On Wednesday, the Society for Healthcare Epidemiology of America's (SHEA) board of directors released new guidelines advising health care facilities to stop "widespread" Covid-19 screening for asymptomatic patients—a move some experts believe "may prove controversial," Jason Mast writes for STAT. 

New guidelines recommend no longer screening asymptomatic patients for Covid-19

Throughout the Covid-19 pandemic, many health care facilities have required routine screening to help prevent the spread of the coronavirus. In addition, many facilities have screened patients before surgery, citing concerns that a Covid-19 infection could lead to complications.

According to SHEA's board, there is not much evidence to suggest that routine screening prevents transmission, but there is evidence to suggest that the practice poses risks. On Wednesday, the board released commentary that referenced data fromstudies that found routine asymptomatic screening lengthened ED stays by almost two hours in one hospital and seven hours in another.

"Those delays can prevent patients from getting screened and sent to specialized care," Mast writes. "And the tests can often pick up residual virus RNA in patients who were infected weeks ago."

Previously, many experts believed that routine testing added another layer of protection against Covid-19, but in the context of "all the kinds of unintended consequences, we may not be gaining as much as we think," said Thomas Talbot, chief hospital epidemiologist at Vanderbilt University Medical Center and lead author of the report. "Widespread routine testing really has not been shown to be beneficial."

According to a study published in JAMA Internal Medicine, screening for Covid-19 symptoms and exposure at hospital entrances turned away fewer than 0.1% of patients, visitors, and health workers.

SHEA's board also noted the expenses associated with testing each patient.

Still, "the report's authors acknowledged some uncertainty," Mast notes. "Despite hospitals' widespread use of asymptomatic screening, relatively few studies have looked into its effects."

The board did not recommend stopping all asymptomatic screening, noting that it may still be helpful in certain settings, especially those involving high transmission rates and at-risk patients. "For example, it could make sense to screen all patients in the transplant or oncology wing of a hospital, where many patients are at high risk for severe Covid, or in behavioral facilities, where health care workers have to be in continual close contact with patients," Mast writes.

Commentary

According to Shira Doron, an infectious disease physician at Tufts Medical Center, the board is advising centers "to think more critically about these policies."

"This is a heavy-hitting group of doctors really calling for policymakers and health systems to take a look at where we are in the pandemic and look at all these practices," Doron said. "In some cases, maybe they were useful in the beginning of the pandemic and less so now."

But some experts on coronavirus transmission have voiced concerns over certain parts of the report. According to Jose-Luis Jimenez, a chemistry professor who studies disease transmission at University of Colorado-Boulder, the board's understanding of viral spread was "very outdated."

While the board correctly noted that many hospital procedures do not generate many infectious aerosols, "that does not matter when you have plenty of efficient aerosol-generating procedures such as talking going on," Jimenez said. Ultimately, Jimenez said he could not comment on whether the benefits of asymptomatic testing outweighed costs.

According to Mast, "[t]he guidelines may also raise concerns among immunocompromised people and others still at high risk for disease, many of whom live in areas where doctors and other health care workers aren't masking, turning medical visits into a potentially dangerous endeavor."

However, Priya Nori, an infectious disease specialist at Montefiore Medical Center, who treats patients with compromised immune systems, said the guidelines still allow facilities to protect their highest-risk patients.

"A running narrative through the pandemic—and justifiably—has been, 'What about the compromised hosts?'" said Nori, who is a member of SHEA but was not involved in the guidelines. "But I think this still can be done widely and safely, and we can still protect the compromised hosts."

In addition, the guidelines could affect the way Covid-19 is tracked in the United States. "There has long been a debate over what percentage of Covid hospitalizations can actually be attributed to the virus, as opposed to patients who happen to test positive upon arrival but are there for a different reason," Mast writes.

Ultimately, stopping routine screenings "is going to have a big impact" on Covid-19 data, Doron added. (Mast, STAT, 12/21)