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Op-Ed: Coexisting With COVID

Since the onset of the COVID-19 public health emergency, hospitals and healthcare providers have been faced with unprecedented challenges. Despite the growing need to resume elective procedures and prevent the serious short and long-term risks of delaying care, this need cannot be addressed without first ensuring that patients and their providers are protected from SARS-CoV-2 infection.

In response, hospital systems – including the Methodist Health System (MHS) in the Dallas-Fort Worth metroplex area, where I work – began exploring strategies that would allow us to safely open up inpatient and outpatient operating rooms for individuals in need of surgery.

Using the best existing science, the goals of MHS were twofold: protect our patients and safeguard our healthcare workers. For patients, we sought to provide every possible guardrail to ensure they could safely undergo procedures while limiting the risk of infection. For our healthcare workers, the question was how to protect them from getting infected while enabling them to care for patients in the safest way possible?

The answer lay in the oft-repeated phrase: testing, testing, testing.

Early on, we recognized the value of PCR testing, which gathers samples through a nasal swab to diagnose someone currently infected by the coronavirus. However, as soon as we started PCR testing, we determined that it wasn’t identifying infected persons 100% of the time. Studies suggest there’s intermittent shedding, meaning times vary when the virus replicates inside your body and is released into the environment. Therefore, an infected person could test negative. This created some holes in our “gold standard” PCR testing.

We then became concerned that too many infected individuals might inaccurately test negative for coronavirus – an ominous prospect that could put the health and safety of countless patients and healthcare providers at risk.

Recognizing this reality and the constantly evolving science around COVID-19 testing, we concluded that health systems returning to care couldn’t reliably depend on just one test – even if it had both high sensitivity and specificity, the two most critical factors in testing accuracy. So we decided to explore the benefits of antibody testing.

Antibody testing uses a serology test to detect whether an individual has had a past infection. By allowing us to identify those who had previously been infected by the disease, or been exposed to the illness at some point, antibody testing proved to be a critical tool in our ongoing struggle against the virus.

By April, there were a handful of highly accurate antibody tests available with high sensitivity, specificity, and positive and negative predictive value. For some tests on the market, available data showed 100% sensitivity and specificity – meaning that we could have high confidence that our test results were accurate. Yet, despite their enormous value, antibody tests alone could not be used to diagnose a current infection.

With this in mind, we decided to implement a dual testing strategy that would allow us to get as close to 99% detection as we could, thereby ensuring the best protection of our patients, providers, and the healthcare system more broadly.

As we resumed procedures, patients who had both a PCR and antibody test, and tested negative to both, were then moved into the OR. If a patient tested positive for either, we evaluated the urgency of the surgery. If the procedure was non-emergent, we delayed it by 14 days and reassessed. In emergent cases, we moved forward with the procedure, using extreme precautions. These patients were treated as COVID positive, even if they only had antibodies.

This is a fairly conservative approach, and we are adapting as we learn. We’ve had to plan for repeat testing. And, we have educated patients about the importance of isolating after testing.

Ultimately, thanks in part to this innovative testing approach, we have successfully protected both our patients and our healthcare workers, as we set out to do.

Healthcare systems nationwide are deploying similar testing strategies to enable patients to return to care. As the science evolves, we will all have to regularly adapt to new testing methods as they improve. Based on today’s science, the current use of antibody testing together with PCR testing in a hospital setting has been instrumental in allowing patients to return to care. And while our approach was initially isolated to surgical patients, we are providing dual testing to all symptomatic inpatients, as well as our preoperative patients.

Things are changing, almost daily. We will follow the science as it becomes available, and where there are cracks, we will supplement our efforts with previously proven methods that give us more information to better protect us all. By following the science, we will coexist with COVID – while scientists in our community, our state, our nation, and our world seek the most expeditious way to manage COVID-19.

Karen S. Roush, MD, MBA, is vice chair of pathology at Methodist Health System in Dallas.

Source: MedicalNewsToday.com