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Screening Tests in the Era of COVID-19: Implications for the Plastic Surgeon
Kristy L Hamilton1, Rod J Rohrich1
1From private practice; the Dallas Plastic Surgery Institute; and the Division of Plastic Surgery, Baylor College of Medicine.
Summary:
The novel coronavirus, severe acute respiratory syndrome coronavirus 2, responsible for the coronavirus disease of 2019 (COVID-19) pandemic, has claimed over 2 million lives to date and brought the global economy to a halt, including elective surgery. As the authors emerge from lockdown, new protocols must be implemented to minimize risk by means of appropriate screening of their patients, surgical adjustments to reduce viral transmission in case of undiagnosed infection, and the development of accurate severe acute respiratory syndrome coronavirus 2 tests while awaiting the distribution of an effective vaccine. Many serology and molecular tests have received emergency use authorization from the U.S. Food and Drug Administration, but they have not yet been independently verified. There are three main types of diagnostic tests available: (1) imaging studies, (2) molecular tests, and (3) serology tests. Imaging studies reveal bilateral lower lobe pneumonia and ground-glass opacities that are suggestive of disease. Quantitative reverse transcription polymerase chain reaction identifies specific segments of viral RNA, indicating the active presence of the virus in the test subject, which is most useful for elective surgery screening. Finally, serology studies detect the presence of immunoglobulin M and immunoglobulin G antibodies to the virus, indicating a current or past infection. Each test offers its own benefits and limitations.
Insights
Accurate COVID-19 testing is crucial for safely resuming elective surgeries. This study reviews imaging, molecular, and serology tests, highlighting their benefits and limitations for patient screening.
Area of Science:
- Infectious Diseases
- Medical Diagnostics
- Public Health
Background:
- The COVID-19 pandemic significantly disrupted healthcare, including elective surgeries.
- Minimizing viral transmission risk requires robust patient screening protocols.
- Accurate diagnostic tests for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) are essential.
Purpose of the Study:
- To review and compare available diagnostic methods for SARS-CoV-2.
- To evaluate the utility of different tests in the context of elective surgery.
- To inform the implementation of effective screening protocols.
Main Methods:
- Review of diagnostic test types: imaging studies, molecular tests, and serology tests.
- Analysis of the benefits and limitations of each testing modality.
- Consideration of test application for pre-operative screening.
Main Results:
- Imaging studies can show suggestive signs like bilateral lower lobe pneumonia.
- Quantitative reverse transcription polymerase chain reaction (RT-PCR) detects active viral RNA, vital for screening.
- Serology tests identify immunoglobulin M (IgM) and immunoglobulin G (IgG) antibodies, indicating current or past infection.
Conclusions:
- Each diagnostic test (imaging, molecular, serology) has unique advantages and disadvantages.
- RT-PCR is particularly useful for screening patients undergoing elective surgery.
- Standardized and verified testing is critical for safe surgical practice post-pandemic.
