Table 1.

Prioritized PICO questions across the four IDSA diagnostic guidelines

Questions addressed in the first IDSA COVID-19 molecular diagnosis guideline
In symptomatic individuals suspected of COVID-19 •In symptomatic individuals in the community suspected of having COVID-19, should testing vs. no testing be done to guide decisions about isolation and contact tracing? •In symptomatic individuals suspected of having COVID-19, is the use of rapid vs. laboratory-based testing (different Emergency Use Authorization approved NAATs) affect the diagnostic accuracy of the test? •In symptomatic individuals suspected of having COVID-19, should one test vs. repeated testing be done to guide decisions about isolation and going back to work? •In symptomatic individuals with URTI or ILI suspected of having COVID-19, should noninvasive specimens be collected by health care providers vs. patients? (will collection by HCP vs patients affect the diagnostic accuracy of the test)? •In symptomatic individuals with URTI or ILI suspected of having COVID-19, which of the following specimen types (nasal vs. mid turbinate vs. oral vs. NP vs. combo) should be used to diagnose COVID-19? (will specimen type affect the diagnostic accuracy of the test)? •In symptomatic individuals with LRTI suspected of having COVID-19, which of the different specimen types (upper vs. lower sampling) should be used? (will specimen type [upper vs. lower sampling] affect the diagnostic accuracy of the test?) In asymptomatic individuals exposed or not exposed •In asymptomatic individuals who have been exposed to COVID-19, should testing vs. no testing be done to diagnose COVID-19 (to guide decisions about quarantine and contact tracing)? •In asymptomatic individuals, should testing vs. no testing be done on admission to the hospital to diagnose COVID-19 (to guide decisions about quarantine and contact tracing)? •In asymptomatic individuals, should testing vs. no testing be done before aerosol-generating surgeries or procedures to diagnose COVID-19 and inform PPE use? •In asymptomatic individuals, should testing vs no testing be done before immunosuppressive procedures, such as solid or stem cell transplantation or cytotoxic chemotherapy to diagnose COVID-19 and inform candidacy?
Questions addressed in the IDSA COVID-19 molecular diagnosis guideline update
•In symptomatic individuals suspected of having COVID-19, can specimen types other than a nasopharyngeal swab (i.e. anterior nasal vs. mid turbinate vs. oropharyngeal vs. saliva vs. a combination) be used to diagnose COVID-19? (will specimen type affect the diagnostic accuracy of the test relative to an NP swab)? •In symptomatic individuals suspected of having COVID-19, does the use of rapid vs. standard laboratory-based tests affect the diagnostic accuracy of the test? •In asymptomatic individuals with cancer or autoimmune disease, should testing vs. no testing be done before immunosuppressive procedures to inform management?
Questions addressed in the IDSA COVID-19 antigen diagnosis guideline
•In symptomatic individuals suspected of having COVID-19, should standard NAAT vs. rapid antigen tests? •In asymptomatic individuals with a risk of exposure to COVID-19, should a single antigen test be used vs. a single standard NAAT? •In asymptomatic individuals with a risk of exposure to COVID-19, should a single standard NAAT be used vs. two consecutive rapid antigen tests? •In asymptomatic individuals with a risk of exposure to COVID-19, should single rapid antigen testing be used vs. no testing? •In asymptomatic individuals with a risk of exposure to COVID-19, should repeat rapid antigen testing be used vs. no testing?
Questions addressed in the IDSA COVID-19 serology diagnosis guideline
•Should IgM vs. IgA vs. IgG vs. a combination be used for SARS-CoV-2 serologic testing? (Outcomes: determining past infection, Mortality, Hospitalization length of Stay, ICU length of Stay, ARDS, Survival) •Should NAAT alone vs. NAAT plus serology (when initial NAAT is negative) be used to diagnose COVID-19 in symptomatic patients? (Outcomes: Determining current or past infection, Mortality, Hospitalization length of Stay, ICU length of Stay, ARDS, Survival) •Should serologic testing vs. no testing be performed to detect past or current COVID-19 infection in patients presenting with symptoms consisting of Pediatric inflammatory multi-system syndrome (PIMS)? •Should rapid serology (capillary blood) vs. standard serology (venous blood) be used to detect SARS-CoV-2 antibodies? (Outcomes: Determining current or past infection, Mortality, Hospitalization length of Stay, ICU length of Stay, ARDS, Survival)

IDSA, Infectious Disease Society of America; NAAT, Nucleic Acid Amplification Test.

URTI, Upper respiratory infection, HCP, Healthcare provider, ILI, influenza-like illness, ARDS, acute respiratory distress syndrome, LRTI, lower respiratory tract infection, ICU, intensive care unit, PPE, personal protective equipment, NP nasopharyngeal.