Preprocedural SARS-CoV-2 Testing to Sustain Medically Needed Health Care Delivery During the COVID-19 Pandemic: A Prospective Observational Study

Abstract

Background We implemented a pre-procedural SARS-CoV-2 screening initiative designed to sustain healthcare during a time when the extent of SARS-CoV-2 infection was unknown. Methods Prospective study of patients undergoing procedures at 3 academic hospitals in Pittsburgh, PA (April 21-June 11) and 19 community hospitals across Middle/Western Pennsylvania and Southwestern New York (May 1-June 11). Patients at academic hospitals underwent symptom screening ≤7 days pre-procedure, then SARS-CoV-2 nasopharyngeal PCR testing 1-4 days pre-procedure. A subset also underwent day-of-procedure testing. Community hospital patients underwent testing per local protocols. We report SARS-CoV-2 PCR-positivity rates, impact, and barriers to testing encountered through June 11. PCR-positivity rates of optional pre-procedural SARS-CoV-2 testing for two consecutive periods following the screening initiative are also reported. Results Of 5881 eligible academic hospitals patients, 2415 (41.1%) were tested (April 21-June 11). Lack of interest, distance, self-isolation, and nursing home/incarceration status were barriers. There were 11 PCR-positive patients (10 asymptomatic) among 10,539 patients tested (0.10%, 95% CI 0.05-0.19): 3/2,415 (0.12%, 95% CI 0.02-0.36) and 8/8,124 (0.10%, 95 CI% 0.04-0.19) at academic and community hospitals, respectively. Procedures were performed as scheduled in 40% (4/10) of asymptomatic PCR-positive patients. Positivity increased during subsequent COVID-19 surges: 54/34,948 (0.15%, 95% CI 0.12–0.20) and 101/24,741 (0.41%, 95% CI 0.33–0.50) PCR-positive patients between June 12-September 10 and September 11–December 15, respectively (p<0.0001). Conclusions Implementing pre-procedural PCR testing was complex and revealed low infection rates (0.24% overall), which increased during COVID-19 surges. Additional studies are needed to define the COVID-19 prevalence threshold at which universal pre-procedural screening is warranted.

Occurrence and transmission potential of asymptomatic and presymptomatic SARS-CoV-2 infections: update of a living systematic review and meta-analysis

“…Amongst all 130 included studies, 88 studies used more than one method of follow-up to ascertain asymptomatic status (Table 1, S2 Table). Only 22 of 130 studies reported the median or mean age [38,47,70,76,77,83,85,95,99,119-121,124,126,128,133,134,139,143,146,152,164] and only five studies included children only [65,67,110,115,118]. Only 31 studies reported the sex of people with asymptomatic SARS-CoV-2 (Table 1, S2 Table) [38,47,51,53,70,71,75,76,83,85,95,99,107,119-122,124,126,128,133,134,139,143,146,147,150,153,158,162,164].…”

“…Only 22 of 130 studies reported the median or mean age [38,47,70,76,77,83,85,95,99,119-121,124,126,128,133,134,139,143,146,152,164] and only five studies included children only [65,67,110,115,118]. Only 31 studies reported the sex of people with asymptomatic SARS-CoV-2 (Table 1, S2 Table) [38,47,51,53,70,71,75,76,83,85,95,99,107,119-122,124,126,128,133,134,139,143,146,147,150,153,158,162,164]. The types of included studies changed across the five versions of the review.…”

Infection Prevention during the Coronavirus Disease 2019 Pandemic

“…In one study, approximately half of patients either declined pre-procedural testing or could not be reached to arrange testing; barriers identified included lack of interest in testing, distance from testing facility, transport issues, and the patient's perception of not being at risk for COVID-19. 99 Positive pre-procedural SARS-CoV-2 testing was associated with delaying of the procedure by 29 days on average, with no COVID-19–related complications identified in any of the patients whether or not their procedure was delayed. 101 Utility of a risk screening questionnaire to identify patients with positive pre-procedural SARS-CoV-2 testing remains unclear; in one study of 1000 patients undergoing endoscopy the negative predictive value of a validated risk screening questionnaire was 99.4%; however, the positive predictive value was only 2.5%.…”

AGA Rapid Review and Guideline for SARS-CoV2 Testing and Endoscopy Post-Vaccination: 2021 Update

“…We found 13 studies that reported on asymptomatic SARS-CoV2 among patients referred for endoscopic procedures who underwent testing. [8][9][10][11][12][13][14][15][16][17][18][19] Across these 13 studies, asymptomatic prevalence ranged from 0.0% to 1.5%, but most studies reported a range from 0% to 0.5% regardless of local surges of COVID-19 cases. A notable example of this is highlighted in 2 UK studies, conducted by the same authors at different time periods and surges; during the first time period from May to June 2020, when local prevalence was low, the asymptomatic prevalence was 0.11% (n ¼ 2611) and during a surge in December 2020, the asymptomatic prevalence remained low (0.37% [9 of 2449]).…”

“…The panel identified 1 study in which authors reported that 3228 of 5881 patients did not receive preprocedural/presurgical testing; 30.5% were not tested due to inability to reach the patient and the remaining patients (69.5%) declined. 13 The most common reasons for declining were lack of interest in testing (19.2%), distance from testing facility (19.0%), and perception of not being at risk due to self-isolation (9.8%). About 4.1% reported that they did not get tested due to lack of transportation and 1.1% reported fear of going to a testing center.…”