新冠肺炎疫情從亞洲和歐洲國家,現在也蔓延到了美國,然而,由於美國疾病管制與預防中心(CDC)初期不開放其他實驗室進行新型冠狀病毒(COVID-19)的檢測,導致檢測不足而錯失了有效控制疫情的黃金時間,公衛學界及醫界須面對此緊急狀況,並調整相關防疫措施,才能儘早確診病例、儘早治療,來避免新冠肺炎疫情在美國的持續惡化。

(財團法人國家衛生研究院 蔡慧如博士摘要整理)

Controversies over diagnostic testing have dominated US headlines about severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the novel coronavirus responsible for coronavirus disease 2019 (COVID-19). Technical challenges with the first test developed by the Centers for Disease Control and Prevention (CDC) left the nation with minimal diagnostic capacity during the first few weeks of the epidemic. The CDC also initially limited access to testing to a narrow group of individuals with known exposure. The delayed discovery of a case of COVID-19 in California, followed quickly by evidence of community transmission in multiple states, revealed the shortcomings of this strategy. In the early stages, COVID-19 has spread beyond the nation’s ability to detect it.

On February 29, the US Food and Drug Administration (FDA) moved to expand testing capacity by eliminating a requirement that advanced laboratories obtain prior FDA authorization before using their own, laboratory-developed tests.1 Then, on March 3, Vice President Pence announced the removal of all federal limits on testing, stating that “subject to doctors’ orders, any American can be tested.” These steps left many with questions about what had happened with testing and what should happen next.

Unraveling this situation requires understanding how the regulatory structure for diagnostic tests interacts with public health emergencies. It also involves appreciating the distinction between testing capacity for public health surveillance and clinical care. While the public may want extensive testing, the usefulness of testing is greater in some scenarios than others. It is important to balance 2 concepts: remedying testing gaps is imperative, yet more testing is not always better.

Author:Joshua M. Sharfstein, Scott J. Becker, Michelle M. Mello, et al.
原文連結:https://jamanetwork.com/journals/jama/fullarticle/2762951