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.