Challenges around current implementation of two novel diagnostic tools for SARS-CoV-2 virus, to determine the timing of de-isolation of COVID-19 patients in the ICU

Introduction/objective: With the CoLab score and/or the viability polymerase chain reaction (v-PCR) test, one can
determine sooner than currently possible when a COVID-19 patient can be de-isolated. The CoLab score detects
host response (blood), v-PCR test intact SARS-CoV-2 particles (nasopharyngeal swab). We investigated a potential implementation of these tests in the ICU.
Design/setting: Based on interviews in two Dutch hospitals, a FRAM model was built to visualize the process of
clinical use of both tests. MIDI questionnaire (implementation), and mini-HTA tool (effects/costs) served as
research framework.
Results: Work processes fit well within the current care (ICU, laboratories, IT). Correct determination of blood
parameters and representativeness of the swab are crucial. Optimal interdisciplinary collaboration, knowledge of
benefits of timely de-isolation, and validity are relevant for implementation. De-isolation improves ICU workflow
and quality of care. Expected gains are fewer days in isolation and cost savings from reduced use of disposable
protective material. Healthcare staff welcomes the potential of these tests. However, constantly changing conditions due to virus mutations, emergence of other viruses (not present at the beginning of the pandemic when
the tests were validated), relatively quick changes in patient types and numbers of ICU hospitalized patients
during a pandemic, impact test validity and the need for implementation.