key: cord-0743852-fdrnfofo
authors: Jung, Jiwon; Kim, Mi-Na; Kim, Sung-Han
title: Universal Screening with Sample Pooling in Preoperative Patients as Long-term Strategy in the COVID-19 Pandemic
date: 2020-08-19
journal: J Korean Med Sci
DOI: 10.3346/jkms.2020.35.e309
sha: 74a76f4a89d0c81851a24d758d41217701662955
doc_id: 743852
cord_uid: fdrnfofo

nan

In Korea, a massive community outbreak of coronavirus disease 2019 (COVID-19) occurred in mid-February; therefore, since February 24th, we have implemented a polymerase chain reaction (PCR)-based universal preoperative screening for SARS-CoV-2 in patients requiring general anesthesia at Asan Medical Center, a tertiary care center in Korea. In parallel with this policy, we delayed elective operations for two weeks for patients with epidemiologic links to COVID-19 cases. On April 1st, we changed the screening protocol to pool five specimens before testing for saving resources. As of April 28th, a total of 9,778 pre-operation screening tests had been performed at Asan Medical Center, none of which were positive for SARS-CoV-2 (0%; 95% confidence interval, 0.00-0.04). During this period, a total of 37,127 SARS-CoV-2 PCR tests had been performed at our hospital, which revealed 128 (0.3%) positive results from 8 confirmed cases of COVID-19. Preoperative screenings accounted for approximately 26% of the test volume at our hospital. From April 1st to April 28th, when pooled testing was performed, a total of 16,277 PCR tests had been performed, of which 3,994 (25%) were preoperative screening test. Therefore, practical burden of preoperative screening decreased from 25% to 6% (799/[16,277 − 3,994 + 799]).

In our experience, universal preoperative screening of the individual samples from patients with low epidemiologic risks was not particularly cost-effective as it did not reveal any positive cases of COVID-19. However, the intubation procedure is a well-known risk for airborne infection of SARS-CoV-2, 4 and the operation room is vulnerable to the spreading of virus-containing aerosols due to the positive-pressured condition. 5 The COVID-19 pandemic is projected to be long-lasting and multiple subsequent outbreaks are expected-as such, further preventive strategies should be sustainable and cost-effective. Wacharapluesadee et al. 6 calculated cost-effectiveness of pooling strategy based on disease prevalence rates.

Universal screening for SARS-CoV-2 in women admitted for delivery

Sample pooling as a strategy to detect community transmission of SARS-CoV-2

Large-scale implementation of pooled RNA extraction and RT-PCR for SARS-CoV-2 detection

Aerosol and surface stability of SARS-CoV-2 as compared with SARS-CoV-1

Risk factors for SARS transmission from patients requiring intubation: a multicentre investigation in Toronto

Evaluating the efficiency of specimen pooling for PCR-based detection of COVID-19

Pooled sample testing may be a reasonable option for universal screening as a long-term strategy depending on the local epidemiological risk for COVID-19 and the resources for screening, by preventing the potential catastrophic harm resulting from the failure to detect asymptomatic patients prior to surgery.