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Discontinuing Precautions in Asymptomatic, PCR-Positive COVID-19 Patients

A survey found most healthcare professionals would clear an asymptomatic patient with a positive PCR test if the patient met other criteria.

Recovered COVID-19 patients can continue to PCR-test positive for several months, so other criteria are often taken into consideration to determine whether a patient can be cleared.

A survey study presented during IDWeek sought to explore the specific qualifications healthcare professionals look for before discontinuing a COVID-19 patient’s care and precautions.

The study was conducted on the basis that asymptomatic patients who may no longer be contagious are sometimes subjected to an unnecessary continuation of COVID-19 care, quarantine, and monitoring.

Investigators for the University of California, Irvine School of Medicine conducted survey research of healthcare epidemiologists and infection prevention experts from the SHEA Research Network from March-April 2021.

The survey was 14 questions and presented various COVID-19 PCR-positive asymptomatic patient case scenarios. With each scenario, respondents were asked if (1) they would consider the case recovered and not infectious, (2) if they have cleared precautions in such cases, and if so, (3) how many transmission events occurred after ending precautions.

The survey used one to five criteria in each scenario: history of COVID-19 symptoms, history of exposure to a household member with COVID-19, COVID-19 PCR cycle threshold (CT) and IgG serology.

Among the 60 respondents, 56 (93%) were physicians, 51 (86%) were hospital epidemiologists, and 46 (77%) had ten or more years of infection prevention experience. The respondents represented facilities that cumulatively treated over 29,000 COVID-19 cases. Of these facilities, 46 (77%) were academic, and 42 (69%) had more than 400 beds.

One in three to one in two respondents considered an incidentally found PCR-positive case to be recovered when the scenario contained only one criterium. When a scenario combined two criteria, half to four-fifths of the respondents determined the PCR-positive case to be recovered. Half of those who responded affirmatively had used those same criteria to clear precautions in their own practice (45-64%), and few to none of these clearances resulted in a transmission event.

The investigators found the majority of healthcare epidemiologists consider a variety of clinical and diagnostic criteria to signify COVID-19 recovery, and many respondents used these to justify discontinuing precautions without high numbers of transmission.

The study, “Assessing Past vs Present COVID-19 Infection: A Survey of Criteria for Discontinuing Precautions in Asymptomatic Patients,” was presented virtually at IDWeek 2021, held September 29-October 3, 2021.