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