SHEA advises towards COVID screening of asymptomatic sufferers

In a latest advice printed within the journal Infection Control and Hospital Epidemiology, the Society for Healthcare Epidemiology of America (SHEA) described the professionals, cons, challenges, and elements to be thought of for using asymptomatic coronavirus illness 2019 (COVID-19) screening to stop extreme acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections.

Study: Asymptomatic screening for extreme acute respiratory coronavirus virus 2 (SARS-CoV-2) as an an infection prevention measure in healthcare services: Challenges and concerns. Image Credit: ST.artwork / Shutterstock

The widespread utilization of laboratory diagnostic providers for asymptomatic COVID-19 sufferers is known as ‘asymptomatic screening.’ The rationale for screening asymptomatic people is to establish probably SARS-CoV-2-infected people unaware of the an infection, stopping onward SARS-CoV-2 transmission. However, SHEA not recommends screening asymptomatic people for SARS-CoV-2 earlier than admission to well being services or previous to surgical procedure.

In the advice, members of SHEA’s board of administrators reviewed information on asymptomatic screening as a measure for COVID-19 prevention and offered suggestions for utilization of the identical to cut back the COVID-19 burden.

“The small benefits that could come from asymptomatic testing at this stage in the pandemic are over ridden by potential harms from delays in procedures, delays in patient transfers, and strains on laboratory capacity and personnel,” mentioned Thomas R. Talbot, MD, MPH, the Chief Hospital Epidemiologist at Vanderbilt University Medical Center, and a member of the SHEA Board of Directors. “Since some tests can detect residual virus for a long period, patients who test positive may not be contagious.”

Pros and cons of asymptomatic COVID-19 screening

Asymptomatic screening may allow early enforcement of isolation precautions and postponement of SARS-CoV-2-infected people for non-emergency AGPs (aerosol-generating procedures), which can in any other case enhance SARS-CoV-2 transmission through aerosols of respiratory particles. Asymptomatic screening is principally carried out for people at hospital admission and earlier than surgical procedures. However, it has been carried out as part of follow-up assessments for inpatients previous to initiating immunosuppressive medicines, for periodic well being assessments of non-vaccinated healthcare professionals (HCPs), and to allow HCPs uncovered to SARS-CoV-2-positive people to renew work. 

However, asymptomatic screening could also be related to hostile outcomes similar to (i) delayed affected person placement and thus receipt of applicable care, (ii) delays in transitions of affected person care ranges and pressure on healthcare capacities from the elevated LOS (size of keep), (iii) postponement of important procedures, (iv) strains on laboratories, testing assets and personnel, and (v) enhance in prices.

Further, since asymptomatic testing utilized NAAT (nucleic acid amplification checks), able to detecting residual SARS-CoV-2 ribonucleic acid (RNA) for extended intervals after decision of an infection, a SARS-CoV-2-positive report won’t point out energetic SARS-CoV-2 an infection and infectivity. Moreover, a affected person testing SARS-CoV-2-negative 3.0 days earlier than operative procedures may be contaminated however examined very early or develop into SARS-CoV-2-positive between testing and the process. The particular person could also be thought of uninfected, which could scale back compliance with non-pharmaceutical interventions similar to face masks carrying by healthcare staff.

Recommendations and elements to be thought of for asymptomatic screening

The group advisable that guides to evaluate SARS-CoV-2 transmission dangers be used to evaluate the necessity for asymptomatic screening. Factors to be thought of when assessing the requirement for asymptomatic screening embody (i) COVID-19 incidence and SARS-CoV-2 transmission in community-based settings, (ii) identification of high-risk people, (iii) facility format, and (iv) procedures which may elevate the SARS-CoV-2 transmission dangers.

Metrics utilized by the CDC (Centers for Disease Control and Prevention) to evaluate the COVID-19 burden in communities embody the (i) ‘COVID-19 community level’ metric, which makes use of biomarkers of inpatient surges in SARS-CoV-2 infections (SARS-CoV-2 infection-associated hospitalization charges and proportion of staffed inpatients’ beds by SARS-CoV-2-positive people), and (ii) ‘community transmission level’ which makes use of general charges of COVID-19 circumstances and SARS-CoV-2-positive testing to judge transmission, particularly in well being services.

Other metrics can point out heightened dangers of healthcare settings-related SARS-CoV-2 transmission, similar to COVID-19 incidence in healthcare services (e.g., COVID-19 circumstances detected one week after hospitalization), SARS-CoV-2 ribonucleic acid detection in wastewater provides, and well being skilled absenteeism. Facilities offering stem cell transplantation or look after hematological most cancers sufferers may require decrease thresholds for asymptomatic COVID-19 screening.

Additionally, areas comprising people who won’t be very more likely to doc novel COVID-19 signs or adjust to an infection prevention measures could also be at elevated threat of COVID-19 severity outcomes and, thus, require asymptomatic screening. SARS-CoV-2 vaccination information may be used for figuring out weak people. Finally, healthcare services similar to semi-private rooms or items using congregate settings might enhance SARS-CoV-2 transmission dangers.

To conclude, based mostly on the findings, the utilization of asymptomatic COVID-19 screening as a instrument for stopping SARS-CoV-2 infections could also be helpful however is resource-intensive and has been overutilized. Before performing intensive asymptomatic screening, strengthening non-pharmaceutical protecting measures similar to utilizing N95 respirators when performing explicit AGPs, energetic vs. passive COVID-19 screening for HCPs, and bettering facility layouts by rising well-ventilated personal rooms could be extra possible. Assessing SARS-CoV-2 transmission dangers in communities and healthcare items and figuring out high-risk populations earlier than incorporating asymptomatic COVID-19 screening in institutional well being practices is important.