Interventional Platform Patient Flow for COVID-19

Tests and ResultsProceeding when PUI

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REPRODUCTION AND INFECTIVTY OF COVID-19

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https://doi.org/10.3390/v11010059

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SARS-CoV-2 is a PLUS (POSITIVE), SINGLE STRANDED RNA virus

The virus utilizes MINUS (NEGATIVE)-STRANDED GENOMIC and SUB-GENOMIC RNA as intermediates in its replication

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RNA NEGATIVE STRAND TEST

The detection of MINUS (NEGATIVE)-STRANDED RNA indicates ACTIVE VIRUS INFECTION and represents a molecular biomarker for infectivity

−YES detection = YES Infection

The absence of a MINUS (NEGATIVE) STRAND indicates with a POSITIVE REGULAR COVID Lab Test means that the virus is no longer making copies of itself and is NOT INFECTIOUS

−NO detection = NOT Infectious

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Test ResultsCOVID REGULAR SWAB

Detects:PLUS AND/OR MINUS STRAND

(Any Viral Particles)

RNA STRAND TEST

Detects:MINUS STRAND

First Positive Detection: Patient is considered Infectious

Any Positive Detection: Patient is considered Infectious

Positive Detection after Initial Test: Patient might be Infectious

Patient can be “Positive” on the test for weeks and longer be infectious

Not Detected: NOT Infectious

Not Detected: NOT Infectious NO RNA STRAND TEST NEEDED

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RNA Single-Strand Assay: Test Result Interpretation

Only plus strand was detected in the sample, which is consistent with inactive virus.

No minus strand was detected in the sample. Unlikely to be shedding infectious fragments of the virus.

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RNA Single-Strand Assay: Test Result Interpretation

The minus strand was detected in the sample. That means the virus can spread to others and is infectious.

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When to Proceed Without Another Test

STANDARD PRECAUTIONS

Any patient has a negative regular COVID-19 test within 3 midnights of their procedure with no new symptoms for COVID

Any inpatient who has been tested after 3 midnights in the hospital with no new symptoms for COVID

− All patients are tested on the day of admission to the hospital

− Just in case a positive patient was not identified on admission asymptomatic patients are retested ONE TIME after 3 days if they are elective and coming to the Interventional Platform

− An inpatient without new symptoms only needs to be tested ONE TIME between 3 and 13 midnights for a procedure

− By day 14 in the hospital they have passed the window where they would have converted from negative to positive

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COVID TEST Surgery &Admission

Inpatient: NO New Test needed

ONE TEST NEEDED FOR INPATIENT REPEAT SURGERY BETWEEN RED ARROWS

TESTING NO LONGER NEEDED AFTER 13 MIDNIGHTS AS AN INPATIENT

IF THE PATIENT IS DISCHARGED ANOTHER TEST IS NEEDED

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When to Proceed with a Patient as a PUI

TREAT AS PUI/COVID PRECAUTIONS

Urgent/Emergent/Transplant Patients who do not have a result

Urgent/Emergent/Transplant Inpatients who have not been tested after the first 3 midnights of their admission

COVID Positive Patients without an RNA strand test result

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Patient was Positive in the Past

CDC Time-Based Infectivity

− Asymptomatic: 10 Days after swab positive test

− Symptomatic: 10 Days or 3 days post symptoms

− Whichever is longer

Patient is no longer infectious and no longer needs to be on isolation/quarantine or treated as a PUI

On the Interventional Platform, we are taking a CONSERVATIVE approach and postponing elective procedures on patients who are coming to SHC from home until 20 days after a positive result

In ADDITION, just in case the person is still infectious (because of our complex patient population) we are getting an RNA STRAND TEST to make sure that the patient is no longer with active virus that makes copies of itself

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POSITIVE COVID TEST

NEW SURGERY DATERNA MINUS STRAND TEST

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THIS IS WHERE A BANNER WILL APPEAR

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THESE ARE ALL THE POSSIBLE BANNERS

Scenario 1:

Scenario 2:

Scenario 3:

Scenario 4:

Scenario 5 (No Banner):

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SCENARIO 1 = Standard Precautions

SCENARIO 2 = Treat as PUI (New Symptoms)

SCENARIO 3 = RNA Strand Test Needed for Standard Precautions. Delay elective case. Get Order for Strand test from MD.*If Urgent/Emergent/Transplant then Treat as PUI*

SCENARIO 4 = Delay elective case until cleared.*If Urgent/Emergent/Transplant then Treat as PUI*

SCENARIO 5 = Check test result. If the test is POSITIVE immediately contact the anesthesia scheduler or anesthesiologist on call.

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Previous Positive Test ResultsTest Result Type Actions

• Previous Positive test result• Past CDC time-based window for

quarantine *• Negative RT-PCR or minus strand

not detected

No further testing needed for 90 days post original positive test result

Previous Positive test result within CDC time-based window for quarantine *

Obtain RT-PCR or Possible RNA Strand Test

Under Guidance of Infection ControlPrevious Positive test result >90 days

Patient resets and following standard testing algorithm

* 10 days if asymptomatic or 3 days post symptoms, whichever is longer