Introduction
On December 31, 2019, news released from the city of Wuhan in China, alerted of an outbreak of cases of an unknown type of viral pneumonia, later identified as a novel coronavirus and given the name of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). The World Health Organization (WHO) declared SARS-CoV-2 a public health emergency of international concern on January 30, 2020 and a global pandemic on March 11. Shortly thereafter, the European region was officially pronounced one of the epicentres of the pandemic, amounting a death toll of 701,991 by January 28, 2021 [1].
The burden imposed by the SARS-CoV-2 pandemic has directly and indirectly permeated all sectors of society, with diverse types or degrees of impact experienced among countries of varying income levels [2,3]. Morbidity and mortality rates have been especially elevated among the high-risk and vulnerable populations [4-6], with Europe being the world region at highest risk due the elevated percentage of people living with underlying health conditions [7]. Furthermore, socio-economic disparities may put segments of the population at higher risk [8-11].
In the absence of effective treatments or universal access to vaccines, alternatives used to suppress the virus transmission included public health measures such as nationwide lockdowns. Although strict non-pharmaceutical measures have been effective in controlling the spread of the virus [12], they are not viable long-term solutions given their negative socio-economic consequences, such as the loss on Gross Domestic Product (GDP) and development of human capital due to the disruption of economic and educational activities, respectively [13-15]. In this context, a key prevention and containment strategy is the detection of SARS-CoV-2 infection through various types of tests that can support important aspects like diagnosis, case management, and tracking the spread of the virus.
Among the proposed tests for SARS-CoV-2, there are two main types of approaches. The first is based on a reverse transcriptase-polymerase chain reaction (RT-PCR), a molecular-based test method usually employed to detect an active pathogen in the body. The second is a serology test, based on an antibody/antigen reaction, which detects a body’s humoral immune responses to a current and/or prior infection. This type of test shows that the body has produced antibodies following the exposure to the virus and can help to confirm prior infections even after the immune system has eliminated the virus.
Currently, there is no clear guidance supporting the use, value, benefits, and impact of serology testing as part of a comprehensive SARS-CoV-2 detecting strategy. The lack of clarity on policies and guidelines regarding the role of serology testing on decisions related to restriction measures may have serious implications on the efforts to curb the pandemic. Departing from a sound bibliographic review, this paper aims to provide an expert and community consensus on the effective use of serology testing as a method to respond to and mitigate the impact of the pandemic. Ultimately, the recommendations herein intend to enable the implementation of SARS-CoV-2 serology testing to support mitigation strategies at the regional, national, and local levels to build community awareness, and to guide advocacy strategies.