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COVID-19 testing statistics by country
Country or region Date[a] Tested Units[b] Confirmed
(cases) 		Confirmed /
tested,
% 		Tested /
population,
% 		Confirmed /
population,
% 		Ref.
Afghanistan 17 Dec 2020 154,767 samples 49,621 32.1 0.40 0.13 [1]
Albania 18 Feb 2021 428,654 samples 96,838 22.6 15.0 3.4 [2]
Algeria 2 Nov 2020 230,553 samples 58,574 25.4 0.53 0.13 [3][4]
Andorra 23 Feb 2022 300,307 samples 37,958 12.6 387 49.0 [5]
Angola 2 Feb 2021 399,228 samples 20,981 5.3 1.3 0.067 [6]
Antigua and Barbuda 6 Mar 2021 15,268 samples 832 5.4 15.9 0.86 [7]
Argentina 16 Apr 2022 35,716,069 samples 9,060,495 25.4 78.3 20.0 [8]
Armenia 29 May 2022 3,099,602 samples 422,963 13.6 105 14.3 [9]
Australia 9 Sep 2022 78,548,492 samples 10,112,229 12.9 313 40.3 [10]
Austria 1 Feb 2023 205,817,752 samples 5,789,991 2.8 2,312 65.0 [11]
Azerbaijan 11 May 2022 6,838,458 samples 792,638 11.6 69.1 8.0 [12]
Bahamas 28 Nov 2022 259,366 samples 37,483 14.5 67.3 9.7 [13]
Bahrain 3 Dec 2022 10,578,766 samples 696,614 6.6 674 44.4 [14]
Bangladesh 24 Jul 2021 7,417,714 samples 1,151,644 15.5 4.5 0.70 [15]
Barbados 14 Oct 2022 770,100 samples 103,014 13.4 268 35.9 [16]
Belarus 9 May 2022 13,217,569 samples 982,809 7.4 139 10.4 [17]
Belgium 24 Jan 2023 36,548,544 samples 4,691,499 12.8 317 40.7 [18]
Belize 8 Jun 2022 572,900 samples 60,694 10.6 140 14.9 [19][20]
Benin 4 May 2021 595,112 samples 7,884 1.3 5.1 0.067 [21]
Bhutan 28 Feb 2022 1,736,168 samples 12,702 0.73 234 1.71 [22]
Bolivia 5 Jun 2022 4,358,669 cases 910,228 20.9 38.1 8.0 [23]
Bosnia and Herzegovina 27 Sep 2022 1,872,934 samples 399,887 21.4 54.7 11.7 [24]
Botswana 11 Jan 2022 2,026,898 232,432 11.5 89.9 10.3 [25][26]
Brazil 19 Feb 2021 23,561,497 samples 10,081,676 42.8 11.2 4.8 [27][28]
Brunei 2 Aug 2021 153,804 samples 338 0.22 33.5 0.074 [29]
Bulgaria 2 Feb 2023 10,993,239 samples 1,295,524 11.8 158 18.6 [30]
Burkina Faso 4 Mar 2021 158,777 samples 12,123 7.6 0.76 0.058 [3][31]
Burundi 5 Jan 2021 90,019 884 0.98 0.76 0.0074 [32]
Cambodia 1 Aug 2021 1,812,706 77,914 4.3 11.2 0.48 [33]
Cameroon 18 Feb 2021 942,685 samples 32,681 3.5 3.6 0.12 [3]
Canada 26 Nov 2022 66,343,123 samples 4,423,053 6.7 175 11.7 [34]
Chad 2 Mar 2021 99,027 samples 4,020 4.1 0.72 0.029 [3][35]
Chile 1 Feb 2023 48,154,268 samples 5,123,007 10.6 252 26.9 [36]
China[c] 31 Jul 2020 160,000,000 cases 87,655 0.055 11.1 0.0061 [37][38]
Colombia 24 Nov 2022 36,875,818 samples 6,314,769 17.1 76.4 13.1 [39][40]
Costa Rica 2 Nov 2021 2,575,363 samples 561,054 21.8 51.5 11.2 [41]
Croatia 2 Feb 2023 5,481,285 cases 1,267,798 23.1 134 31.1 [42]
Cuba 2 Feb 2023 14,301,394 samples 1,112,470 7.8 126 9.8 [43][44]
Cyprus[d] 29 Jan 2023 27,820,163 samples 644,160 2.3 3,223 74.4 [45]
Czechia 1 Feb 2023 22,544,928 samples 4,590,529 20.4 211 42.9 [46]
Denmark[e] 31 Jan 2023 67,682,707 samples 3,399,947 5.0 1,162 58.4 [47][48]
Djibouti 28 Apr 2022 305,941 15,631 5.1 33.2 1.7 [49]
Dominica 20 Jun 2022 209,803 cases 14,821 7.1 293 20.7 [50]
Dominican Republic 22 Jul 2022 3,574,665 samples 626,030 17.5 32.9 5.8 [51]
DR Congo 28 Feb 2021 124,838 25,961 20.8 0.14 0.029 [3][52]
Ecuador 23 Jul 2021 1,627,189 samples 480,720 29.5 9.5 2.8 [53]
Egypt 23 Jul 2021 3,137,519 samples 283,947 9.1 3.1 0.28 [3][54]
El Salvador 18 Mar 2022 1,847,861 samples 161,052 8.7 28.5 2.5 [55]
Equatorial Guinea 30 Jan 2023 403,773 17,113 4.2 30.8 1.3 [56]
Estonia 31 Jan 2023 3,637,908 samples 613,954 16.9 274 46.2 [57]
Eswatini 8 Dec 2021 415,110 49,253 11.9 36.5 4.3 [58]
Ethiopia 24 Jun 2021 2,981,185 samples 278,446 9.3 2.6 0.24 [59]
Faroe Islands 27 Feb 2022 774,000 samples 34,237 4.4 1,493 65.7 [60]
Fiji 2 Jan 2023 667,953 samples 68,848 10.3 74.5 7.7 [61]
Finland 14 Jan 2022 9,042,453 samples 371,135 4.1 163 6.7 [62]
France[f][g] 15 May 2022 272,417,258 samples 29,183,646 10.7 417 44.7 [63]
Gabon 23 Jul 2021 958,807 samples 25,325 2.6 3.1 0.082 [64]
Gambia 15 Feb 2021 43,217 samples 4,469 10.3 2.0 0.21 [65]
Georgia[h] 3 Nov 2021 4,888,787 samples 732,965 15.0 132 19.7 [66]
Germany 7 Jul 2021 65,247,345 samples 3,733,519 5.7 77.8 4.5 [67][68]
Ghana 3 Jul 2021 1,305,749 samples 96,708 7.4 4.2 0.31 [69]
Greece 18 Dec 2022 101,576,831 samples 5,548,487 5.5 943 51.5 [70]
Greenland 30 Jan 2022 164,573 samples 10,662 6.5 293 19.0 [71]
Grenada 11 May 2021 28,684 161 0.56 25.7 0.14 [72]
Guatemala 6 Jan 2023 6,800,560 samples 1,230,098 18.1 39.4 7.1 [73]
Guinea 21 Jul 2021 494,898 samples 24,878 5.0 3.8 0.19 [3][74]
Guinea-Bissau 7 Jul 2022 145,231 8,400 5.8 7.7 0.45 [75]
Guyana 15 Jun 2022 648,569 cases 66,129 10.2 82.5 8.4 [76]
Haiti 26 Nov 2022 223,475 cases 33,874 15.2 2.0 0.30 [77]
Honduras 26 Nov 2021 1,133,782 samples 377,859 33.3 11.8 3.9 [78]
Hungary 10 May 2022 11,394,556 samples 1,909,948 16.8 118 19.8 [79]
Iceland 9 Aug 2022 1,988,652 samples 203,162 10.2 546 55.8 [80]
India 8 Jul 2022 866,177,937 samples 43,585,554 5.0 63 31.7 [81][82]
Indonesia 3 Jul 2023 76,062,770 cases 6,812,127 9.0 28.2 2.5
Iran 31 May 2022 52,269,202 samples 7,232,268 13.8 62.8 8.7 [83]
Iraq 3 Aug 2022 19,090,652 samples 2,448,484 12.8 47.5 6.1 [84]
Ireland 31 Jan 2023 12,990,476 samples 1,700,817 13.1 264 34.6 [85]
Israel 17 Jan 2022 41,373,364 samples 1,792,137 4.3 451 19.5 [86]
Italy 16 Mar 2023 269,127,054 samples 25,651,205 9.5 446 42.5 [87]
Ivory Coast 3 Mar 2021 429,177 samples 33,285 7.8 1.6 0.13 [88]
Jamaica 30 Sep 2022 1,184,973 samples 151,931 12.8 43.5 5.6 [89]
Japan 1 Mar 2021 8,487,288 432,773 5.1 6.7 0.34 [90]
Jordan 6 Jun 2021 7,407,053 samples 739,847 10.0 69.5 6.9 [91]
Kazakhstan 28 May 2021 11,575,012 samples 385,144 3.3 62.1 2.1 [92]
Kenya 5 Mar 2021 1,322,806 samples 107,729 8.1 2.8 0.23 [93]
Kosovo 31 May 2021 611,357 cases 107,410 17.6 33.8 5.9 [94]
Kuwait 9 Mar 2022 7,754,247 samples 624,573 8.1 181 14.6 [95]
Kyrgyzstan 10 Feb 2021 695,415 samples 85,253 12.3 10.7 1.3 [96]
Laos 1 Mar 2021 114,030 cases 45 0.039 1.6 0.00063 [97]
Latvia 5 Sep 2021 3,630,095 samples 144,518 4.0 189 7.5 [98]
Lebanon 14 Jun 2021 4,599,186 samples 542,649 11.8 67.4 8.0 [99]
Lesotho 30 Mar 2022 431,221 32,910 7.6 21.5 1.6 [100]
Liberia 17 Jul 2021 128,246 5,396 4.2 2.5 0.11 [101]
Libya 14 Apr 2022 2,578,215 samples 501,862 19.5 37.6 7.3 [3][102]
Lithuania 31 Jan 2023 9,046,584 samples 1,170,108 12.9 324 41.9 [103][104]
Luxembourg[i] 12 May 2022 4,248,188 samples 244,182 5.7 679 39.0 [105]
Madagascar 19 Feb 2021 119,608 cases 19,831 16.6 0.46 0.076 [106]
Malawi 29 Nov 2022 624,784 samples 88,086 14.1 3.3 0.46 [107]
Malaysia 7 Sep 2021 23,705,425 cases 1,880,734 7.9 72.3 5.7 [108]
Maldives 13 Mar 2022 2,216,560 samples 174,658 7.9 398 31.3 [109][110]
Mali 7 Jul 2021 322,504 samples 14,449 4.5 1.6 0.071 [3][111]
Malta 8 Sep 2021 1,211,456 samples 36,606 3.0 245 7.4 [112]
Mauritania 16 Apr 2021 268,093 18,103 6.8 6.1 0.41 [113]
Mauritius 22 Nov 2020 289,552 samples 494 0.17 22.9 0.039 [114]
Mexico 15 Oct 2021 10,503,678 cases 3,749,860 35.7 8.2 2.9 [115]
Moldova[j] 20 Apr 2022 3,213,594 samples 516,864 16.1 122 19.6 [116]
Mongolia 10 Jul 2021 3,354,200 cases 136,053 4.1 100 4.1 [117]
Montenegro 10 May 2021 394,388 samples 98,449 25.0 62.5 15.6 [118][119]
Morocco 6 Jan 2023 14,217,563 cases 1,272,299 8.9 38.5 3.4 [120]
Mozambique 22 Jul 2021 688,570 samples 105,866 15.4 2.2 0.34 [121]
Myanmar 16 Sep 2021 4,047,680 samples 440,741 10.9 7.4 0.81 [122]
Namibia 4 Jul 2022 1,062,663 samples 166,229 15.6 38.7 6.1 [123]
Nepal 26 Jul 2022 5,804,358 samples 984,475 17.0 20.7 3.5 [124]
Netherlands 6 Jul 2021 14,526,293 cases 1,692,834 11.7 83.4 9.7 [125]
New Caledonia 3 Sep 2021 41,962 samples 136 0.32 15.7 0.050 [126]
New Zealand 29 Jan 2023 7,757,935 samples 2,136,662 27.5 156 42.9 [127][128]
Niger 22 Feb 2021 79,321 cases 4,740 6.0 0.35 0.021 [129]
Nigeria 28 Feb 2021 1,544,008 samples 155,657 10.1 0.75 0.076 [130]
North Korea 25 Nov 2020 16,914 cases 0 0 0.066 0 [131]
North Macedonia 1 Jul 2021 881,870 samples 155,689 17.7 42.5 7.5 [132][133]
Northern Cyprus[k] 12 Jul 2022 7,096,998 samples 103,034 1.5 2,177 31.6 [134]
Norway 20 Jan 2022 9,811,888 samples 554,778 5.7 183 10.3 [135]
Oman 28 Oct 2020 509,959 samples 114,434 22.4 11.0 2.5 [136]
Pakistan 5 Mar 2021 9,173,593 samples 588,728 6.4 4.2 0.27 [137]
Palestine 5 Feb 2022 3,078,533 samples 574,105 18.6 60.9 11.4 [138]
Panama 28 Jan 2023 7,475,016 samples 1,029,701 13.8 179 24.7 [139]
Papua New Guinea 17 Feb 2021 47,490 cases 961 2.0 0.53 0.011 [140]
Paraguay 27 Mar 2022 2,609,819 samples 647,950 24.8 36.6 9.1 [141]
Peru 17 Nov 2022 36,073,768 samples 4,177,786 11.6 109.9 12.7 [142]
Philippines 7 Jan 2023 34,402,980 samples 4,073,980 11.8 34.1 4.0 [143][144]
Poland 27 Apr 2022 36,064,311 samples 5,993,861 16.6 94.0 15.6 [145]
Portugal 5 Jan 2022 27,515,490 samples 1,499,976 5.5 268 14.6 [146]
Qatar 11 Nov 2022 4,061,988 cases 473,440 11.7 141 16.4 [147]
Romania 29 Jan 2021 5,405,393 samples 724,250 13.4 27.9 3.7 [148]
Russia 6 Jun 2022 295,542,733 samples 18,358,459 6.2 201 12.5 [149][150]
Rwanda 6 Oct 2021 2,885,812 samples 98,209 3.4 22.3 0.76 [151]
Saint Kitts and Nevis 26 Aug 2021 30,231 cases 995 3.3 57.6 1.9 [152]
Saint Lucia 7 Oct 2022 212,132 samples 29,550 13.9 116.6 16.2 [153]
Saint Vincent 28 Jan 2023 113,504 cases 9,585 8.4 103.0 8.7 [154]
San Marino 29 Jan 2023 192,613 samples 23,427 12.2 563 68.4 [155]
Saudi Arabia 26 Apr 2022 41,849,069 samples 753,632 1.8 120 2.2 [156]
Senegal 12 Jul 2021 624,502 samples 46,509 7.4 3.9 0.29 [157]
Serbia 2 Feb 2023 12,185,475 cases 2,473,599 20.3 175 35.5 [158]
Singapore 3 Aug 2021 16,206,203 samples 65,315 0.40 284 1.1 [159][160]
Slovakia 2 Feb 2023 7,391,882 samples 1,861,034 25.2 135 34.1 [161]
Slovenia 2 Feb 2023 2,826,117 samples 1,322,282 46.8 135 63.1 [162]
South Africa 24 May 2021 11,378,282 cases 1,637,848 14.4 19.2 2.8 [163][164]
South Korea 1 Mar 2021 6,592,010 samples 90,029 1.4 12.7 0.17 [165]
South Sudan 26 May 2021 164,472 10,688 6.5 1.3 0.084 [166]
Spain 1 Jul 2021 54,128,524 samples 3,821,305 7.1 116 8.2 [167][168]
Sri Lanka 30 Mar 2021 2,384,745 samples 93,128 3.9 10.9 0.43 [169][170]
Sudan 7 Jan 2021 158,804 samples 23,316 14.7 0.36 0.053 [3]
Sweden 24 May 2021 9,996,795 samples 1,074,751 10.8 96.8 10.4 [171][172]
Switzerland[l] 7 Nov 2022 23,283,909 samples 4,276,836 18.4 270 49.7 [173]
Taiwan[m] 3 Feb 2023 30,275,725 samples 8,622,129 28.48 128.3 36.528 [174]
Tanzania 18 Nov 2020 3,880 509 13.1 0.0065 0.00085 [3]
Thailand 4 Mar 2021 1,579,597 cases 26,162 1.7 2.3 0.038 [175]
Togo 6 Jan 2023 807,269 39,358 4.9 9.4 0.46 [176]
Trinidad and Tobago 3 Jan 2022 512,730 cases 92,997 18.1 37.6 6.8 [177]
Tunisia 23 Aug 2021 2,893,625 samples 703,732 24.3 24.5 6.0 [178]
Turkey 2 Jul 2021 61,236,294 samples 5,435,831 8.9 73.6 6.5 [179]
Uganda 11 Feb 2021 852,444 samples 39,979 4.7 1.9 0.087 [180]
Ukraine 24 Nov 2021 15,648,456 samples 3,367,461 21.5 37.2 8.0 [181]
United Arab Emirates 1 Feb 2023 198,685,717 samples 1,049,537 0.53 2,070 10.9 [182]
United Kingdom 19 May 2022 522,526,476 samples 22,232,377 4.3 774 32.9 [183]
United States 29 Jul 2022 929,349,291 samples 90,749,469 9.8 281 27.4 [184][185]
Uruguay 16 Apr 2022 6,089,116 samples 895,592 14.7 175 25.8 [186]
Uzbekistan 7 Sep 2020 2,630,000 samples 43,975 1.7 7.7 0.13 [187]
Venezuela 30 Mar 2021 3,179,074 samples 159,149 5.0 11.0 0.55 [188]
Vietnam 28 Aug 2022 45,772,571 samples 11,403,302 24.9 46.4 11.6 [189]
Zambia 10 Mar 2022 3,301,860 samples 314,850 9.5 19.0 1.8 [190]
Zimbabwe 15 Oct 2022 2,529,087 samples 257,893 10.2 17.0 1.7 [3][191]
  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 Taiwan.
  4. ^ Excluding Northern Cyprus.
  5. ^ Excluding Greenland and the Faroe Islands.
  6. ^ Excluding Overseas France.
  7. ^ Testing data from 4 May to 12 May is missing because of the transition to the new reporting system SI-DEP.
  8. ^ Excluding Abkhazia and South Ossetia.
  9. ^ Data for residents only.
  10. ^ Excluding Transnistria.
  11. ^ Northern Cyprus is not recognized as a sovereign state by any country except Turkey.
  12. ^ Includes data for Liechtenstein.
  13. ^ Not a United Nations member.

Laboratory testing for the respiratory coronavirus disease 2019 (COVID-19) and the associated SARS-CoV-2 virus includes methods that detect the presence of virus and those that detect antibodies produced in response to infection. Detection of antibodies (serology) can be used both for clinical purposes and population surveillance.

Due to limited testing, as of March 2020 no countries had reliable data on the prevalence of the virus in their population.[192] This variability also affects reported case-fatality rates.

Test methods

As of 6 March 2020, WHO listed the development laboratories and protocols for detection of virus[193]
Country Institute Gene targets
China China CDC ORF1ab and Nucleoprotein (N)
Germany Charité RdRP, E, N
Hong Kong HKU ORF1b-nsp14, N
Japan National Institute of Infectious Diseases,
Department of Virology III		 Pancorona and multiple targets,
Spike protein (Peplomer)
Thailand National Institute of Health N
US US CDC Three targets in N gene
France Pasteur Institute Two targets in RdRP

Detection of virus

CDC 2019-nCoV Laboratory Test Kit.jpg
CDC 2019-nCoV Laboratory Test Kit
Sample collection in Florida

Using real time reverse transcription polymerase chain reaction (rRT-PCR)[194] the test can be done on respiratory samples obtained by various methods, including nasopharyngeal swab or sputum sample.[195] Results are generally available within a few hours to 2 days.[196] Molecular methods leverage polymerase chain reaction (PCR) along with nucleic acid tests, and other advanced analytical techniques, to detect the genetic material of the virus using real-time reverse transcription polymerase chain reaction for diagnostic purposes.

Thermocycler
A thermocycler or thermal cycler, also known as a PCR machine.

One of the early PCR tests was developed at Charité in Berlin in January 2020 using real-time reverse transcription polymerase chain reaction (rRT-PCR), and formed the basis of 250,000 kits for distribution by the World Health Organization (WHO).[197]

The South Korean company Kogenebiotech developed a clinical grade, PCR-based SARS-CoV-2 detection kit (PowerChek Coronavirus) on 28 January 2020.[198][199] It looks for the "E" gene shared by all beta coronaviruses, and the RdRp gene specific to SARS-CoV-2.[200] Other companies in the country, such as Solgent and Seegene, also developed versions of clinical grade detection kits, named DiaPlexQ and Allplex 2019-nCoV Assay, respectively, in February 2020.

In China, BGI Group was one of the first companies to receive emergency use approval from China's National Medical Products Administration for a PCR-based SARS-CoV-2 detection kit.[201]

In the United States, the Centers for Disease Control and Prevention (CDC) is distributing its 2019-Novel Coronavirus (2019-nCoV) Real-Time RT-PCR Diagnostic Panel to public health labs through the International Reagent Resource.[202] One of three genetic tests in older versions of the test kits caused inconclusive results due to faulty reagents, and a bottleneck of testing at the CDC in Atlanta; this resulted in an average of fewer than 100 samples a day being successfully processed throughout the whole of February 2020. Tests using two components were not determined to be reliable until 28 February 2020, and it was not until then that state and local laboratories were permitted to begin testing.[203] The test was approved by the Food and Drug Administration under an Emergency Use Authorization.

US commercial labs began testing in early March 2020. As of 5 March 2020 LabCorp announced nationwide availability of COVID-19 testing based on RT-PCR.[204] Quest Diagnostics similarly made nationwide COVID-19 testing available as of 9 March 2020.[205] No quantity limitations were announced; specimen collection and processing must be performed according to CDC requirements.

In Russia, the COVID-19 test was developed and produced by the State Research Center of Virology and Biotechnology VECTOR. On 11 February 2020 the test was registered by the Federal Service for Surveillance in Healthcare.[206]

On 12 March 2020, Mayo Clinic was reported to have developed a test to detect COVID-19 infection.[207]

On 13 March 2020, Roche Diagnostics received FDA approval for a test which could be performed within 3.5 hours, thus allowing one machine to do approximately 4,128 tests in a 24-hour period.[208]

On 19 March 2020, the FDA issued emergency use authorization (EUA) to Abbott Laboratories for a test on Abbott's m2000 system; the FDA had previously issued similar authorization to Hologic, LabCorp, and Thermo Fisher Scientific.[209] On 21 March 2020, Cepheid Inc similarly received EUA from the FDA for a test that takes ~45 minutes.[210]

A test which uses a monoclonal antibody which specifically binds to the nucleocapsid protein (N protein) of the novel coronavirus is being developed in Taiwan, with the hope that it can provide results within 15 to 20 minutes just like a rapid influenza test.[211]

Chest CT scans and radiographs

A March 2020 literature review concluded that "chest radiographs are of little diagnostic value in early stages, whereas CT [computed tomography] findings may be present even before symptom onset."[212] Typical features on CT include bilateral multilobar ground-glass opacificities with a peripheral, asymmetric and posterior distribution.[212] Subpleural dominance, crazy paving and consolidation develop as the disease evolves.[213] A study comparing PCR to CT in Wuhan at the epicenter of the current pandemic has suggested that CT is significantly more sensitive than PCR, though less specific, with many of its imaging features overlapping with other pneumonias and disease processes.[214] As of March 2020, the American College of Radiology recommends that "CT should not be used to screen for or as a first-line test to diagnose COVID-19".[215]

Human readers and artificial intelligence

A small study showed that Chinese radiologists demonstrated 72-94% sensitivity and 24-94% specificity in differentiating COVID-19 from other types of viral pneumonia using CT imaging.[216] Artificial intelligence based convolutional neural networks have also been developed to detect imaging features of the virus both on radiographs[217] and CT with significantly higher specificity.[218]

As of March 2020, the CDC recommends PCR for initial screening[219] because it has higher specificity than CT.[citation needed]

  • Typical CT imaging findings
    Typical CT imaging findings
  • CT imaging of rapid progression stage.
    CT imaging of rapid progression stage.

Detection of antibodies

Part of the immune response to infection is the production of antibodies including IgM and IgG. These can be used to detect infection in individuals starting 7 days or so after the onset of symptoms, to determine immunity, and in population surveillance.[citation needed]

Assays can be performed in central laboratories (CLT) or by point-of-care testing (PoCT). The high-throughput automated systems in many clinical laboratories will be able to perform these assays but their availability will depend on the rate of production for each system. For CLT a single specimen of peripheral blood is commonly used, although serial specimens can be used to follow the immune response. For PoCT a single specimen of blood is usually obtained by skin puncture. Unlike PCR methods an extraction step is not needed before assay.[citation needed]

It is hoped that a point of care test will be available in the United States by March 30.[220]

A blood test to detect antibodies is being developed as of March 9, 2020.[221] It will allow the determination of whether a person has ever been infected and will work regardless of whether the person developed symptoms.[221] It is hoped that it can return results in 15 minutes by detecting both IgM and IgG antibodies.[222]

In late March 2020, Euroimmun Medical Laboratory Diagnostics and Epitope Diagnostics received European approvals for their test kits, which can detect IgG and IgA antibodies against the virus in blood samples. The testing capacity is several hundred samples within hours and therefore much faster than the conventional PCR assay of viral RNA. The antibodies are usually detectable 14 days after the onset of the infection.[223]

Approaches to testing

Hong Kong has set up a scheme where suspected patients can stay home, "emergency department will give a specimen tube to the patient", they spit into it, send it back and get a test result a while after.[224]

The British NHS has announced that it will start testing suspected cases at home, which removes the risk of a patient infecting others if they come to a hospital or having to disinfect an ambulance if one is used.[225]

In drive-through testing for COVID-19 for suspected cases, a healthcare professional takes sample using appropriate precautions.[226][227] Drive-through centers have helped South Korea do some of the fastest, most-extensive testing of any country.[228]

In Germany, the National Association of Statutory Health Insurance Physicians said on March 2, that it had a capacity for about 12,000 tests per day in the ambulatory setting and 10.700 had been tested in the prior week. Costs are borne by the health insurance when the test is ordered by a physician.[229] According to the president of the Robert Koch Institute, Germany has an overall capacity for 160,000 tests per week.[230] As of March 19 drive in tests were offered in several large cities.[231] As of March 26, 2020 the total number of tests performed in Germany was unknown, because only positive results are reported. Health minister Jens Spahn estimated 200,000 tests/week.[232]

In Israel, researchers at Technion and Rambam Hospital developed and tested a method for testing samples from 64 patients simultaneously, by pooling the samples and only testing further if the combined sample is found to be positive.[233][234][235]

In Wuhan a makeshift 2000-sq-meter emergency detection laboratory named "Huo-Yan" (Chinese: 火眼, or "Fire Eye" in English) was opened on 5 February 2020 by BGI,[236][237] which can process over 10,000 samples a day.[238][237] With the construction overseen by BGI-founder Wang Jian and taking 5-days,[239] modelling has show cases in Hubei would have been 47% higher and the corresponding cost of the tackling the quarantine would have doubled if this testing capacity hadn't come on line.[240] The Wuhan Laboratory has been promptly followed by Huo-Yan labs in Shenzhen, Tianjin, Beijing, and Shanghai, in a total of 12 cities across China. By 4 March 2020 the daily throughput totals were 50,000 tests per day.[241]

Insufficient amounts of reagent has become a bottleneck for mass testing.[242][243][244] A simple alternative is freely available[245] by heating samples at 98 °C (208 °F) for 5 minutes to release RNA genomes for further testing.[246]

Production and volume

Number of tests done per day in the United States.
Blue: CDC lab
Orange: Public health lab
Gray: Data incomplete due to reporting lag

China[247] and the United States[248] had problems with the reliability of test kits early in the outbreak, and these countries and Australia[249] were unable to supply enough kits to satisfy demand and recommendations for testing by health experts. In contrast, experts say South Korea's broad availability of testing helped reduce the spread of the novel coronavirus. Testing capacity, largely in private sector labs, was built up over several years by the South Korean government.[250] On 16 March, the World Health Organization called for ramping up the testing programmes as the best way to slow the advance of Covid-19 pandemic.[251][252]

"Testing has to happen, it is the priority. The problem is low-income countries are probably arriving on the third wave, after China, after Europe. Access to tests is going to be problematic," said Karl Blanchet, director of the Centre for Education and Research in Humanitarian Action. While many richer countries were currently focused on their own populations and economies, the humanitarian community would have to look at changing the way it works, by investing in the strengthening of worldwide public health systems rather than focusing on single-issue campaigns.[253]

See also

References

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