S0528 The SARS-2 (Novel Coronavirus) Positivity Among Patients Referred for Elective Upper Endoscopy in a Tertiary Endoscopy Unit: Data to Inform Resuming Endoscopic Activities in COVID-19 Era

Abstract

INTRODUCTION: Covid-19 pandemic has changed every aspect of everyday life globally and this includes performing endoscopic procedures with appropriate infection control to ensure safety of both patients and providers. Evidence suggests higher rates of transmissibility of the virus through aerosolized droplets during upper endoscopies as well as viral particles detected though feces. Initial statements by joint GI societies recommendation provided preliminary framework for infection control during procedures. However, optimal strategies in resuming endoscopies are still not fully understood. We aim to describe a protocol to uniformly test patients for upper endoscopies (including EGD, EUS, ERCP, etc) prior to the procedure date presenting to a large tertiary hospital in urban settings. METHODS: All patients referred to the Cuyahoga county hospital in Cleveland, OH for elective upper endoscopic procedures were included between 5/ 6 to 5/22/2020. Patients were screened over the phone 1–3 days prior to their procedure. This included symptom screening (cough, fevers, dyspnea or acute diarrhea), hx of exposure, or recent travel history to endemic areas. If screened negative per questionnaire, then will be referred for SARS-2 nasal swab real-time PCR 24 hours prior to the procedure. RESULTS: Over the course of 2 week period, a total of 138 asymptomatic patients were referred for real-time nasal swab PCR testing with 65% completion rate of test among them. Of those not completing the test, 6 proceeded with their procedures (and were considered as if they tested positive) and the rest were no shows for their endoscopies. A total of 3 out of 90 (3.33%) patients tested returned positive for SARS-2. CONCLUSION: Even though 3.33% positivity rate in asymptomatic patients does not seem very significant, this is a relatively high rate in the northeast Ohio were the disease prevalence was lower than national average. Detecting positive patients is not only important from PPE and proper intraprocedural infection control but also is important from public health stand point where infected patients can come into contact a larger number of patients (many of whom are at higher risk for the infection given their comorbidities), health care providers and staff, and contaminating the equipment, endoscopy rooms, etc. Therefore, standard clinical and PCR testing for asymptomatic patients tend to identify asymptomatic patients and even 24-hr prior testing seem to have a relatively good feasibility and adherence among patients.