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COVID-19

An influential board of infectious disease physicians recommended on Wednesday that hospitals and other healthcare facilities stop routinely screening asymptomatic patients for Covid-19 because the risks outweigh the benefits.

The new guidelines issued by the board of directors of the Society for Healthcare Epidemiology of America may be contentious. Many healthcare facilities routinely tested all admits throughout the pandemic to prevent the virus from spreading to both healthcare workers and other patients. They’ve also tested patients before surgery, partly due to concerns that a Covid infection might cause complications.

Statements from Board

However, the board stated that three years into the pandemic, there was still little evidence that routine screening prevents transmission and substantial evidence that it comes at a cost. According to a detailed commentary published on Wednesday, routine asymptomatic testing increased emergency department stays by nearly two hours in one hospital and seven hours in another. These delays may prevent patients from being screened and transferred to specialized care. Furthermore, the tests frequently detect residual virus RNA in patients who were infected weeks ago.

At the same time, the authors of the report acknowledged some uncertainty. Despite the widespread use of asymptomatic screening in hospitals, few studies have been conducted to investigate its effects.

Notably, the board did not recommend that facilities discontinue asymptomatic screening in all cases. It may still be useful in certain circumstances, such as when transmission rates are high or patients are particularly vulnerable. It might make sense, for example, to screen all patients in a hospital’s transplant or oncology wing, where many patients are at high risk for severe Covid, or in behavioral facilities, where healthcare workers must maintain constant close contact with patients.

Routine testing had seemed like a powerful additional layer of protection, but in the context of “all the kinds of unintended consequences, we may not be gaining as much as we think,” said Thomas Talbot, chief hospital epidemiologist at Vanderbilt University Medical Center and lead author of the report. “Widespread routine testing is not beneficial,” Talbot said. “It’s still a very data-deficient area,”

The report also notes one study that found a Covid test can cost $54.50 per patient — which adds up if you test every patient. And it cited a study in Spain that found a more targeted approach that screened just 25% of patients before elective surgery admissions were equally effective at reducing transmission.

Words of Experts

The board is advising centers to “think more critically about these policies,” according to Shira Doron, an infectious disease physician at Tufts Medical Center who has published analyses of asymptomatic screening in the VA medical system but was not involved in the report.

“This is a powerful group of doctors calling on policymakers and health systems to examine where we are in the pandemic and all of these practices,” she added. “In some cases, they may have been useful at the start of the pandemic but are less so now.”

However, some of the board’s reasoning raised concerns from coronavirus transmission experts. According to Jose-Luis Jimenez, a chemistry professor at the University of Colorado-Boulder who studies disease transmission, its understanding of viral spread is “very outdated.”

Although the board correctly pointed out that many hospital procedures do not generate many infectious aerosols, “that does not matter when you have plenty of efficient aerosol-generating procedures going on, such as talking,” Jimenez wrote in an email. He went on to say that he couldn’t speak to the larger question of whether asymptomatic screening was worth the costs.

Linsey Marr, a Virginia Tech aerosol transmission expert, agreed that the board appeared to be underestimating the risk of aerosol transmission. “It’s a little frustrating,” she admitted, adding that universal rapid testing, which would better reflect whether a patient is currently contagious, could be a good alternative to the problems with PCR.

Final Guidelines

The guidelines may also raise concerns among immunocompromised people and others who are still at high risk for disease, many of whom live in areas where doctors and other healthcare workers are not masking, making medical visits potentially dangerous.

The change could have an impact not only on patient care but also on how Covid is tracked across the country. There has long been debate over what percentage of Covid hospitalizations can be attributed to the virus, as opposed to patients who test positive upon arrival but are there for another reason.

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