COVID & Elective Procedures | Strash Foot & Ankle Care
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COVID & Elective Procedures

08 Feb COVID & Elective Procedures

Posted at 14:32h in General, Uncategorized by

The American Society of Anesthesiologists (ASA) recently released guidance on when a patient with COVID is no longer infectious, optimal time to wait after recovery from COVID to schedule elective procedures, and guidelines for repeat COVID testing.

When is a patient with COVID-19 no longer infectious?

Key points:

  • In patients with COVID-19, RT-PCR testing may detect viral RNA for a prolonged period (possibly weeks to months).  However, detection of viral RNA does not correlate with infectivity.
  • Mild to moderate and asymptomatic COVID-19:

In studies of COVID-19 patients with mild to moderate COVID, replication-competent virus (i.e., virus capable of causing infection) has not been detected after 10 days from symptom onset.

For mild to moderate COVID-19 illness, the CDC recommendations are to discontinue isolation and other transmission-based precautions when:

  1. At least 10 days have passed from onset of symptoms and
  2. At least 24 hours have passed since last fever without use of fever-reducing mediations and
  3. Symptoms (e.g., cough, shortness of breath) have improved.

For asymptomatic patients who are not severely immunocompromised, isolation and precautions can be discontinued 10 days after the first positive COVID test.

  • Severely or critically ill COVID-19 patients:

In approximately 95% of severely or critically ill COVID-19 patients replication-competent virus (i.e., virus capable of causing infection) has not been detected after 15 days from symptom onset. Replication-competent virus has not been detected in this patient group after 20 days from symptom onset.

For severe to critical COVID-19 illness and in patients who are severely immunocompromised, the CDC recommendations, are to discontinue isolation and other transmission-based precautions when:

  1.  At least 10 days and up to 20 days have passed from onset of symptoms and
  2. At least 24 hours have passed since last fever without use of fever-reducing mediations and
  3. Symptoms (e.g., cough, shortness of breath) have improved.
  • Downgrading for isolation and transmission based precautions in this group calls for clinical judgement and may include consultation with Infectious Disease physicians.
  • Immunocompromised patients, including patients with advanced age, diabetes mellitus and ESRD, may have a prolonged period of infectivity.
  • Generally speaking, patients who show continuous clinical improvement can be safely removed from isolation and transmission-based precautions following the symptom based guidelines above.

What is the optimal time to wait after recovery from COVID-19 to minimize postoperative complications?

  1. COVID-19 can impact virtually all major organ systems, so it is important to consider the timing of an elective surgical procedure post-COVID in order to reduce the risk of COVID-related post-operative complications.
  2. Suggested wait times can be extrapolated from the limited information on COVD-19 patients and from prior experience with similar viruses.
  3. The American Society of Anesthesiologists recommends the following suggested wait times for elective surgery after COVID-19 infection:
  • Four weeks for an asymptomatic patient or recovery from only mild, non-respiratory symptoms.
  • Six weeks for a symptomatic patient (e.g., cough, dyspnea) who did not require hospitalization.
  • Eight to 10 weeks for a symptomatic patient who is diabetic, immunocompromised, or hospitalized.
  • Twelve weeks for a patient who was admitted to an intensive care unit due to a COVID-19 infection.

Is repeat COVID-19 testing needed?

  1. The CDC does not recommend re-testing for COVID-19 within 90 days of symptom onset.  Repeat testing is strongly discouraged since persistent or recurrent positive tests are common after recovery and a positive test after the time frames outlined above is not indicative of infectivity.
  2. If a patient presents with new COVID-like symptoms with 90 days, re-testing can be considered.