Commentary: The Many Faces of COVID-19 at a Glance: A University Hospital Multidisciplinary Account From Milan, Italy

We thank Priori et al. for their case study reporting the clinical, pathological, and radiological findings they observed in COVID-19 patients at their teaching hospital in Milan, Italy (1). The authors stated that chest CT has low specificity for COVID-19 infection in suspected patients and therefore cannot distinguish SARS-CoV2 infection from other respiratory diseases (1). This conclusion is based on the first version of a “Living” Cochrane Systematic Review on the diagnostic accuracy of imaging tests for COVID-19, published in September 2020, which identified that chest CT had a specificity of 18.1% [95% confidence interval (95% CI) 3.71–55.8] and sensitivity of 86.2% (95% CI 71.9–93.8) (2).

The “Living” Systematic Review strives to stay updated as new evidence emerges in this continuously evolving field of research. The second version of this review was published in November 2020 (3), and the third, most recent version, was published in March 2021 (4). In the latest version, the specificity of chest CT was 80.0% (95% CI 74.9–84.3) and the sensitivity was 87.9% (95% CI 84.6–90.6); the pooled estimates were drawn from 41 studies and 16,133 participants (4). The substantial rise in specificity can be possibly explained by the use of scoring systems (such as CO-RADS), which provide better definitions for index test positivity. Another explanation may be higher quality studies emerging later in the pandemic, benefitting from improved knowledge about COVID-19 (3). Additionally, the latest version includes an evaluation of the diagnostic accuracy of X-ray and ultrasound in COVID-19 infection (4). Our hope is that authors continue to prioritize transparent reporting and methodological rigor in future studies. The team conducting this Cochrane review will continuously aim to provide the most up to date evidence on the diagnostic accuracy of these imaging modalities.

Statements

Summary

Keywords

COVID-19, diagnostic accuracy, chest CT, evidence-based medicine, living systematic review

Citation

Al Khalil A, Absi M, Islam N, Ebrahimzadeh S and McInnes MDF (2021) Commentary: The Many Faces of COVID-19 at a Glance: A University Hospital Multidisciplinary Account From Milan, Italy. Front. Public Health 9:748263. doi: 10.3389/fpubh.2021.748263

Received

27 July 2021

Accepted

19 August 2021

Published

14 September 2021

Volume

9 - 2021

Edited by

Amer Harky, Liverpool Heart and Chest Hospital, United Kingdom

Reviewed by

Amr Ashry, Assiut University, Egypt

Updates

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Copyright

© 2021 Al Khalil, Absi, Islam, Ebrahimzadeh and McInnes.

This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

*Correspondence: Matthew D. F. McInnes mmcinnes@toh.ca

This article was submitted to Infectious Diseases - Surveillance, Prevention and Treatment, a section of the journal Frontiers in Public Health

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