Screening and Testing Pregnant Patients for SARS-CoV-2: First-Wave Experience of a Designated COVID-19 Hospitalization Centre in Montréal

Abstract

Objective Coronavirus Disease 2019 (COVID-19) may present asymptomatically in a large proportion of cases in endemic areas. Accordingly, universal testing has been suggested as a potential strategy for reducing transmission in the obstetrical setting. We describe the clinical characteristics of patients who tested positive for Severe Acute Respiratory Syndrome Coronavirus (SARS-CoV-2) during pregnancy at a designated COVID-19 hospitalization centre in Montreal, Quebec. Methods A single-centre retrospective cohort was constructed to include all pregnant patients who tested positive for SARS-CoV-2 between March 22 and July 31, 2020, and received care at the Jewish General Hospital. Initially, testing was restricted to at-risk patients, identified through the use of a screening questionnaire. Beginning on May 15, 2020, universal testing was implemented, and all pregnant patients admitted to hospital were tested. Data were collected through chart review. Results Of 803 patients tested for SARS-CoV-2 during the study period, 41 (5%) tested positive. Among those patients who were symptomatic, the most commonly reported symptoms were cough (53%), fever (37%), dyspnea (30%), and anosmia and/or ageusia (20%). Prior to the implementation of universal testing, 13% (3/24) of patients with SARS-CoV-2 were asymptomatic. Following the implementation of universal testing, 80% (8/10) of patients with SARS-CoV-2 were asymptomatic. Conclusion Our findings suggest that most pregnant patients with SARS-CoV-2 are asymptomatic or have mild symptoms of COVID-19. Particularly in endemic areas, universal testing of pregnant patients presenting to hospital should be strongly considered as an important measure to prevent in-hospital and community transmission of COVID-19.

Global Percentage of Asymptomatic SARS-CoV-2 Infections Among the Tested Population and Individuals With Confirmed COVID-19 Diagnosis

“…Of these, 282 studies underwent full-text review. Ninety-five studies with information concerning the percentage of asymptomatic infections among the tested and confirmed populations were included in the final analysis (Figure 1).…”

“…Among 95 studies, 18 were excluded because that the percentage of asymptomatic infections among the confirmed population was 100% . The remaining 77 studies were included in the meta-analysis for the percentage of asymptomatic infections among the confirmed population, covering 19 884 individuals with confirmed COVID-19, among whom 11 069 had asymptomatic infections. The pooled percentage of asymptomatic infections among the confirmed population was 40.50% (95% CI, 33.50%-47.50%), with high heterogeneity among studies ( I 2 = 99%; P < .001) (eFigure 2 in the Supplement).…”

COVID-19 Screening for Hospitalized Patients: The Role of Expanded Hospital Surveillance in a Low Prevalence Setting

“…13 However, patients with early COVID-19 or certain groups of patients, such as pregnant women, may only experience mild symptoms or could even be asymptomatic. 14,15 Chest computed tomography, which often shows bilateral patchy shadows or ground glass opacity over the peripheral lungs in COVID-19 patients, is a sensitive tool that can be helpful in the diagnosis of COVID-19 when the clinical presentation and molecular test results are conflicting. 5,6,8,16,17 However, it is not routinely used as a screening tool.…”

“…Isolation of high-risk patients is not enough to prevent nosocomial infections, and therefore universal screening for COVID-19 using a Reverse Transcription-Polymerase Chain Reaction (RT-PCR) test to detect SARS-CoV-2 remains necessary prior to hospitalization. 15,18 Nevertheless, it is important to note that negative results from screening at admission may not be used as a basis for estimating the risks of nosocomial transmission. 19 Nosocomial infections due to COVID-19 are not easy to prevent, and it remains difficult to immediately control the spread without proper intervention measures.…”

Establishing a Universal RT-PCR Testing System Is Essential for the Safe Performance of Scheduled Surgeries During the COVID-19 Pandemic in Japan: A Retrospective Study

“…All surgical departments are required to have a system in place to safely perform scheduled surgeries during the COVID-19 pandemic, not just orthopedics. Although there is little evidence regarding universal testing using reverse transcription-polymerase chain reaction (RT-PCR) for elective surgery in Japan, there are several reports from other countries [ 2 - 4 ].…”