More harm than good? Potential benefits and unintended consequences associated with screening asymptomatic hospital admissions for severe acute respiratory syndrome coronavirus 2

Abstract

To the Editor-During the coronavirus disease 2019 (COVID-19) pandemic, screening of asymptomatic patients for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) at the time of healthcare facility admission has often been used in an effort to reduce the risk of nosocomial transmission. 1-3 However, the Society for Healthcare Epidemiology of America recently recommended against routine use of asymptomatic screening in healthcare facilities, including admission screening. 4 Such testing is of unclear benefit when other control measures are in place and may result in unintended adverse consequences, including delays in medical care and unnecessary isolation and treatment of noninfectious patients. 4 In Veterans' Affairs (VA) hospitals, it is recommended that all new admissions be screened for SARS-CoV-2 using a polymerase chain reaction (PCR) test. At this stage of the pandemic, PCR screening can be problematic because tests often remain positive for months after COVID-19, and undiagnosed infections are not uncommon. 1,4,5 The cycle threshold (Ct) of the PCR test can be useful in assessing whether asymptomatic patients are infectious because high Ct values, which correlate with low viral burden, suggest a remote infection. 1 In previous studies, many asymptomatic patients with positive PCR tests have been deemed noninfectious based on clinical presentation, serology, and high Ct value. 1,5 Here, we conducted a retrospective study to evaluate the potential benefits and adverse consequences associated with screening asymptomatic patients being admitted to a VA hospital.The Cleveland VA Medical Center's Research and Development Committee determined that the study was a nonresearch, qualityimprovement project not requiring approval from the institutional review board. Between September 1, 2022, and January 31, 2023, we obtained the Ct values of all patients testing positive for SARS-CoV-2 on admission except those with prior COVID-19 within 90 days. The Xpert Xpress CoV-2 plus assay (Cepheid) was used