How Testing Impacts Management
For patients who are being screened prior to potential head and neck surgery, a nasopharyngeal swab should be performed by a healthcare provider, preferably 24 hours prior to surgery.31 In an effort to broaden access to testing, the CDC has now allowed self-collection of nasal swabs.32 While there are no data on the sensitivity of these self-administrated tests, there is potentially lower sensitivity due to inadequate sampling. Until more data is available, self-administered testing has not been established as an adequate alternative to testing performed by a health care provider.
Given the above sensitivity limitations of PCR-based assays, it is not clear whether a negative COVID-19 test should impact practice patterns in a high-risk specialty such as Otolaryngology-Head and Neck Surgery. Current sensitivities are considered to be acceptable for the general population and for patients who do not undergo high-risk procedures. However, for patients who undergo AGPs, the impact of a false negative result has serious implications to healthcare providers and other patients in the hospital. As such, many institutions have recommended that all personnel at risk for exposure to aerosolization of SARS-CoV-2 wear full personal protective equipment. This would include N95 or powered air purifying respirator (PAPR), even for asymptomatic patients with negative testing during this pandemic.7
For patients who test positive for COVID-19, the CDC has recommended that these patients be quarantined for at least 7 days and be asymptomatic with two negative PCR results done 24 hours apart to confirm clearance of SARS-CoV-2.33 New evidence has emerged suggesting that performing elective surgery on patients with COVID-19 carries high risk of patient morbidity. Of 34 patients who underwent elective surgeries and subsequently became positive for COVID-19, 44% required admission to the ICU and the mortality rate was 20.5%.34 As such, all patients with confirmed COVID-19 should be discussed within a multi-disciplinary team and surgery deferred, if possible, until proof of virus clearance is obtained and the patient is asymptomatic.