Introduction
In December of 2019, an outbreak of patients with severe pneumonia was reported in Wuhan, China. A novel Coronavirus was isolated as the causative agent. It has been named by the World Health Organization (WHO) as the severe acute respiratory distress syndrome coronavirus 2 (SARS-CoV-2) which causes the coronavirus disease 2019 (COVID-19). The genome of this novel coronavirus is a single-stranded positive-sense RNA (+ssRNA). It belongs to the family Coronaviridae containing strains responsible for the SARS outbreak in 2003 as well as the Middle East respiratory syndrome (MERS) outbreak in 2012. SARS-CoV-2 has spread rapidly across the world and by March 11th, 2020, the WHO officially declared the outbreak a pandemic.4 This pandemic has resulted in unprecedented challenges to the healthcare system and to society as a whole.
Among the healthcare workforce, otolaryngologists are at particular risk for acquiring the disease due to performance of exams and procedures involving a potentially infected upper aerodigestive tract. Routine endoscopic examinations including nasal endoscopy, flexible laryngoscopy as well as the use of energy devices during surgery are considered aerosol generating procedures (AGPs) with high risk for transmission.5 An analysis of 138 patients hospitalized with COVID-19 in Wuhan, China found that 40 (29%) were healthcare workers.6 In fact, the first reported physician death associated with the disease was that of an otolaryngologist in Wuhan.7 In recognition of these risks and to conserve limited resources, the American Academy of Otolaryngology-Head and Neck Surgery has recommended only performing procedures or surgeries that are time sensitive or emergent.8 Similar recommendations have been made by the American College of Surgeons as well as the Centers for Medicare and Medicaid Services (CMS).9,10 In an effort to reduce risk, many professional societies have recommended screening for COVID-19 prior to high risk procedures as emerging data suggests that patients can be asymptomatic carriers.5,11
In this article, we will review the current testing standards for COVID-19 and discuss their strengths and limitations. Of note, new information on the COVID-19 pandemic is being published at a fast rate. The data presented here rely primarily on early studies with confounders that can influence interpretation. As there is no current gold standard for SARS-CoV-2 testing, careful re-evaluation of the published evidence over time will be imperative.