key: cord-0943451-gvtvzarh
authors: Henderson, Cassandra E.; Rezai, Shadi; Roxland, Beth
title: Cohorting Asymptomatic Patients by COVID-19 Status - Beware of False Negative RT-PCR Test Results and Inevitable Racial Segregation
date: 2020-08-25
journal: J Natl Med Assoc
DOI: 10.1016/j.jnma.2020.08.003
sha: c491b045742cf84f6b880478975396cd7bed5f9b
doc_id: 943451
cord_uid: gvtvzarh

nan

T he severe acute respiratory syndrome coronavirus (SARS-CoV-2) pandemic has altered the entire health care delivery landscape in the U.S. More frequent use of the highly specific, real-time polymerase chain reaction (RT-PCR) analysis to detect viral genetic material is central to controlling the worldwide spread of this viral infection. Expert opinion supports use of preadmission or pre-surgical RT PCR testing of asymptomatic individuals to inform use of personal protective equipment (PPE), hospital isolation and bed assignment, and maternal-neonatal separation immediately after birth. 1 While highly specific for SARS CoV2, up to 37% of RT-PCR test results are false negative. 2 Negative RT PCR test results serve as the basis for many crucial healthcare decisions, including allocating scarce PPE to those who are considered more at-risk for contracting the infection, and the general relaxing of health safety and precautionary measures by healthcare workers around patients identified as COVID-19 "negative. This may promote a false sense of security and potentially increase the risk of SARS CoV2 transmission between undiagnosed positive healthcare worker and truly negative patients, as well as between a true negative health care worker and false negative patient.

Reports from multiple investigators indicate Black and Hispanic populations are disproportionately affected by SARS-CoV-2. 3, 4 Healthcare units created to separate Covid-19 positive patients from those believed to be negative will inevitably result in designated COVID-19 positive units that are heavily comprised of black and brown patients. Without due attention by governmental and healthcare entities to address issues of implicit and explicit biases that exist among members of the healthcare team, these segregated Covid-19 positive units could foreseeably lead to disparate treatment, even if not consciously intended. 5 SARS-CoV 2 diagnostic testing provides little guidance for management of asymptomatic individuals as the sensitivity and specificity has yet to be determined. To mitigate potential harms of policies to cohort asymptomatic individuals by COVID-19 status, health care team members should use universal PPE regardless of patient's assigned COVID-19 status and maintain a heighten sense of awareness to prevent unintended negative consequences this separation policy might be expected to have on minority populations.

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

Evaluating the Accuracy of Different Respiratory Specimens in the Laboratory Diagnosis and Monitoring of the Viral Shedding of 2019-nCoV Infections. medRxiv preprint

SARS-Cv-1 positivity rate for latinos in the baltimore-Washington, DC region

Hospitalization rates and characteristics of patients hospitalized with laboratoryconfirmed coronavirus disease 2019-COVID-NET, 14 states

The associations of clinicians' implicit attitudes about race with medical visit communication and patient ratings of interpersonal care