Introduction
In December of 2019, an outbreak of patients with severe pneumonia was
reported in Wuhan, China. A novel Coronavirus was isolated as the
causative agent. It has been named by the World Health Organization
(WHO) as the severe acute respiratory distress syndrome coronavirus 2
(SARS-CoV-2) which causes the coronavirus disease 2019 (COVID-19). The
genome of this novel coronavirus is a single-stranded positive-sense RNA
(+ssRNA). It belongs to the family Coronaviridae containing
strains responsible for the SARS outbreak in 2003 as well as the Middle
East respiratory syndrome (MERS) outbreak in 2012. SARS-CoV-2 has spread
rapidly across the world and by March 11th, 2020, the
WHO officially declared the outbreak a pandemic.4 This
pandemic has resulted in unprecedented challenges to the healthcare
system and to society as a whole.
Among the healthcare workforce, otolaryngologists are at particular risk
for acquiring the disease due to performance of exams and procedures
involving a potentially infected upper aerodigestive tract. Routine
endoscopic examinations including nasal endoscopy, flexible laryngoscopy
as well as the use of energy devices during surgery are considered
aerosol generating procedures (AGPs) with high risk for
transmission.5 An analysis of 138 patients
hospitalized with COVID-19 in Wuhan, China found that 40 (29%) were
healthcare workers.6 In fact, the first reported
physician death associated with the disease was that of an
otolaryngologist in Wuhan.7 In recognition of these
risks and to conserve limited resources, the American Academy of
Otolaryngology-Head and Neck Surgery has recommended only performing
procedures or surgeries that are time sensitive or
emergent.8 Similar recommendations have been made by
the American College of Surgeons as well as the Centers for Medicare and
Medicaid Services (CMS).9,10 In an effort to reduce
risk, many professional societies have recommended screening for
COVID-19 prior to high risk procedures as emerging data suggests that
patients can be asymptomatic carriers.5,11
In this article, we will review the current testing standards for
COVID-19 and discuss their strengths and limitations. Of note, new
information on the COVID-19 pandemic is being published at a fast rate.
The data presented here rely primarily on early studies with confounders
that can influence interpretation. As there is no current gold standard
for SARS-CoV-2 testing, careful re-evaluation of the published evidence
over time will be imperative.