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      Diagnostic Approaches For COVID-19: Lessons Learned and the Path Forward

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          Abstract

          Coronavirus disease 2019 (COVID-19) is a transmitted respiratory disease caused by the infection of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Although humankind has experienced several outbreaks of infectious diseases, the COVID-19 pandemic has the highest rate of infection and has had high levels of social and economic repercussions. The current COVID-19 pandemic has highlighted the limitations of existing virological tests, which have failed to be adopted at a rate to properly slow the rapid spread of SARS-CoV-2. Pandemic preparedness has developed as a focus of many governments around the world in the event of a future outbreak. Despite the largely widespread availability of vaccines, the importance of testing has not diminished to monitor the evolution of the virus and the resulting stages of the pandemic. Therefore, developing diagnostic technology that serves as a line of defense has become imperative. In particular, that test should satisfy three criteria to be widely adopted: simplicity, economic feasibility, and accessibility. At the heart of it all, it must enable early diagnosis in the course of infection to reduce spread. However, diagnostic manufacturers need guidance on the optimal characteristics of a virological test to ensure pandemic preparedness and to aid in the effective treatment of viral infections. Nanomaterials are a decisive element in developing COVID-19 diagnostic kits as well as a key contributor to enhance the performance of existing tests. Our objective is to develop a profile of the criteria that should be available in a platform as the target product. In this work, virus detection tests were evaluated from the perspective of the COVID-19 pandemic, and then we generalized the requirements to develop a target product profile for a platform for virus detection.

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          Most cited references244

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          Virological assessment of hospitalized patients with COVID-2019

          Coronavirus disease 2019 (COVID-19) is an acute infection of the respiratory tract that emerged in late 20191,2. Initial outbreaks in China involved 13.8% of cases with severe courses, and 6.1% of cases with critical courses3. This severe presentation may result from the virus using a virus receptor that is expressed predominantly in the lung2,4; the same receptor tropism is thought to have determined the pathogenicity-but also aided in the control-of severe acute respiratory syndrome (SARS) in 20035. However, there are reports of cases of COVID-19 in which the patient shows mild upper respiratory tract symptoms, which suggests the potential for pre- or oligosymptomatic transmission6-8. There is an urgent need for information on virus replication, immunity and infectivity in specific sites of the body. Here we report a detailed virological analysis of nine cases of COVID-19 that provides proof of active virus replication in tissues of the upper respiratory tract. Pharyngeal virus shedding was very high during the first week of symptoms, with a peak at 7.11 × 108 RNA copies per throat swab on day 4. Infectious virus was readily isolated from samples derived from the throat or lung, but not from stool samples-in spite of high concentrations of virus RNA. Blood and urine samples never yielded virus. Active replication in the throat was confirmed by the presence of viral replicative RNA intermediates in the throat samples. We consistently detected sequence-distinct virus populations in throat and lung samples from one patient, proving independent replication. The shedding of viral RNA from sputum outlasted the end of symptoms. Seroconversion occurred after 7 days in 50% of patients (and by day 14 in all patients), but was not followed by a rapid decline in viral load. COVID-19 can present as a mild illness of the upper respiratory tract. The confirmation of active virus replication in the upper respiratory tract has implications for the containment of COVID-19.
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            Detection of SARS-CoV-2 in Different Types of Clinical Specimens

            This study describes results of PCR and viral RNA testing for SARS-CoV-2 in bronchoalveolar fluid, sputum, feces, blood, and urine specimens from patients with COVID-19 infection in China to identify possible means of non-respiratory transmission.
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              Antibody responses to SARS-CoV-2 in patients with COVID-19

              We report acute antibody responses to SARS-CoV-2 in 285 patients with COVID-19. Within 19 days after symptom onset, 100% of patients tested positive for antiviral immunoglobulin-G (IgG). Seroconversion for IgG and IgM occurred simultaneously or sequentially. Both IgG and IgM titers plateaued within 6 days after seroconversion. Serological testing may be helpful for the diagnosis of suspected patients with negative RT-PCR results and for the identification of asymptomatic infections.
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                Author and article information

                Journal
                ACS Nano
                ACS Nano
                nn
                ancac3
                ACS Nano
                American Chemical Society
                1936-0851
                1936-086X
                03 August 2022
                : acsnano.2c01697
                Affiliations
                []Department of Chemical, Biochemical and Environmental Engineering, University of Maryland Baltimore County, Interdisciplinary Health Sciences Facility , 1000 Hilltop Circle, Baltimore, Maryland 21250, United States
                []Departments of Diagnostic Radiology and Nuclear Medicine and Pediatrics, Center for Blood Oxygen Transport and Hemostasis, University of Maryland Baltimore School of Medicine, Health Sciences Research Facility III , 670 W Baltimore Street, Baltimore, Maryland 21201, United States
                [§ ]Department of Bioengineering, the University of Illinois at Urbana−Champaign , Urbana, Illinois 61801, United States
                []Biomedical Engineering Department, Jordan University of Science and Technology , Irbid 22110, Jordan
                Author notes
                Author information
                https://orcid.org/0000-0003-0175-4704
                Article
                10.1021/acsnano.2c01697
                9364978
                35921264
                5c2cb4a9-b29b-455c-8049-90b2dc19f9e7
                © 2022 American Chemical Society

                This article is made available via the PMC Open Access Subset for unrestricted RESEARCH re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for the duration of the World Health Organization (WHO) declaration of COVID-19 as a global pandemic.

                History
                : 17 February 2022
                : 12 July 2022
                Funding
                Funded by: National Institute of Biomedical Imaging and Bioengineering, doi 10.13039/100000070;
                Award ID: R03 EB028026-02S1
                Funded by: University of Maryland, Baltimore, doi 10.13039/100019823;
                Award ID: NA
                Funded by: University of Maryland, Baltimore County, doi 10.13039/100006636;
                Award ID: NA
                Funded by: National Institute of Biomedical Imaging and Bioengineering, doi 10.13039/100000070;
                Award ID: R03EB028026
                Funded by: National Institute of Biomedical Imaging and Bioengineering, doi 10.13039/100000070;
                Award ID: R03 EB028026-02S2
                Categories
                Review
                Custom metadata
                nn2c01697
                nn2c01697

                Nanotechnology
                infectious diseases,pandemic preparedness,covid-19,diagnostic tests,biosensing,advanced materials,nanotechnology,antigen tests,molecular tests

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