Testing
History and physical exam alone are often insufficient to guide PPE and
procedural decision-making, as up to 80% of patients may be mildly
symptomatic or asymptomatic COVID-19 carriers. 1011 Clear protocols to advise testing, with
accommodations for limitations in resources, are therefore important to
appropriately protect providers and patients against transmission.
As it stands, there is no “gold standard test”; negative results do
not preclude SARS-CoV2 infection and should not be used as the sole
basis for patient management decisions (West CP). Rather, symptoms,
history, and test findings should be used together to guide assessment
of COVID-19 status.12 In otolaryngology, COVID-19
status (known or inferred) is integral to direct appropriate PPE for all
involved staff in the operating room or clinic setting. Currently, the
most available molecular diagnostic tests are real-time
reverse-transcription polymerase chain reaction assays for two or more
viral targets. However, as there are concerns for the low sensitivity
and negative predictive value of a single test, a combination of two PCR
tests or the addition of chest CT to the diagnostic algorithm have been
suggested to improve sensitivity, although this combination may not be
universally feasible in the preoperative setting.13The current negative predictive value of each test is variable, but
guidance for de-isolation of infected patient includes at least two
upper respiratory tract samples negative for SARS-CoV-2 collected at
least 24 hours apart by the European Centre for Disease Prevention and
Control and the Department of Health of Hong Kong. This testing approach
may potentially be used as testing kit availability and result
turnaround times improve to screen patients for elective
surgery.14