On the sensitivity and specificity of postmortem upper respiratory tract testing for SARS-CoV-2

Jennifer A. Hall*, Ross J. Harris, Hannah E. Emmett, Belinda Lowe, Anika Singanayagam, Katherine A. Twohig, Asad Zaidi, Meaghan Kall, Maria Zambon, Gavin Dabrera

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

Abstract

Background: Postmortem testing can improve our understanding of the impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) if sufficiently sensitive and specific. 

Methods: We investigated the postmortem sensitivity and specificity of reverse transcriptase polymerase chain reaction (PCR) testing on upper respiratory swabs using a dataset of everyone tested for SARS-CoV-2 before and after death in England, 1 March to 29 October 2020. We analyzed sensitivity in those with a positive test before death by time to postmortem test. We developed a multivariate model and conducted time-to-negativity survival analysis. For specificity, we analyzed those with a negative test in the week before death. 

Results: Postmortem testing within a week after death had a sensitivity of 96.8% if the person had tested positive within a week before death. There was no effect of age, sex, or specimen type on sensitivity, but individuals with coronavirus disease 2019 (COVID-19)-related codes on their death certificate were 5.65 times more likely to test positive after death (95% confidence interval, 2.31-13.9). Specificity was 94.2%, increasing to 97.5% in individuals without COVID-19 on the death certificate. 

Conclusion: Postmortem testing has high sensitivity (96.8%) and specificity (94.2%) if performed within a week after death and could be a useful diagnostic tool.

Original languageEnglish
Pages (from-to)389-394
Number of pages6
JournalJournal of Infectious Diseases
Volume224
Issue number3
Early online date17 May 2021
DOIs
Publication statusPublished - 1 Aug 2021

Bibliographical note

Funding Information: This work was supported by Public Health England and undertaken as part of the core functions of Public Health England in relation to the surveillance of communicable diseases and outbreak response.

Open Access: Free to read, but no Open Access licence.

Publisher Copyright: © Crown copyright 2021. This article contains public sector information licensed under the Open Government Licence v3.0 (http://www.nationalarchives.gov.uk/doc/open-government-licence/version/3/).

Citation: Jennifer A Hall, Ross J Harris, Hannah E Emmett, Belinda Lowe, Anika Singanayagam, Katherine A Twohig, Asad Zaidi, Meaghan Kall, Maria Zambon, Gavin Dabrera, On the Sensitivity and Specificity of Postmortem Upper Respiratory Tract Testing for SARS-CoV-2, The Journal of Infectious Diseases, Volume 224, Issue 3, 1 August 2021, Pages 389–394,

DOI: https://doi.org/10.1093/infdis/jiab270

Keywords

  • COVID-19
  • SARS-CoV-2
  • post mortem
  • sensitivity
  • specificity

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