First Do No Harm: Moving Beyond Universal Preprocedural Testing for COVID-19

Abstract

Pre-procedural testing for SARS-CoV-2 was introduced early in the pandemic in an effort to protect healthcare workers, direct appropriate use of personal protective equipment (PPE), and improve patient outcomes. In light of our appreciation for the efficacy of PPE and the nuances associated with interpretation of polymerase chain reaction (PCR) testing for SARS-CoV-2, particularly as community transmission decreases, we call for a re-evaluation of universal pre-procedural testing. We propose a transition to a patient-centered approach, focusing on testing patients whose outcomes would be improved by a delayed procedure in the event of a positive test and a greater reliance on appropriate PPE rather than pre-procedural test results. We recommend that a community infection rate threshold be set at which point pre-procedural testing is discontinued, understanding that there is an inflection point at which testing downsides outweigh the benefits.

Coronavirus disease 2019 (COVID-19) universal admission screening in patients and companions in Taiwan from May 2021 to June 2022: A nationwide multicenter study

“…11,13,16 Nevertheless, concerns about the potential drawbacks of universal admission screening remain, such as unnecessary isolation of individuals with false-positive test results and delay of necessary treatment for cases. 7,11,[14][15][16][17] Therefore, in the era of vaccination, it is debatable whether universal admission screening is still necessary, especially in areas with a low community prevalence of SARS-CoV-2. 5,7,10,11,17,22 All positivity rates of the periods observed during this study were less than the prevalence threshold of 10% recommended by international academic associations for the implementation of universal testing for asymptomatic hospitalized patients.…”

“…7,11,[14][15][16][17] Therefore, in the era of vaccination, it is debatable whether universal admission screening is still necessary, especially in areas with a low community prevalence of SARS-CoV-2. 5,7,10,11,17,22 All positivity rates of the periods observed during this study were less than the prevalence threshold of 10% recommended by international academic associations for the implementation of universal testing for asymptomatic hospitalized patients. 7,11 Although several studies supported universal admission screening, none of these were based on the intervention with cost and effectiveness assessments.…”

“…3,5,[13][14][15] Moreover, the potential benefits of universal admission screening should be balanced with the unintended harmful consequences to patients, such as the risk of delaying appropriate treatments or incurring unnecessary isolation due to false-positive results or lingering positivity from a past infection. 7,11,[15][16][17] Hence, whether universal admission screening is justified remains controversial in areas with a low prevalence of COVID-19, where the positive detection rate is relatively low, and the cost-effectiveness is unclear. 3,5,10,15,16 Since the global COVID-19 pandemic, Taiwan has experienced 2 waves of widespread COVID-19 circulation in the community as of June 2022.…”

Finding the off-ramp: Rethinking severe acute respiratory coronavirus virus 2 (SARS-CoV-2) preoperative screening

“…Placing additional barriers to treatment in the form of complicated testing protocols is a detriment to both individual and public health. Therefore, [7] the primary goal of preprocedural testing should be reducing harm by identifying infection in patients likely to suffer poor outcomes were they to undergo a procedure in the setting of unrecognized COVID-19 infection. In light of the effectiveness of COVID-19 vaccines at preventing severe disease, it is important that vaccination status be included in decisions regarding pre-procedural testing.…”

“…Therefore, the primary goal of preprocedural testing should be reducing harm by identifying infection in patients likely to suffer poor outcomes were they to undergo a procedure in the setting of unrecognized COVID-19 infection. 7 In light of the effectiveness of COVID-19 vaccines at preventing severe disease, it is important that vaccination status be included in decisions regarding preprocedural testing. Emergence of novel variants with immune evading capacity should always prompt reconsideration of these protocols, particularly if they impact the efficacy of vaccines against severe disease.…”