Clinical Screening for COVID-19 in Asymptomatic Patients With Cancer
Manish A. Shah, Sebastian Mayer, Francie Emlen, Evan Sholle, Paul J. Christos, Melissa M. Cushing, Manuel Hidalgo
Abstract
Division of Hematology and Medical Oncology created separate units for patients with confirmed COVID-19, patients with symptomatic but unconfirmed COVID-19, and asymptomatic patients with no known high-risk COVID-19 exposures. 2 Patients were contacted prior to their appointment and triaged based on their COVID-19 risk status. To understand the success of our clinical screening and triaging procedures, we implemented a severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) testing protocol in asymptomatic patients who required cancer care across the Division of Hematology and Medical Oncology. Methods This quality improvement study, approved by Weill Cornell Medicine, follows the Standards for Quality Improvement Reporting Excellence (SQUIRE) reporting guideline. Informed consent was waived because data were deidentified, per institutional policy. Patients were considered asymptomatic if they had no recent fever (defined as body temperature 100.5 F for 5 days); no COVID-19 symptoms, which included cough, headache, loss of taste, and shortness of breath 3 ; or high risk exposure (eg, contact with an individual with confirmed COVID-19, nursing home stay, or hospitalization) within 14 days. Diagnosis of COVID-19 was confirmed using SARS-CoV-2 nasal swab polymerase chain reaction (PCR) testing (Cobas 6800; Roche Diagnostics) and SARS-CoV-2 IgM and IgG serological tests (Pylon 3D; ET HealthCare). 4 Patients were retested every 1 to 2 weeks. Rates of positive SARS-CoV-2 PCR and COVID-19 serological tests and 95% CIs are reported, using the 2-sided Clopper-Pearson (exact) 95% CI. Statistical analyses were conducted using Stata statistical software version 13.1 (StataCorp).