Coronavirus Disease 2019 Serial Testing Among Hospitalized Patients in a Midwest Tertiary Medical Center, July–September 2020

Abstract

We implemented serial COVID-19 testing for inpatients with a negative test on admission. The conversion rate (negative to positive) on repeat testing was one percent. We identified patients during their incubation period and hospital-onset cases, rapidly isolated them, and potentially reduced exposures. Serial testing and infectiousness determination were resource intensive.

A SARS-CoV-2 Cluster in an Acute Care Hospital

“…Viral loads and contagiousness tend to be highest early in infection, immediately before and after symptom onset ( 10–12 ). Patients incubating infection on admission may therefore pose a particularly high threat of causing nosocomial infections as they evolve into acute disease after admission ( 13 ). By contrast, most patients admitted to the hospital with confirmed COVID-19 have already been symptomatic for several days and may therefore be at a less contagious phase of the disease ( 14 , 15 ).…”

Serial surveillance for SARS-CoV-2 in hospitalized antepartum women

“…Serial SARS-CoV-2 testing was performed every 5 days in 4580 hospitalized patients in a large tertiary care center, and 96.9% had negative results. 3 Only 1% converted from a negative to a positive test during admission. We plan to continue to test all admitted pregnant women for SARS-CoV-2 and to perform a second test on hospital day 5, in case a patient is admitted during the incubation period for SARS-CoV-2.…”

Molecular epidemiology of large coronavirus disease 2019 (COVID-19) clusters before and after the implementation of routine serial testing at an academic medical center in Iowa, 2020

“…Serial SARS-CoV-2 testing is known to be effective in identifying hospital-associated COVID-19 early or detecting COVID-19 that might have been in the incubation period upon admission screening. 3 In addition, when COVID-19 outbreaks occur, serial testing of patients and HCP (until no new cases are detected after 14 days), can be used to control outbreaks. 7 However, data assessing the impact of serial testing on prevention or reduction of COVID-19 clusters are limited.…”

“…Patient admission screening (nasopharyngeal RT-PCR) was started in May 2020 and serial testing for all inpatients (RT-PCR every 5 days) in July 2020. 3 Nasopharyngeal swab specimens were retrieved for whole-genome sequencing (WGS). WGS was performed using a MinION sequencer from Oxford Nanopore Technology and protocols from the ARTIC network.…”

“…Undetected cases during hospital admission may contribute to nosocomial transmission and outbreaks. 2,3 Investigating hospital COVID-19 outbreaks is challenging because of the multitude of patient interactions and the high incidence in the community. Viral genome sequencing data can help discern healthcare-associated from community-associated infections.…”