Epidemiologists and public health officials argue for the necessity and availability of accurate and rapid tests for the novel coronavirus, SARS-CoV-2. However, the roles and usefulness of different testing modalities are often confused.
As testing plays a crucial role in the fight to bring COVID-19 disease under control, it is important to understand and be able to appropriately interpret the results from the different types of tests currently available. This is also highly relevant for insurers as the frequency with which these test results will be encountered during the underwriting or claims processes will certainly increase.
Currently, there are two main categories of tests for SARS-CoV-2:
- Viral tests
- Reverse transcription – polymerase chain reaction (RT-PCR)
- Antigen tests
- Serology or antibody tests
The following table provides a basic overview of each.
Oral and/or nasal swab samples
Oral and/or nasal swab samples
Basis of test
Looks for the virus' genetic material.
Looks for specific proteins on the virus' surface.
Looks for the presence of antibodies to COVID-19 in the blood.
A positive result indicates current infection with the virus. While the test can remain positive for a time after a patient has recovered, it will eventually become negative.
A positive result indicates current infection with the virus.
A positive result indicates that a person has had prior exposure to the virus and has generated an immune response to it. It is not yet proven that the antibodies provide protection from future reinfection with the virus.
These tests are generally considered very good and are viewed as the "gold standard" test for current or acute infection. However, a single negative result should not be considered a “rule out” in patients with strongly suggestive symptoms.
Antigen tests produce results more quickly but may be less sensitive. Thus, they are not yet routinely used.
There are some concerns about "false positives," when patients might be told, incorrectly, that they have previously been exposed to the virus. The test accuracy is improving and false positives should become less of a concern.
Some countries are now embarking on broad-based, community serological or antibody testing programs in order to determine what percentage of the population has already been infected by SARS-CoV-2. The tests being used vary in sensitivity and specificity and based on the actual positive prevalence in the population, the positive and negative predictive value of the results will vary.
For insurers, it is critical to appreciate the distinctions between the various types of COVID-19 testing currently available and to understand the meaning of results. As the availability of these tests grows, insurers seem likely to encounter increasing volumes of test results during the underwriting and claims process.
RGA's Global Underwriting Manual reflects our deepening understanding of COVID-19 data and the unique challenges this pandemic presents to insurers. The manual features a dedicated COVID-19 section with comprehensive and expanded underwriting guidance, including for applicants who have contracted the infection and those who have recovered. As broad-based community testing could potentially lead to many more insurance applicants disclosing a positive or negative COVID-19 test result, this addition becomes particularly important. The manual also features important underwriting guidance around travel and an additional questionnaire regarding applicants who have contracted the virus.