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COVID-19

COVID-19 Brief: SARS-CoV-2 / COVID-19 testing – the essentials

Test long

Epidemiologists and public health officials argue for the necessity and availability of accurate and rapid tests for the novel coronavirus, SARS-CoV-2. However, the roles and usefulness of different testing modalities are often confused. 


As testing plays a crucial role in the fight to bring COVID-19 disease under control, it is important to understand and be able to appropriately interpret the results from the different types of tests currently available. This is also highly relevant for insurers as the frequency with which these test results will be encountered during the underwriting or claims processes will certainly increase.      

Test Categories

Currently, there are two main categories of tests for SARS-CoV-2:   

  • Viral tests
    • Reverse transcription – polymerase chain reaction (RT-PCR)
    • Antigen tests
  • Serology or antibody tests

The following table provides a basic overview of each.

SARS-CoV-2/COVID-19 Testing

Test:        

RT-PCR

Antigen

Antibody

Specimen source       

Oral and/or nasal swab samples

Oral and/or nasal swab samples

Blood samples

Basis of test

Looks for the virus' genetic material.

Looks for specific proteins on the virus' surface.

Looks for the presence of antibodies to COVID-19 in the blood.

Test results

A positive result indicates current infection with the virus. While the test can remain positive for a time after a patient has recovered, it will eventually become negative.

A positive result indicates current infection with the virus.

A positive result indicates that a person has had prior exposure to the virus and has generated an immune response to it. It is not yet proven that the antibodies provide protection from future reinfection with the virus.

Accuracy

These tests are generally considered very good and are viewed as the "gold standard" test for current or acute infection. However, a single negative result should not be considered a “rule out” in patients with strongly suggestive symptoms.

Antigen tests produce results more quickly but may be less sensitive. Thus, they are not yet routinely used.

There are some concerns about "false positives," when patients might be told, incorrectly, that they have previously been exposed to the virus. The test accuracy is improving and false positives should become less of a concern.

Some countries are now embarking on broad-based, community serological or antibody testing programs in order to determine what percentage of the population has already been infected by SARS-CoV-2. The tests being used vary in sensitivity and specificity and based on the actual positive prevalence in the population, the positive and negative predictive value of the results will vary.    

Summary

For insurers, it is critical to appreciate the distinctions between the various types of COVID-19 testing currently available and to understand the meaning of results. As the availability of these tests grows, insurers seem likely to encounter increasing volumes of test results during the underwriting and claims process.

RGA's Global Underwriting Manual reflects our deepening understanding of COVID-19 data and the unique challenges this pandemic presents to insurers. The manual features a dedicated COVID-19 section with comprehensive and expanded underwriting guidance, including for applicants who have contracted the infection and those who have recovered. As broad-based community testing could potentially lead to many more insurance applicants disclosing a positive or negative COVID-19 test result, this addition becomes particularly important. The manual also features important underwriting guidance around travel and an additional questionnaire regarding applicants who have contracted the virus. For more information, contact RGA.


References

  1. Johns Hopkins COVID-19 Testing Insights Initiative https://coronavirus.jhu.edu/testing (Accessed 2 June 2020).
  2. Testing for COVID-19https://www.cdc.gov/coronavirus/2019-ncov/symptoms-testing/testing.html (Accessed 2 June 2020)
  3. Watson, J et al.Interpreting a COVID-19 test result.BMJ 2020;369:m1808 (Published 12 May 2020)

The Authors

  • Colin Weston
    Vice President,
    Head of Global Health Claims
    Global Health
    Send email >


  • Nic Lempriere-Hogg
    Senior Vice President
    Global Underwriting Solutions

    RGA
  • Nicky Virgo
    Vice President
    Head of Underwriting
    Manual Development

Summary

As broad-based community testing for COVID-19 grows, understanding and interpreting results will be essential, yet many still struggle to distinguish between test types. RGA offers a guide, and has updated its Global Underwriting Manual with comprehensive underwriting guidance for applicants who have contracted and recovered from the disease.  

  • antibody testing
  • antigen testing
  • Colin Weston
  • Global Underwriting Manual
  • GUM
  • Nic Hogg
  • Nic Lempriere-Hogg
  • Nicki Virgo
  • Nicky Virgo
  • RT-PCR
  • serology
  • test guidance
  • test questionnarie
  • testing
  • testing guidance
  • underwrite COVID-19 test
  • underwriting manual
  • viral testing
  • Virgo
  • Weston