayo Clinic announced a nucleic acid test.[138]

On 16 March, the WHO called for ramping up testing programmes as the best way to slow the spread.[139][140] Several European countries initially conducted more tests than the US.[141][142] By 19 March, drive-in tests were offered in several large cities.[143]

As of 22 March, according to the president of the Robert Koch Institute, Germany had capacity for 160,000 tests per week.[144] As of 26 March, German Health Minister Jens Spahn estimated that Germany was conducting 200,000 tests per week.[145] Germany has a large medical diagnostics industry, with more than a hundred testing labs that provided the technology and infrastructure to enable rapid increases in testing. Costs are borne by insurance when the test is ordered by a physician.[146] As of the end of March at least 483,295 samples were tested and 33,491 (6.9%) had tested positive.[147]

On 26 March, it was reported that 80% of test kits that Czechia purchased from China gave inaccurate results.[148][149] Slovakia purchased 1.2 million antibody-based test kits from China that were found to be inaccurate.[150] China accused Czechia and Slovakia of incorrect use of those tests.[151] Ateş Kara of the Turkish Health Ministry said the test kits Turkey purchased from China had a "high error rate".[152][153]

Spain purchased test kits from Chinese firm Shenzhen Bioeasy Biotechnology Co Ltd, but found that results were unacceptable. The maker explained that the incorrect results may stem from failure to collect samples or use the kits correctly. On 27 March, the Spanish ministry switched to another vendor, Shenzhen Bioeasy.[154]

By 31 March, the United Arab Emirates was testing more of its population per head than any other country.[155] UAE implemented a combination of drive-through sample collection, and a mass-throughput laboratory from Group 42 and BGI. The lab conduced tens of thousands RT-PCR tests per day and was the first to be operational at that scale other than China.[156]

By the month's end, testing had surpassed 200k/week.[157]


The FDA gave an EUA for the US' first antibody test on the 2nd.[158][65]

On 5 April, the U.S. subsidiary of China's BGI Group sent a proposal to the state of California offering to build in California, at cost ($10 million), the world's largest COVID-19 testing site, in two weeks, and train Americans to operate it. California's consultants recommended against it, because of the risk of security and commercial competition.[159]

As of 7 April, the World Health Organization (WHO) had accepted two diagnostic tests for procurement under the Emergency Use Listing procedure (EUL).[160]

On 13 April, Health Canada approved a nucleic acid test from Spartan Bioscience. Institutions may "test patients" with a handheld DNA analyzer "and receive results without having to send samples away to a [central] lab".[161][162]

By the start of April, the United Kingdom was delivering around 10,000 swab tests per day.[163] The British NHS announced that it was piloting a scheme to test suspected cases at home, to remove the risk of one patient infecting others at a hospital or disinfecting an ambulance used to transport a patient.[164]

The UK purchased 3.5 million antibody test kits from China, but in early April 2020 announced these were not usable.[165][166] On 21 April 2020, the Indian Council of Medical Research (ICMR) advised Indian states to stop using test kits purchased from China after receiving complaints from one state. Rajasthan health minister Raghu Sharma on 21 April said the kits gave only 5.4 percent accurate results.[167]

Antibody survey results found from 2% to 30% positive.[168] On preliminary data, WHO concluded that 2% to 3% of the world population had developed antibodies.[169]

By month end, testing had surpassed 750k/week.[157]


A video compilation of free testing sites in California.

In May antibody tests were conducted on 5,603 major league baseball employees and 0.7% tested positive, showing that they had been infected. 70% of those who tested positive had had no symptoms.[170][171][172] The US was conducting an average of 2.5 million tests per week for the week ending 17 May. This grew to 3.2 million by 14 June.[173][174]

Attempts to culture virus from upper respiratory specimens were largely unsuccessful when viral burden is low but detectable (i.e., Ct values[when defined as?] higher than 33–35).[94]

On 1 May, Quotient Limited announced the CE Mark for its MosaiQ COVID-19 antibody test,[175] designed as a serological disease screen specific to the Coronavirus.[176] The test has a 100% sensitivity and 99,8% specificity claim.[177][178]

On 3 May, Roche received an EUA for a selective ELISA serology test.[179][180]

On 8 May, the FDA granted its first EUA for antigen test: "Sofia 2 SARS Antigen FIA" by Quidel Corp.[181][57]

The FDA announced on 14 May a review of 15 adverse event reports about the Abbott ID Now device for low sensitivity.[182]

On 21 May, researchers at Ben-Gurion University in Israel reported a one-minute coronavirus test with 90% accuracy, based on the "change in the resonance in the THz spectral range" shown by the coronavirus through THz spectroscopy.[183]

Nearly two million antibody tests imported into Australia and costing $20 million were declared unusable.[184][185][186]

In early May Harvard's Global Health Institute estimated that the US needed to test more than 900k per day.[187][188] Other recommendations ranged up to 23m per day.[189][190][191][192]

As of 24 May, countries that publicised their testing data had typically performed tests equal to 2.6 percent of their population, although no country had tested more than 17.3%.[193]

On 29 May Siemens received an EUA for its anti-spike RBD-targeting serology test that it believes detects neutralizing antibodies.[194]

By month end, testing had surpassed 1.4m/week.[157]


In June, researchers announced a nucleic acid diagnostic test using reverse transcription-loop-mediated isothermal amplification (RT-LAMP), an existing technology used in pathogenic microorganism identification, genetically modified ingredients, tumor detection, and embryo sex identification. The test identified virus in samples of serum, urine, saliva, oropharyngeal swabs and nasopharyngeal swabs. Once commercialized the test has the potential to provide rapid (30-45 minute) diagnosis at point of care. The test was 100% selective and highly sensitive, detecting virus at a concentration of .06 fg/ml.[195]

As of 14 June 2020, the percentage testing positive in the US as a whole had fallen below 5%.[196] As of late June, test numbers crossed 600k/day.[173]


On 6 November, the U.S. Food and Drug Administration (FDA) authorized the first serology test that detects neutralizing antibodies from recent or prior SARS-CoV-2 infection, which are antibodies that bind to a specific part of a pathogen and have been observed in a laboratory setting to decrease SARS-CoV-2 viral infection of cells.[197] The FDA issued an emergency use authorization (EUA) for the cPass SARS-CoV-2 Neutralization Antibody Detection Kit, which specifically detects this type of antibody.[197] The FDA granted Lucira Health emergency use authorization for the first US at-home rapid molecular diagnostic test. With a prescription from a healthcare provider, consumers can use the test kit to take a nasal swab then perform a 30-minute SARS-CoV-2 detection test at home.[198]


On 15 December, the U.S. Food and Drug Administration (FDA) issued an emergency use authorization (EUA) for the first over-the-counter (OTC) fully at-home diagnostic test for COVID-19.[199][200][201] The Ellume COVID-19 Home Test is a rapid, lateral flow antigen test, a type of test that runs a liquid sample along a surface with reactive molecules.[199] The test detects fragments of proteins of the SARS-CoV-2 virus from a nasal swab sample from any individual two years of age or older.[199] The Ellume COVID-19 Home Test uses a mid-turbinate nasal swab (sample is collected further back than the usual nasal swab, but not as far back as nasopharyngeal swabs, which are only appropriate for use by a trained health care provider) to detect certain proteins of the virus known as antigens.[199] The Ellume COVID-19 Home Test uses an analyzer that connects with a software application on a smartphone to help users perform the test and interpret results.[199] Results are delivered in as little as 20 minutes to individuals via their smartphone.[199]

Testing protocols

A sample collection kiosk for COVID-19 testing in India

Drive-through testing

In drive-through testing, the person undergoing testing remains in a vehicle while a healthcare professional approaches the vehicle and obtains a sample, all while taking appropriate precautions such as wearing personal protective equipment (PPE).[202][203] Drive-through centers helped South Korea accelerate its testing program.[204]

Home collection

In Hong Kong test subjects can stay home and receive a specimen tube. They spit into it, return it and later get the result.[205]

Pooled testing

In Israel, researchers at Technion and Rambam Hospital developed a method for testing samples from 64 patients simultaneously, by pooling the samples and only testing further if the combined sample was positive.[206][207][208] Pool testing was then adopted in Israel, Germany, Ghana[209][210][211] South Korea,[212] Nebraska,[213] China[214] and the Indian states of Uttar Pradesh,[215] West Bengal,[216] Punjab,[217] Chhattisgarh[218] and Maharashtra.[219]

Open source, multiplexed designs released by Origami Assays can test as many as 1122 patient samples using only 93 assays.[220] These balanced designs can be run in small laboratories without robotic liquid handlers.

Multi-tiered testing

One study proposed a rapid immune response assay as a screening test, with a confirmatory nucleic acid test for diagnosis, followed by a rapid antibody test to determine course of action and assess population exposure/herd immunity.[221]

Required volume

Required testing levels are a function of disease spread. The more the cases, the more tests are needed to manage the outbreak. COVID-19 tends to grow exponentially at the beginning of an outbreak, meaning that the number of required tests initially also grows exponentially. If properly targeted testing grows more rapidly than cases, it can be contained.

WHO recommends increasing testing until fewer than 10% are positive in any given jurisdiction.[222]

United States

Number of tests done per day in the US.
Blue: CDC lab
Orange: Public health lab
Gray: Data incomplete due to reporting lag
Not shown: Testing at private labs; total exceeded 100,000 per day by 27 March.[223]

Economist Paul Romer reported that the US has the technical capacity to scale up to 20 million tests per day, which is his estimate of the scale needed to fully remobilize the economy.[190] The Edmond J. Safra Center for Ethics estimated on 4 April that this capacity could be available by late July.[224] Romer pointed to single-molecule real-time sequencing equipment from Pacific Biosciences[225][190] and to the Ion Torrent Next-Generation Sequencing equipment from ThermoFisher Scientific.[226][190] According to Romer, "Recent research papers suggest that any one of these has the potential to scale up to millions of tests per day." This plan requires removing regulatory hurdles. Romer estimated that $100 billion would cover the costs.[190]

Romer also claimed that high test accuracy is not required if tests are administered frequently enough. He ran model simulations in which 7% of the population is tested every day using a test with a 20% false negative rate and a 1% false positive rate. The average person would be tested roughly every two weeks. Those who tested positive would go into quarantine. Romer's simulation indicated that the fraction of the population that is infected at any given time (known as the attack rate) peaks reaches roughly 8% in about thirty days before gradually declining, in most runs reaching zero at 500 days, with cumulative prevalence remaining below 20%.[227]

Available tests

A temporary drive-in testing site for COVID-19 set up with tents in a parking lot

Countries around the world developed tests independently and in partnership with others.

Nucleic acid tests

Tests developed in China, France, Germany, Hong Kong, Japan, the United Kingdom, and the US targeted different parts of the viral genome. WHO adopted the German system for manufacturing kits sent to low-income countries without the resources to develop their own.

PowerChek Coronavirus looks for the "E" gene shared by all beta coronaviruses, and the RdRp gene specific to SARS-CoV-2.[228]

US President Donald Trump displays a COVID-19 testing kit from Abbott Laboratories in March 2020.

Abbott Laboratories' ID Now nucleic acid test uses isothermal amplification technology.[229] The assay amplifies a unique region of the virus's RdRp gene; the resulting copies are then detected with "fluorescently-labeled molecular beacons".[230] The test kit uses the company's "toaster-size" ID Now device, which is widely deployed in the US.[231] The device can be used in laboratories or in point of care settings, and provides results in 13 minutes or less.[230]

Primerdesign offers its Genesig Real-Time PCR Coronavirus (COVID‑19). Cobas SARS-CoV-2 Qualitative assay runs on the Cobas® 6800/8800 Systems by Roche Molecular Systems. They are offered by the United Nations and other procurement agencies.

Antigen tests

Quidel's "Sofia 2 SARS Antigen FIA"[57][181] is a lateral flow test that uses monoclonal antibodies to detect the virus's nucleocapsid (N) protein.[232] The result is read out by the company's Sofia 2 device using immunofluorescence.[232] The test is simpler and cheaper but less accurate than nucleic acid tests. It can be deployed in laboratories or at point of care and gives results in 15 minutes.[181] A false negative result occurs if the sample's antigen level is positive but below the test's detection limit, requiring confirmation with a nucleic acid test.[232]

Serology (antibody) tests

Antibodies are usually detectable 14 days after the onset of the infection. Multiple jurisdictions survey their populations using these tests.[233][234] The test requires a blood draw.[citation needed]

Private US labs including Quest Diagnostics and LabCorp offer antibody testing upon request.[235]

Antibody tests are available in various European countries.[236] Quotient Limited developed a CE marked COVID-19 antibody test.[237][238][239]

Roche offers a selective ELISA serology test.[240]

A summary review in BMJ has noted that while some "serological tests … might be cheaper and easier to implement at the point of care [than RT-PCR]", and such testing can identify previously infected individuals, "caution is warranted … using serological tests for … epidemiological surveillance". The review called for higher quality studies assessing accuracy with reference to a standard of "RT-PCR performed on at least two consecutive specimens, and, when feasible, includ[ing] viral cultures."[241][242] CEBM researchers have called for in-hospital 'case definition' to record "CT lung findings and associated blood tests"[243] and for the WHO to produce a "protocol to standardise the use and interpretation of PCR" with continuous re-calibration.[244]


The location of sample collection impact on sensitivity for COVID-19 in 205 Wuhan patients[127]
Samples source Positive rate
Bronchoalveolar lavage fluid specimens 93% (14/15)
Sputum 72% (75/104)
Nasal swabs 63% (5/8)
Fibrobronchoscope brush biopsy 46% (6/13)
Pharyngeal swabs 32% (126/398)
Feces 29% (44/153)
Blood 1% (3/307)

Accuracy is measured in terms of specificity and selectivity. Test errors can be false positives (the test is positive, but the virus is not present) or false negatives, (the test is negative, but the virus is present).[245]

Sensitivity and specificity

Sensitivity indicates whether the test accurately identifies whether the virus is present. Each test requires a minimum level of viral load in order to produce a positive result. A 90% sensitive test will correctly identify 90% of infections, missing the other 10% (a false negative). Even relatively high sensitivity rates can produce high rates of false negatives in populations with low incidence rates.[245]

Specificity indicates how well-targeted the test is to the virus in question. Highly specific tests pick up only the virus in question. Non-selective tests pick up other viruses as well. A 90% specific test will correctly identify 90% of those who are uninfected, leaving 10% with a false positive result.[245]

Low-specificity tests have a low positive predictive value (PPV) when prevalence is low. For example, suppose incidence is 5%. Testing 100 people at random using a test that has a specificity of 95% would yield on average 5 people who are actually negative who would incorrectly test positive. Since 5% of the subjects actually are positive, another five would also test positive correctly, totaling 10 positive results. Thus, the PPV is 50%,[246] an outcome no different from a coin toss. In this situation retesting those with a positive result increases the PPV to 94.5%, meaning that only 4.5% of the second tests would return the incorrect result, on average less than 1 incorrect result.[247]

Causes of test error

Improper sample collection, exemplified by failure to acquire enough sample and failure to insert a swab deep into the nose. This results in insufficient viral load, one cause of low clinical sensitivity.

The time course of infection also affects accuracy. Samples may be collected before the virus has had a chance to establish itself or after the body has stopped its progress and begun to eliminate it. A May 2020 review of PCR-RT testing found that the median probability of a false-negative result decreased from 100% on day 1, to 67% on day 4. On the day of symptom onset, the probability was 38%, which decreased to 20% 3 days later.[248]

Improper storage for too long a time can cause RNA breakdown and lead to wrong results as viral particles disintegrate.[249]

Improper design and manufacture can yield inaccurate results. Millions of tests made in China were rejected by various countries throughout the period of March 2020 through May 2020.

Test makers typically report the accuracy levels of their tests when seeking approval from authorities. In some jurisdictions, these results are cross-validated by additional assessments. Reported results may not be achieved in clinical settings due to such operational inconsistencies.

PCR-based test

Detection of SARS-CoV-2 by nasal swab over six weeks in patients who experienced mild to moderate illness

RT-PCR is the most accurate diagnostic test.[126] It typically has high sensitivity and specificity in a laboratory setting: however, in one study sensitivity dropped to 66–88% clinically.[250]

In one study sensitivity was highest at week one (100%), followed by 89.3%, 66.1%, 32.1%, 5.4% and zero by week six.[251][252]

A Dutch CDC-led laboratory investigation compared 7 PCR kits.[253] Test kits made by BGI, R-Biopharm AG, BGI, KH Medical and Seegene showed high sensitivity.[254]

High sensitivity kits are recommended to assess people without symptoms, while lower sensitivity tests are adequate when diagnosing symptomatic patients.[253]

The University of Oxford's Centre for Evidence-Based Medicine (CEBM) has pointed to mounting evidence[255][256] that "a good proportion of 'new' mild cases and people re-testing positives via RT-PCR after quarantine or discharge from hospital are not infectious, but are simply clearing harmless virus particles which their immune system has efficiently dealt with", and have called for "an international effort to standardize and periodically calibrate testing".[257] On 7 September, the UK government issued "guidance for procedures to be implemented in laboratories to provide assurance of positive SARS-CoV-2 RNA results during periods of low prevalence, when there is a reduction in the predictive value of positive test results".[258]

On 4 January 2021, the US FDA issued an alert about the risk of false results, particularly false negative results, with the Curative SARS-Cov-2 Assay real-time RT-PCR test.[45]

Isothermal nucleic amplification test

One study reported that the ID Now COVID-19 test showed sensitivity of 85.2%. Abbott responded that the issue could have been caused by analysis delays.[259] Another study rejected the test in their clinical setting because of this low sensitivity.[260]

Confirmatory testing

The WHO recommends countries that do not have testing capacity and national laboratories with limited experience on COVID‑19 send their first five positives and the first ten negative COVID‑19 samples to one of the 16 WHO reference laboratories for confirmatory testing.[261][262] Out of the sixteen reference laboratories, seven are in Asia, five in Europe, two in Africa, one in North America and one in Australia.[263]

National responses


Iceland managed the pandemic with aggressive contact tracing, inbound travel restrictions, testing, and quarantining, but with less aggressive lock-downs.[264]



Researchers tested the entire population of , the site of Italy's first COVID‑19 death. They tested about 3,400 people twice, at an interval of ten days. About half the people testing positive had no symptoms. All discovered cases were quarantined. Along with restricting travel to the commune, new infections were completely eliminated.[265]


Unlike other Asian countries, Japan did not experience a pandemic of SARS or MERS, so the country's PCR testing system was not well developed.[266][267] Japan preferentially tested patients with severe illness and their close contacts at the beginning. Japan's Novel Coronavirus Expert Meeting chose cluster measures to identify infections clusters.[266][267] The Expert Meeting analyzed the outbreak from Wuhan and identified conditions leading to clusters (closed spaces, crowded spaces and close-contact), and asked people to avoid them.[267][268]

In January, contact tracers took action shortly after the first infection was found. Only administrative tests were carried out at first, until insurance began covering PCR tests on 6 March. Private companies began to test, and the test system gradually expanded.[266][269]

On 3 April, those with positive tests were legally permitted to recuperate at home or in a hotel if they had asymptomatic or mild illness, ending the hospital bed shortage.[270] The first wave (from China) was contained,[271] but a second wave (caused by returnees from Europe and the US) in mid-March led to spreading infection in April.[267] On 7 April, Japan declared a state of emergency, (less strict than a lockdown, because it did not block cities or restrict outings).[267][270][272] On 13 May, antigen test kits became covered by insurance, and were combined with a PCR test for diagnosis.[273][274]

Japan's PCR test count per capita remained far smaller than in some other countries even though its positive test rate was lower. Excess mortality was observed in March.[268][failed verification][272][failed verification][275] The Expert Meeting stated, "The Japanese health care system originally carries out pneumonia surveillance, allowing it to detect most of the severely ill patients who develop pneumonia. There are a large number of CT scanners in Japan and they have spread to small hospitals all over the country, so pneumonia patients are rarely missed. In that sense, it meets the same standards as other countries that mainly carry out PCR tests."[268][275] The group recommended using CT scans data and doctor's findings for diagnosis.[276][277] On the Diamond Princess cruise ship, many people who initially tested negative later tested positive. Half of coronavirus-positives there who remained mild or asymptomatic had pneumonia findings on CT scans and their CT image showed a frosted glass shadow that is characteristic of infection.[278][279]

As of 18 July, Japan's daily PCR testing capacity was about 32,000, more than three times the 10,000 cases as of April. When the antigen test is added to it, the number is about 58,000. The number of tests per 1,000 people in the United States is about 27 times that of Japan, the UK is 20 times, Italy is 8 times, and South Korea is twice (as of 26 July).[280][281][282] The number of those infected with coronavirus and inpatients has increased in July, but the number of serious cases has not increased. This is thought to be due to the proper testing of those infected in July compared to those in April. In April, the number of tests could not catch up with the increase in the number of infected people, and the test standards were strict, so the test positive rate exceeded 30% at the peak. It means that there were quite a few cases where the those infected was not PCR tested. It is thought that the severe case was preferentially tested though there were a lot of mild cases and asymptomatic carriers mainly in the young during the first wave. In other words, it became possible to grasp the actual situation of infection much better than before by strengthening the testing system.[283] At the end of July, accommodation facilities for mild and asymptomatic carriers became full, and the authorities requested hospitals to prepare beds for the mild. However, it became difficult to treat patients with other illnesses and to maintain the ICU system including the staff due to the occupation of hospital beds by patients with mild symptoms.[284][285][286]


On 27 April, Russia tested 3 million people and had 183,000 positive results.[287] On 28 April Anna Popova, head of Federal Service for Surveillance in Healthcare (Roszdravnadzor) stated that 506 laboratories were testing; that 45% of those who tested positive had no symptoms; that 5% of patients had a severe form; and 40% of infections were from family members. Illness improved from six days to one day after symptoms appeared. Antibody testing was carried out on 3,200 Moscow doctors, finding 20% immunity.[288]


With contact tracing, inbound travel restrictions, testing, and quarantining, Singapore arrested the initial spread without complete lockdown.[289]


In late October 2020 Slovakia tested 3.62 million people in a weekend, from a population of 5.4m, representing 67% of the total (or 82% of the adult population), 38,359 tested positive, representing 1.06% of those tested. The government considered the mass test would significantly assist in controlling the virus and avoid a lockdown and may repeat the exercise at a later date.[290]

South Korea

South Korea's broad testing approach helped reduce spread. Testing capacity, largely in private sector labs, was built up over several years by the South Korean government in the early 2000s.[291]

The government exploited the resident registration number (RRN) system. Authorities mobilized young men who were eligible for military service as social service agents, security and public health doctors. Public health doctors were mainly dispatched to public health centers and life treatment centers where mildly ill patients were accommodated. They performed PCR tests and managed mild patients. Social service agents worked in pharmacies to fill staff shortages. Korea's 10k PCR tests per million residents was the world's highest as of 13 April rising to 20k by mid-June. Twenty-seven Korean companies exported test kits worth $48.6 million in March, and were asked to provide test kits or humanitarian assistance by more than 120 countries. Korean authorities set up a treatment center to isolate and manage patients with asymptomatic and minor illnesses in one facility in order to vacate hospital beds for the more severely ill.

Centers were sited mainly at national facilities and corporate training centers. The failure of Korea's MERS quarantine in May 2015 left Korea more prepared for COVID-19 than countries that did not face that pandemic. Then President Park Geun-hye allowed Korean CDC-approved private sector testing for infectious diseases in 2016. Korea already had a system for isolating, testing and treating infectious disease patients separately from others. Patients with respiratory illness but no epidemiological relevance were treated at the National Hospital, and those with epidemiological relevance were treated at selected clinics.[109][292][293][294][295][296][297][298][299]

Korea established a large scale drive-through/walk-through" test testing program. However, the most common method was "mobile examination". In Daegu City, 54% of samples were collected by 23 March in home or hospital. Collecting samples door-to-door of avoided the risk of travel by possibly infected patients, but required additional staff. Korea solved the problem by drafting more than 2,700 public insurance doctors.[109][295][294]

The government disclosed personal information to the public via KCDC without patient consent. The authorities used digital surveillance to trace possible spread.[292][295][296][298][299][300][301][302][303] [304]


Health insurance IDs and national identification card numbers were used to trace contacts.[305][306][307][308]

United States

New York State

New York State's control measures consisted of PCR tests, stay-at-home measures and strengthening the healthcare system. On 29 February before its first case, the state allowed testing at the Wordsworth Center. They managed to convince the CDC to approve tests at state laboratories and the FDA to approve a test kit. As of 13 March the state was conducting more than 1,000 daily tests, growing to 10,000/day on 19 March. In April, the number exceeded 20,000. Many people queued at hospitals to get tested. On 21 March New York City health officials directed medical providers to test only those entering the hospital, for lack of PPE.[298][309][310][311][312]

USS Theodore Roosevelt

Following an outbreak, 94% of the 4,800 aircraft carrier crew were tested. Roughly 60 percent of the 600-plus sailors who tested positive were asymptomatic.[313] Five infected sailors who completed quarantine subsequently developed flu-like symptoms and again tested positive.[314]

Delayed testing

A shortage of trained medical laboratory scientists, assay reagents, analyzers, transport medium, and PPE coupled with high demand had limited initially limited the availability of testing and led to significantly increased turnaround times.[citation needed]

Testing statistics by country

Testing strategies vary by country and over time,[315] with some countries testing very widely,[7] while others have at times focused narrowly on only testing the seriously ill.[316] The country that tests only people showing symptoms will have a higher figure for "% (Confirmed cases as percentage of tested samples or tested cases)" than the country that also tests others.[317] If two countries are alike in every respect, including which people they test, the one that tests more people will have a higher "Confirmed / million people". Studies have also found that countries that test more, relative to the number of deaths, have lower estimated case fatality rates[8] and younger age distributions of cases.[10]

Location Date[a] Tested Units[b] Confirmed
% Tested /
Confirmed /
Afghanistan 17 December 154,767 samples 49,621 32.1 3,976 1,275 [318]
Albania 22 January 327,774 samples 70,655 21.6 114,486 24,679 [319]
Algeria 2 November 230,553 samples 58,574 25.4 5,288 1,343 [320][321]
Andorra 18 January 134,259 samples 9,147 6.8 1,731,414 117,960 [322]
Angola 19 January 339,634 samples 19,011 5.6 10,911 611 [323]
Antigua and Barbuda 19 January 8,599 samples 190 2.2 89,307 1,973 [324]
Argentina 22 January 5,806,612 samples 1,853,830 31.9 127,957 40,852 [325]
Armenia 20 January 628,405 samples 165,221 26.2 212,893 55,759 [326]
Australia 21 January 12,594,719 samples 28,750 0.23 501,782 1,145 [327]
Austria 21 January 8,488,882 samples 396,857 4.7 953,528 44,578 [328]
Azerbaijan 21 January 2,341,807 samples 228,246 9.7 236,594 23,060 [329]
Bahamas 21 January 57,763 samples 8,101 14.0 149,786 21,007 [330]
Bahrain 21 January 2,596,967 samples 98,878 3.8 1,654,703 63,002 [331]
Bangladesh 18 January 3,455,160 samples 528,329 15.3 20,979 3,208 [332]
Barbados 22 January 93,972 samples 1,191 1.3 327,400 4,149 [333]
Belarus 22 January 4,330,509 samples 234,111 5.4 456,237 24,665 [334]
Belgium 20 January 7,720,287 samples 684,256 8.9 670,409 59,419 [335]
Belize 21 January 66,632 samples 11,676 17.5 163,119 28,584 [336]
Benin 20 January 412,697 3,643 0.88 35,174 310 [337]
Bhutan 21 January 409,600 samples 851 0.21 552,245 1,147 [338]
Bolivia 18 January 482,520 cases 188,733 39.1 42,222 16,515 [339]
Bosnia and Herzegovina 22 January 575,996 samples 119,420 20.7 168,345 34,903 [340]
Botswana 20 January 599,609 18,630 3.1 266,012 8,265 [341][342]
Brazil 6 January 20,103,645 samples 7,873,830 39.2 95,665 37,468 [343][344]
Brunei 20 January 88,304 samples 174 0.20 192,174 379 [345]
Bulgaria 21 January 1,301,250 samples 213,864 16.4 187,230 30,772 [346]
Burkina Faso 21 January 122,596 samples 9,857 8.0 5,865 472 [320][347]
Burundi 5 January 90,019 884 0.98 7,586 74 [348]
Cambodia 22 January 382,668 456 0.12 23,549 28 [349]
Cameroon 16 July 135,000 samples 16,157 12.0 5,086 609 [350]
Canada 21 January 16,895,320 cases 731,450 4.3 445,848 19,302 [351]
Chad 19 January 77,650 samples 2,977 3.8 5,680 218 [320][352]
Chile 21 January 7,465,412 samples 685,107 9.2 391,450 35,924 [353]
China 31 July 160,000,000 samples 91,418 0.06 111,163 64 [354][355][356][357]
Colombia 21 January 6,927,364 samples 1,987,418 28.7 143,547 41,183 [358]
Costa Rica 20 January 561,356 samples 187,712 33.4 112,284 37,547 [359]
Croatia 21 January 1,139,956 cases 227,326 19.9 279,658 55,768 [360]
Cuba 20 January 1,737,174 samples 19,530 1.1 153,371 1,724 [361][362]
Cyprus[c] 21 January 1,001,015 samples 29,636 3.0 1,159,569 34,330 [363]
Czechia 22 January 4,380,044 samples 924,847 21.1 409,582 86,483 [364]
Denmark[d] 22 January 12,431,739 samples 193,038 1.6 2,134,257 33,140 [365][366]
Djibouti 22 January 105,649 5,917 5.6 114,611 6,419 [367]
Dominica 18 January 8,498 cases 113 1.3 118,646 1,578 [368]
Dominican Republic 19 January 973,586 samples 198,123 20.3 89,498 18,213 [369]
DR Congo 13 January 102,460 20,478 20.0 1,144 229 [320][370]
Ecuador 21 January 832,522 samples 236,189 283.7 48,730 13,825 [371]
Egypt 18 November 709,186 samples 111,284 15.7 7,087 1,112 [320]
El Salvador 21 January 675,048 samples 52,672 7.8 104,074 8,121 [372]
Equatorial Guinea 21 January 84,190 5,401 6.4 64,318 4,126 [373]
Estonia 21 January 726,969 samples 39,212 5.4 547,268 29,519 [374]
Eswatini 20 January 121,554 13,789 11.3 106,975 12,135 [375]
Ethiopia 18 January 1,891,919 samples 131,546 7.0 16,457 1,144 [376]
Faroe Islands 22 January 217,483 samples 652 0.30 4,173,537 12,512 [377]
Fiji 19 January 23,812 samples 55 0.23 26,563 61 [378]
Finland 21 January 2,690,257 samples 41,565 1.5 485,323 7,498 [379]
France[e] 21 January 40,885,502 samples 2,987,965 7.3 610,031 44,582 [380]
Gabon 8 January 389,912 samples 9,694 2.5 12,548 312 [381]
Georgia[f] 22 January 1,521,505 samples 251,974 16.6 409,352 67,792 [382]
Germany 20 January 37,449,922 samples 2,068,002 5.5 446,564 24,659 [383]
Ghana 18 January 726,313 samples 59,480 8.2 23,374 1,914 [384]
Greece 22 January 3,930,631 samples 151,041 3.8 365,013 14,026 [385]
Greenland 22 January 17,382 samples 30 0.17 309,945 535 [386]
Grenada 14 January 18,314 139 0.76 164,319 1,247 [387]
Guatemala 21 January 727,972 samples 152,956 21.0 42,169 8,860 [388]
Guinea 13 January 239,048 cases 14,065 5.9 18,202 1,071 [389]
Guyana 18 January 44,500 cases 6,931 15.6 56,588 8,814 [390]
Haiti 20 January 47,097 cases 11,099 23.6 4,117 970 [391]
Honduras 17 January 343,797 samples 133,507 38.8 35,859 13,925 [392]
Hungary 22 January 3,018,389 samples 356,973 11.8 312,451 36,952 [393]
Iceland 22 January 466,846 samples 5,981 1.3 1,281,629 16,420 [394]
India 22 January 190,148,024 samples 10,625,428 5.6 137,802 7,700 [395][396]
Indonesia 23 January 5,813,504 cases 977,474 16.8 21,563 3,626 [397][398]
Iran 23 January 8,850,281 samples 1,367,032 15.4 106,394 16,434 [399]
Iraq 21 January 5,267,174 samples 611,407 11.6 130,951 15,201 [400]
Ireland 22 January 2,900,940 samples 184,279 6.4 589,442 37,444 [401]
Israel 17 January 9,490,422 samples 546,087 5.8 1,034,373 59,519 [402]
Italy 22 January 30,431,493 samples 2,441,854 8.0 504,170 40,455 [403]
Ivory Coast 20 January 305,299 samples 25,597 8.4 11,574 970 [404]
Jamaica 21 January 156,367 samples 14,658 9.4 57,382 5,379 [405]
Japan 23 January 6,599,350 356,074 5.4 52,314 2,823 [406]
Jordan 22 January 3,678,331 samples 318,911 8.7 345,120 29,922 [407]
Kazakhstan 15 January 5,942,556 samples 166,146 2.8 318,576 8,907 [408]
Kenya 18 January 1,128,360 samples 99,227 8.8 23,723 2,086 [409]
Kosovo 22 January 216,409 cases 57,317 26.5 119,532 31,659 [410]
Kuwait 21 January 1,436,192 samples 159,834 11.1 334,777 37,257 [411]
Kyrgyzstan 3 November 426,462 samples 60,279 14.1 65,373 9,240 [412]
Laos 15 January 97,529 cases 41 0.04 13,692 6 [413]
Latvia 21 January 1,078,860 samples 58,710 5.4 93,158 30,579 [414]
Lebanon 22 January 2,466,437 samples 272,411 11.0 361,359 39,911 [415]
Lesotho 18 January 44,360 7,018 15.8 22,100 3,496 [416]
Liberia 21 January 62,223 1,914 3.1 12,265 377 [417]
Libya 20 January 614,899 samples 111,746 18.2 89,582 16,280 [320][418]
Lithuania 22 January 1,850,397 samples 174,846 9.4 662,197 62,572 [419][420]
Luxembourg[g] 21 January 1,828,776 samples 49,428 2.7 2,920,863 78,945 [421]
Madagascar 15 January 105,342 cases 18,301 17.4 4,011 697 [422]
Malawi 21 January 118,488 samples 16,049 13.5 6,194 839 [423]
Malaysia 21 January 4,236,922 cases 172,549 4.1 129,284 5,265 [424]
Maldives 22 January 379,612 samples 14,830 3.9 967,231 37,786 [425][426]
Mali 19 January 164,214 samples 7,880 4.8 8,109 389 [320][427]
Malta 21 January 580,752 samples 16,280 2.8 1,176,662 32,985 [428]
Mauritania 20 January 177,612 16,212 9.1 40,336 3,682 [429]
Mauritius 22 November 289,552 samples 494 0.17 228,717 390 [430]
Mexico 19 January 3,768,930 cases 1,668,396 44.3 29,296 12,969 [431]
Moldova[h] 20 January 601,914 samples 154,118 25.6 227,963 58,369 [432]
Mongolia 19 January 880,860 cases 1,536 0.17 262,671 458 [433]
Montenegro 4 August 24,469 cases 3,361 13.7 38,765 5,325 [434]
Morocco 21 January 5,245,083 cases 463,706 8.8 142,103 12,563 [435]
Mozambique 22 January 319,169 samples 30,848 9.7 10,212 987 [436]
Myanmar 18 January 2,151,828 samples 134,795 6.3 39,549 2,477 [437]
Namibia 21 January 247,890 samples 31,515 12.7 90,249 11,474 [438]
Nepal 21 January 2,031,756 samples 268,646 13.2 72,316 9,562 [439]
Netherlands 19 January 6,970,400 cases 921,850 13.2 400,023 52,904 [440]
New Caledonia 21 January 19,994 samples 44 0.22 73,668 162 [441]
New Zealand 22 January 1,480,691 samples 1,920 0.13 297,114 385 [442][443]
Niger 19 January 69,827 cases 4,225 6.1 3,111 188 [444]
Nigeria 18 January 1,172,234 samples 112,004 9.6 5,729 547 [445]
North Korea 19 June 922 cases 0 0 36 0 [446]
North Macedonia 21 January 437,267 samples 89,817 20.5 210,515 43,241 [447][448]
Northern Cyprus[i] 20 January 373,605 samples 1,971 0.53 1,146,028 6,046 [449]
Norway 20 January 3,223,039 samples 59,456 1.8 619,094 11,077 [450]
Oman 1 July 194,945 samples 41,194 21.1 41,947 8,864 [451]
Pakistan 18 January 7,442,084 samples 523,011 7.0 33,701 2,368 [452]
Palestine 21 January 978,179 samples 173,964 17.8 15,475 34,435 [453]
Panama 20 January 1,563,685 samples 303,777 19.4 374,368 72,728 [454]
Papua New Guinea 17 January 40,697 cases 835 2.1 4,555 93 [455]
Paraguay 18 January 611,068 samples 122,588 20.1 85,673 17,187 [456]
Peru 21 January 5,989,114 samples 1,082,907 18.1 182,459 32,991 [457]
Philippines 21 January 7,442,227 samples 507,717 6.8 73,699 5,028 [458]
Poland 21 January 8,284,096 samples 1,464,448 17.7 215,810 38,151 [459]
Portugal 22 January 6,722,120 samples 609,136 9.1 654,118 59,274 [460]
Qatar 21 January 1,340,046 cases 148,258 11.1 465,124 51,460 [461]
Romania 21 January 5,244,752 samples 703,776 13.4 270,325 36,274 [462]
Russia 22 January 98,509,055 samples 3,677,352 3.7 671,278 25,059 [463][464]
Rwanda 19 January 804,337 samples 11,548 1.4 62,100 892 [465]
Saint Kitts and Nevis 15 January 6,391 cases 34 0.53 121,870 648 [466]
Saint Lucia 22 January 22,832 samples 770 3.4 125,527 4,233 [467]
Saint Vincent 20 January 24,866 cases 655 2.6 225,622 5,943 [468]
San Marino 22 January 31,974 samples 2,861 8.9 934,038 83,577 [469]
Saudi Arabia 21 January 11,875,017 samples 365,775 3.1 341,100 10,507 [470]
Senegal 18 January 313,698 samples 23,224 7.4 19,786 1,465 [471]
Serbia 22 January 2,527,514 cases 380,802 15.1 362,952 54,683 [472]
Singapore 18 January 6,061,147 samples 59,127 0.98 1,062,688 10,367 [473][474]
Slovakia 22 January 1,658,408 samples 233,027 14.1 303,856 42,696 [475]
Slovenia 21 January 769,373 samples 155,752 20.2 367,407 74,378 [476]
South Africa 21 January 7,820,613 cases 1,380,807 17.7 131,863 23,282 [477][478]
South Korea 19 January 4,985,981 samples 73,115 1.5 96,424 1,414 [479]
South Sudan 19 January 83,134 3,773 4.5 6,506 295 [480]
Spain 14 January 30,165,217 samples 2,456,675 8.1 645,479 52,568 [481][482]
Sri Lanka 23 January 1,576,145 samples 56,863 3.6 72,290 2,608 [483]
Sudan 7 January 158,804 samples 23,316 14.7 3,622 532 [320]
Sweden 20 January 4,916,424 samples 542,952 11.0 476,047 52,573 [484][485]
Switzerland[j] 22 January 4,135,714 samples 509,279 10.4 569,274 59,159 [486]
Taiwan[k] 21 January 326,755 samples 872 0.27 13,843 37 [487]
Tanzania 18 November 3,880 509 13.1 65 8.5 [320]
Thailand 22 January 1,299,551 cases 13,104 1.0 18,718 189 [488]
The Gambia 19 January 35,520 samples 3,950 11.1 16,339 1,817 [489]
Togo 19 January 195,594 4,383 2.2 22,721 509 [490]
Trinidad and Tobago 22 January 80,170 cases 7,456 9.3 58,776 5,466 [491]
Tunisia 19 January 786,348 samples 188,373 24.0 66,535 15,939 [492]
Turkey 21 January 28,032,559 samples 2,412,505 8.6 337,112 29,012 [493]
Uganda 18 January 801,935 samples 38,534 4.8 17,532 842 [494]
Ukraine 21 January 6,057,828 samples 1,182,969 19.5 144,128 28,145 [495]
United Arab Emirates 21 January 24,033,072 samples 267,258 1.1 2,503,614 27,841 [496]
United Kingdom 22 January 67,231,066 samples 3,583,907 5.3 995,341 53,059 [497]
United States 22 January 291,407,518 samples 24,483,676 8.4 880,421 73,972 [498]
Uruguay 21 January 779,127 samples 34,992 4.5 224,505 10,083 [499]
Uzbekistan 14 July 1,400,000 samples 13,872 0.99 41,132 408 [500]
Venezuela 19 January 2,514,620 samples 121,117 4.8 87,050 4,193 [501]
Vietnam 15 October 1,260,799 samples 1,124 0.09 12,771 11 [502]
Zambia 21 January 806,196 samples 42,213 5.2 46,462 2,433 [503]
Zimbabwe 19 January 280,810 samples 28,675 10.2 18,893 1,929 [320][504]
  1. ^ Local time.
  2. ^ For some countries it is unclear whether they report samples or cases. One person tested twice is recorded as one case and two samples.
  3. ^ Excluding Northern Cyprus.
  4. ^ The autonomous territories of Greenland and the Faroe Islands are listed separately.
  5. ^ Testing data from 4 May to 12 May is missing because of the transition to the new reporting system SI-DEP.
  6. ^ Excluding Abkhazia and South Ossetia.
  7. ^ Data for residents only.
  8. ^ Excluding Transnistria.
  9. ^ Northern Cyprus is not recognized as a sovereign state by any country except Turkey.
  10. ^ Includes data for Liechtenstein.
  11. ^ Not a United Nations member.

See also


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Further reading

External links