Pre-Procedural COVID Testing: The “New Normal”

Bronchoscopy in the COVID-19 Era

“… 7 , 20 , 21 Debate remains on the balance of this resource use versus questionnaire screening, especially in areas where there is low prevalence and likely lower yield in testing. 22 – 24 Ultimately, the decision to implement pre-procedural COVID-19 testing should take testing capability, availability, and regional disease prevalence into consideration. Regardless, precautions should be taken to minimize transmission even with testing given the false negativity rate with testing.…”

Reply

“…As concluded by Kidambi et al, 1 the implications of even 1 positive patient in the endoscopy unit could result in catastrophic consequences. Despite the overwhelming rise in positive COVID-19 cases in our community, we continued to perform elective and semi-elective endoscopic procedures in a manner that proved safe both for patients and staff using our continued approach of pre-procedure screening questionnaires and PCR testing in addition to physical distancing, full barrier personal protective equipment, and hand hygiene.…”

“…We thank Kidambi et al 1 for their interest in and insightful feedback regarding our work “Yield and Implications of Pre-Procedural COVID-19 PCR Testing on Routine Endoscopic Practice.” 2 Resumption of elective endoscopy in the coronavirus disease 2019 (COVID-19) era has been challenging due to a lack of evidence-based guidance; conflicting levels of input from federal, state, and local governments; and widely variable COVID-19 prevalence rates by region. We previously reported our experience using a routine pre-procedure COVID-19 testing strategy for maintaining the safety of patients and staff.…”

“…Our findings were particularly important for practices at an early stage in the pandemic, when resources such as PCR tests and personal protective equipment were limited. As highlighted by Kidambi et al, 1 there is a well-documented potential for asymptomatic spread of COVID-19; however, multiple studies of pre-procedure PCR COVID-19 testing have now demonstrated that asymptomatic carriers are rare in low prevalence areas. 1 , 2 , 3 In addition, PCR testing results may vary based on disease prevalence, prompting recent guidelines by the American Gastroenterology Association recommending against a pre-procedure testing strategy in low- or high-prevalence areas due to high false-positive or false-negative rates, respectively.…”

Pragmatic Return to Effective Dental Infection Control through Triage and Testing (PREDICT): A feasibility study to improve dental office safety

“…(21) Hospitals and medical o ces quickly incorporated these testing technologies into their practice work ows to increase safety and minimize in-o ce disease transmission for staff and patients. (22)(23)(24) Dental practices, however, were slow to adopt this mitigation strategy (25) , despite the nature of dental procedures, many being aerosol generating using of high-speed handpieces and ultrasonic scalers, compounding the potential risk of SARS-CoV-2 transmission within the dental o ce. (26)(27)(28)(29)(30)(31)(32) When a virus with high morbidity and/or mortality is widely circulating within a community, testing is a key mitigation strategy that should be considered within dental practice to help prevent in-o ce transmission.…”