Conclusion
Currently, there is no gold standard for the diagnosis of SARS-CoV-2.
Early evidence suggests that the current standard for the diagnosis of
SARS-CoV-2 using RT-PCR has variations in sensitivity dependent on the
sub-site tested. Nasal swab specimens appear to have high viral loads,
but even then sensitivities are in the range of
60-70%.1-3 Furthermore, while clinical history, CT
imaging, and laboratory tests may support the diagnosis of COVID-19,
none of these tests alone or in combination with RT-PCR have been proven
to have optimal sensitivity to rule out SARS-CoV-2 infection, especially
for high risk AGPs. As such even for patients tested negative for
COVID19, many institutions suggest that the highest level of PPE
available should be worn that protects against potential transmission of
aerosolized SARS-CoV-2 for procedures of the upper aerodigestive tract.
Moreover, the emerging data demonstrating high morbidity and mortality
for patients who develop COVID-19 after elective surgeries would suggest
that elective surgery should be postponed in this patient population.
Finally, it is imperative to point out once again the evidence on the
COVID-19 pandemic is rapidly evolving. We will need to constantly
re-evaluate the nature of testing and result interpretation, especially
as the prevalence of SARS-CoV-2 continues to change and new testing
methodologies become available.