Innovative screening tests for COVID-19 in South Korea
Article information
Abstract
Recently, the number of Corona Virus Disease 2019 (COVID-19) cases has increased remarkably in South Korea, so the triage clinics and emergency departments (ED) are expected to be overcrowded with patients with presumed infection. As of March 21st, there was a total of 8,799 confirmed cases of COVID-19 and 102 related deaths in South Korea that was one of the top countries with high incidence rates [1]. This sharp increase in infection is associated with 1) outbreaks in individual provinces, 2) deployment of rapid and aggressive screening tests, 3) dedicated healthcare staffs for virus screening tests, 4) quarantine inspection data transparency and accurate data reporting, and 5) public health lessons from previous Severe Acute Respiratory Syndrome (SARS) and Middle East Respiratory Syndrome (MERS) outbreaks. This commentary introduces innovative screening tests that are currently used in South Korea for COVID-19, e.g., Drive-Through and Walk-Through tests, and compare the advantages and disadvantages of both methods.
Drive-Through (DT) and Walk-Through (WT) tests are designed to provide a rapid screening, have a minimal risk of infection, and reduce excessive use of medical supplies like personal protective equipment (PPE) [2]. The risk of infection may be reduced by limiting the exposure of testees or direct contacts between the testees and healthcare workers. The DT tests are generally conducted in large low-traffic areas, such as public parking or stadium parking lots [2,3]. On the other hand, the WT tests can be performed in a clean testing booth that can be installed near the hospital. Table 1 shows the pros and cons of DT and WT testing for COVID-19.
DRIVE-THROUGH (DT) TESTING FOR COVID-19
Testing for COVID-19 can be performed at a drive-through site, as shown in Figure 1. The driver/ testee can stay inside his car during the entire process (<15 min), consisting of multiple steps: patient registration (3-4 min), medical examination (2 min), specimen collection (2 min), discharge instructions (2 min), and payment for testing service (2 min). Healthcare workers are supposed to wear the level-D PPE that is composed of inner and outer gloves, a gown (hooded coverall), an N95 mask (respirator), goggles (eye shield) or a face shield, and safety shoes or boots. Depending on the required contact level with patients or the availability of medical supply resources, healthcare staff may use PPE after modifying it, following the facility guidelines [4].
WALK-THROUGH (WT) TESTING FOR COVID-19
Testing for COVID-19 can be performed at a walking-through site, as shown in Figure 2.
Negative pressure booth
In the WT test using a negative pressure booth, the testee stays inside the disinfected booth, while the healthcare worker is outside the booth, disallowing a direct contact between the two. The clean booth is designed to enclose the testee with transparent walls and a pair of gloves on one wall for healthcare staff to use when collecting patient samples and examining the patient. Before the test, healthcare staff is required to put on the PPE consisting of a pair of gloves, a gown, and a disposable face mask. The PPE can be adjusted to follow the facility guidelines or according to the availability of medical supply resources. The whole testing process, from registration to payment, can be completed in about 20 minutes.
Positive pressure booth
The WT test using a positive pressure booth combines the advantages of the DT test and the WT test using a negative pressure booth. The tester stays inside the booth while the testee stays outside; thus, direct contact between the two is avoided (Fig. 3). The positive pressure booth looks similar to the negative pressure booth. Positive pressure inside the booth is used to prevent contaminants from coming inside the booth. The testing process is similar but shorter (<10 min) since it is unnecessary to disinfect the booth after each test.
Pandemics caused by viruses have tended to break out once every decade or every other decade over the past 300 years [5]. Now, they may be occurring more often and in more variable cycles. Successful management of viral infection and diseases requires quarantine and treatment of those who may have an infection. Thus, early-stage screening tests that are efficient and effective are essential for preventing the virus from spreading widely. Each step of the testing process should be completed quickly and minimize the existing risk of infection for healthcare workers and testees alike, meeting the general safety requirements.
In this commentary, we introduce innovative screening testing that has been successfully applied to the COVID-19 outbreak in South Korea. Although the efficacy of the methods should be further clarified, we believe that our experience with a successful implementation of these tests for COVID-19 may apply to other countries.