Letter to the editor: ‘Implementation of facemask sampling for the detection of infectious individuals with SARS-CoV-2 in high stakes clinical examinations – a feasibility study’

Abstract

This is a discussion on implementation of facemask sampling for the detection of infectious individuals with SARS-CoV-2 in high-stakes clinical examinations. Important concerns on diagnostic accuracy and reliability are raised.

Dear Editor,

We would like to comment on the publication on ‘Implementation of facemask sampling for the detection of infectious individuals with SARS-CoV-2 in high stakes clinical examinations – a feasibility study’.¹ This work presents a novel method for detecting SARS-CoV-2 transmission by face mask sampling (FMS) in a PACES simulation. Nonetheless, there are still concerns about the effectiveness and consistency of FMS as a diagnostic technique. The focus of the work by Pan et al is primarily on the acceptability and feasibility of implementing this method.¹ However, it is equally important to address the issues on diagnostic procedure and quality control, since it can impact the results and their further interpretation. Although the identification of one person as infected with SARS-CoV-2 using traditional upper respiratory tract sampling (URTS) is noteworthy, questions are raised regarding the sensitivity (the ability of the test to detect infected individuals) and specificity (ability of the test to correctly identify non-infected individuals) of this method due to the absence of viral RNA detection with face mask sample. The authors ought to talk about the apparent differences between the FMS and URTS results as well as potential reasons for the FMS results’ unfavorable outcomes. Investigating whether elements like the mask’s design, the type of sample collected (viral particles in exhaled air versus droplets), or the time elapsed since infection could provide valuable insights into the variability of the outcomes.

An important issue that requires further clarification is how the participants perceived the FMS procedure. The fact that participants expressed satisfaction with the ease of use, effort, ethics and communication is heartening, but the belief that a positive FMS result alone is insufficient for a definitive diagnosis raised concerns about the diagnostic validity of the test. In subsequent research, the authors should provide more detailed guidance on how to address these concerns. This could include developing clearer diagnostic criteria for FMS or creating a validated algorithm that compares FMS performance with other established diagnostic techniques, such as traditional URTS to establish its role in a multi-modal diagnostic strategy. Moreover, 69% of participants indicated that confirmatory testing was necessary. These results emphasise the significance of developing a standard diagnostic approach that may use FMS as a supplement to existing testing techniques rather than their replacement.

The results suggest that mask sampling (MS) should be considered with recently identified viral load dynamics when devising future tactics. This may provide more detailed information about how the virus spreads. In particular, analysing the relationship between exhaled viral loads from MS and both symptomatic individuals could provide valuable information that enhances public health interventions and policies. Indeed, in a previous study by Zhou et al,² the use of MS to assess viral emissions was studies and the applicability of the FMS was already confirmed. However, important issues related to diagnostic reliability and accuracy remain the context of laboratory medicine.

Examining the relationship between exhaled viral loads from MS and symptomatic and asymptomatic infected individuals may provide important information that improves public health interventions and policies. Ultimately, despite the promising results of the initial study, adopting and applying MS in the management of infectious diseases such as COVID-19 will require building a solid foundation for the technique’s diagnostic reliability.

The findings indicate that while thinking about future strategies, MS should be investigated in conjunction with newly discovered viral load dynamics. This could offer more thorough insights into the virus’s dissemination. Analysing the correlation between mask-sampled exhaled viral loads and symptomatic and asymptomatic infected persons may yield valuable insights that could enhance public health interventions and policy. Overall, even with the early study’s encouraging findings, adopting and utilising MS in the treatment of infectious disorders like COVID-19 will depend on developing a strong framework regarding the diagnostic reliability of the technique.

CRediT authorship contribution statement

Hinpetch Daungsupawong: Writing – review & editing, Writing – original draft, Visualization, Validation, Conceptualization. Viroj Wiwanitkit: Visualization, Validation, Supervision, Conceptualization.

Declaration of competing interest

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.