The Appropriate Use of Testing for COVID-19

Zitek, Tony

doi:10.5811/westjem.2020.4.47370

Cited by 179 publications

(201 citation statements)

References 10 publications

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“…While the risks of donor‐derived infection and induction immunosuppression remain uncertain, our findings are reassuring, with no evidence of COVID‐19 among recipients up to 2 months posttransplant. Although negative SARS‐CoV‐2 PCR may be insufficient to definitively rule‐out COVID‐19, 18,25,26 our findings align with the societal guidelines suggesting that negative donor and recipient pretransplant tests are the minimum necessary assurance that proceeding with transplantation is safe for both recipients and providers 22,23 . While the sensitivity of SARS‐CoV‐2 PCR is significantly higher for BAL versus nasopharyngeal specimens (~90‐95% versus ~60‐80%), variable resource availability among donor hospitals may limit the safety and feasibility of performing BAL, supporting the high prevalence of nasopharyngeal tests among donors in our study 22,25,26 .…”

Section: Discussionsupporting

confidence: 75%

“…Although negative SARS‐CoV‐2 PCR may be insufficient to definitively rule‐out COVID‐19, 18,25,26 our findings align with the societal guidelines suggesting that negative donor and recipient pretransplant tests are the minimum necessary assurance that proceeding with transplantation is safe for both recipients and providers 22,23 . While the sensitivity of SARS‐CoV‐2 PCR is significantly higher for BAL versus nasopharyngeal specimens (~90‐95% versus ~60‐80%), variable resource availability among donor hospitals may limit the safety and feasibility of performing BAL, supporting the high prevalence of nasopharyngeal tests among donors in our study 22,25,26 . While chest computed tomography (CT) is highly sensitive (~97%) for detecting COVID‐19 and may help identify false‐negative nasopharyngeal tests, the specificity of CT is poor (~25%), 22,27 suggesting that routine use of CT in donor screening may result in considerable false positives, and avoidance of otherwise suitable donors.…”

Section: Discussionsupporting

confidence: 75%

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Lung transplantation during the COVID-19 pandemic: Safely navigating the new “normal”

Halpern

Olaso

Krischak

et al. 2020

American Journal of Transplantation

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In the United States, an overall national decline in organ transplants has accompanied the substantial burden of COVID‐19. Amidst significant regional variations in COVID‐19, lung transplantation (LTx) remains a critical life‐saving operation. Our LTx practice during the early pandemic may provide a blueprint for managing LTx in an era of continued community prevalence. Patients who underwent LTx at our institution between March 1 and May 20, 2020 were included. Recipient, operative, and donor characteristics were compared to those from our program in 2019, and COVID‐19 testing practices were evaluated for March, April, and May to understand how our practice adapted to the pandemic. Our program performed 36 LTx, 33% more than the same period in 2019. Recipient, operative, and donor characteristics during COVID‐19 were similar to those in 2019. By April 1, all donors and recipients underwent pretransplant COVID‐19 testing, all returning negative results. To date, no recipients have developed posttransplant COVID‐19. At our institution, pretransplant COVID‐19 testing, use of local donor lungs, and avoidance of donors from areas of increased community penetration supported a safe and effective LTx practice during the early COVID‐19 pandemic. Continued follow‐up is required to ensure the long‐term safety of these newly transplanted patients.

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Section: Discussionsupporting

confidence: 75%

Section: Discussionsupporting

confidence: 75%

Lung transplantation during the COVID-19 pandemic: Safely navigating the new “normal”

Halpern

Olaso

Krischak

et al. 2020

American Journal of Transplantation

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“…To elaborate on these key issues, RT-PCR COVID-19 testing was shown to have high specificity with moderate sensitivity, resulting in cases of false negative results [21]. Usually, these false results are a consequence of incorrect sampling [22] and could be addressed by education of health care staff.…”

Section: Discussionmentioning

confidence: 99%

Hazardous Postoperative Outcomes of Unexpected COVID‐19 Infected Patients: A Call for Global Consideration of Sampling all Asymptomatic Patients Before Surgical Treatment

et al. 2020

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Background In December 2019, a novel coronavirus was identified as the cause of many pneumonia cases in China and eventually declared as a pandemic as the virus spread globally. Few reports were published on the outcome of surgical procedures in diagnosed COVID-19 patients and even fewer on the surgical outcomes of asymptomatic undiagnosed COVID-19 surgical patients. We aimed to review all published data regarding surgical outcomes of preoperatively asymptomatic untested coronavirus disease 2019 (COVID-19) patients. Methods This report is a review on the perioperative period in COVID-19 patients who were preoperatively asymptomatic and not tested for COVID-19. Searches were conducted in PubMed April 4th, 2020. All publications, of any design, were considered for inclusion. Results Four reports were identified through our literature search, comprising 64 COVID-19 carriers, of them 51 were diagnosed only in the postoperative period. Synthesis of these reports, concerning the postoperative outcomes of patients diagnosed with COVID-19 during the perioperative period, suggested a 14/51 (27.5%) postoperative mortality rate and severe mostly pulmonic complications, as well as medical staff exposure and transmission. Conclusions COVID-19 may have potential hazardous implications on the perioperative course. Our review presents results of unacceptable mortality rate and a high rate of severe complications. These observations warrant further well-designed studies, yet we believe it is time for a global consideration of sampling all asymptomatic patients before surgical treatment.

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“…However, caution is required, and we need to consider possible confounders. Indeed, the true prevalence of SARS-CoV-2 cannot be determined with certainty, especially due to the false-negative rate of nasopharyngeal swab with RT-PCR that was reported as high as 30%, with an estimated sensitivity and speci city of 78.2% and 98.8% respectively [8].…”

Section: Resultsmentioning

confidence: 99%

Prevalence of SARS-CoV-2 Infection in the Obstetric Population at Admission: Results from a High-Volume Hospital Setting in the North of Italy

Franchi

Bosco

Barbieri

et al. 2020

Preprint

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Based on the strong recommendation of the World Health Organization to implement testing for SARS-CoV-2, at our Department of Obstetrics and Gynecology in northeast Italy we started performing universal screening in the obstetric population prior to hospitalization. All pregnant women admitted at our department were tests for SARS-CoV-2 with a nasopharyngeal swab test based on the specific SARS-CoV-2 sequences amplification with reverse transcription polymerase chain reaction (RT-PCR) assay. From April 10th to May 25th (45 days), 473 women were tested, and 2 (0.42%) out of 473 patients were found positive to SARS-CoV-2 during the first three weeks when the numbers of infection were higher and social contacts reduced. No patients reported either respiratory or gastrointestinal symptoms. After comparison with other reports, our results suggest a reduction in the prevalence of SARS-CoV-2 in the obstetric population related to both the trend over time and space of the infection spread and the effect of control measures. The identification of only asymptomatic patients appears supporting the implementation of universal screening instead of a test performed based on anamnestic information or symptoms to identify patients with SARS-CoV-2.

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The Appropriate Use of Testing for COVID-19

Cited by 179 publications

References 10 publications

Lung transplantation during the COVID-19 pandemic: Safely navigating the new “normal”

Lung transplantation during the COVID-19 pandemic: Safely navigating the new “normal”

Hazardous Postoperative Outcomes of Unexpected COVID‐19 Infected Patients: A Call for Global Consideration of Sampling all Asymptomatic Patients Before Surgical Treatment

Prevalence of SARS-CoV-2 Infection in the Obstetric Population at Admission: Results from a High-Volume Hospital Setting in the North of Italy

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