Analysis of COVID-19-Related RT-qPCR Test Results in Hungary: Epidemiology, Diagnostics, and Clinical Outcome

Abstract

Background: Effective testing is an essential tool for controlling COVID-19. We aimed to analyse the data from first-wave PCR test results in Hungary's Southern Transdanubian region to improve testing strategies. Methods: We performed a retrospective analysis of all suspected COVID-19 cases between 17 March and 8 May 2020, collecting epidemiological, demographic, clinical and outcome data (ICU admission and mortality) with RT-qPCR test results. Descriptive and comparative statistical analyses were conducted. Results: Eighty-six infections were confirmed among 3,657 tested patients. There was no difference between the positive and negative cases in age and sex distribution; however, ICU admission (8.1 vs. 3.1%, p = 0.006) and in-hospital mortality (4.7 vs. 1.6%, p = 0.062) were more frequent among positive cases. Importantly, none of the initially asymptomatic patients (n = 20) required ICU admission, and all survived. In almost all cases, if the first test was negative, second and third tests were performed with a 48-h delay for careful monitoring of disease development. However, the positive hit rate decreased dramatically with the second and third tests compared to the first (0.3 vs. 2.1%, OR = 0.155 [0.053-0.350]). Higher E-gene copy numbers were associated with a longer period of PCR positivity. Conclusion: In our immunologically naïve suspected COVID-19 population, coronavirus infection increased the need for intensive care and mortality by 3-4 times. In the event of the exponential phase of the pandemic involving a bottleneck in testing capacity, a second or third test should be reconsidered to diagnose more coronavirus infections.

Keywords: COVID-19; PCR diagnostics; SARS-CoV-2; epidemiology; surveillance; testing.

Figure 1

Age and sex distribution of the study population during the observation period.

Figure 2

Incident cases representing the dynamics of the pandemic spreading in 5-day intervals. (A) Hungary and (B) south-western Hungary.

Figure 3

Epidemiology and clinical outcome of the study population and comparison of negative and positive cases confirmed by polymerase chain reaction (PCR). SYMP, symptoms; SD, standard deviation; ICU, intensive care unit; Mort, mortality.

Figure 4

Links between polymerase chain reaction (PCR) positivity with first and subsequent testing and viral excretion among the (A) general population and (B) health care providers.