COVID-19

COVID-19 (in the context of infection prevention during GI endoscopy and bronchoscopy):

• Multi-society guideline: “Management of endoscopes, endoscope reprocessing, and storage areas during the COVID-19 Pandemic” (2020)
• “ASGE Releases Recommendations for Endoscopy Units in the Era of COVID-19” — ASGE (March 13, 2020)
• “Coronavirus (COVID-19) outbreak: what the department of endoscopy should know” — Repici et al. Gastrointest Endosc (March 2020)
  

  ---

• “ESGE and ESGENA Position Statement on gastrointestinal endoscopy and the COVID-19 pandemic” — Update 1 (March 18, 2020)
• “Considerations in performing endoscopy during the COVID-19 pandemic” — Soetikno et al. Gastrointest Endosc (March 2020)
• “Practice of endoscopy during COVID-19 pandemic: position statements of the Asian Pacific Society for Digestive Endoscopy (2020)

• “Critical Supply Shortages — The Need for Ventilators and Personal Protective Equipment during the Covid-19 Pandemic” — NEJM (March 25, 2020)
• “SARS-CoV-2 Viral Load in Upper Respiratory Specimens of Infected Patients” — NEJM (March 19, 2020)
• “Aerosol and Surface Stability of SARS-CoV-2 as Compared with SARS-CoV-1” — NEJM (March 17, 2020)
  • “Our results indicate that aerosol and fomite transmission of SARS-CoV-2 is plausible, since the virus can remain viable and infectious in aerosols for hours and on surfaces up to days (depending on the inoculum shed).” 

• “Study: COVID-19 Is Also Spread by Fecal-Oral Route” — Medpage Today (March 9, 2020)
  • “Viral RNA is detectable in fecal samples from suspected cases, indicating that the virus sheds into the stool.”
  • “It is a potentially important finding of relevance to the emergence of COVID-19 globally, but the exact extent of gastrointestinal transmission of the virus remains unclear.”
• “Detection of SARS-CoV-2 in Different Types of Clinical Specimens” — JAMA (March 11, 2020)
  • “Bronchoalveolar lavage fluid specimens showed the highest positive rates (14 of 15; 93%), followed by sputum (72 of 104; 72%), nasal swabs (5 of 8; 63%), fibrobronchoscope brush biopsy (6 of 13; 46%), pharyngeal swabs (126 of 398; 32%), feces (44 of 153; 29%), and blood (3 of 307; 1%).”
  • “Importantly, the live virus was detected in feces, implying that SARS-CoV-2 may be transmitted by the fecal route.”
• “Interim U.S. Guidance for Risk Assessment and Public Health Management of Healthcare Personnel with Potential Exposure in a Healthcare Setting to Patients with Coronavirus Disease (COVID-19).” CDC (March 7, 2020)
  • “For this guidance high-risk exposures refer to HCP who have had prolonged close contact with patients with COVID-19 who were not wearing a facemask while HCP nose and mouth were exposed to material potentially infectious with the virus causing COVID-19.”
  • “Being present in the room for procedures that generate aerosols or during which respiratory secretions are likely to be poorly controlled (e.g., cardiopulmonary resuscitation, intubation, extubation, bronchoscopy, nebulizer therapy, sputum induction) on patients with COVID-19 when the healthcare providers’ eyes, nose, or mouth were not protected, is also considered high-risk.”
  • “(Healthcare personnel) who were wearing a gown, gloves, eye protection and a facemask (instead of a respirator) during an aerosol-generating procedure would be considered to have a medium-risk exposure.”
• American Association for Bronchology and Interventional Pulmonology (AABIP). Statement on the Use of Bronchoscopy and Respiratory Specimen Collection in Patients with Suspected or Confirmed COVID-19 Infection.
  • “Bronchoscopy is relatively CONTRAINDICATED in patients with suspected and confirmed COVID19 infections.”
  • Because it is an aerosol generating procedure that poses substantial risk to patients and staff, bronchoscopy should have an extremely limited role in diagnosis of COVID-19 and only be considered in intubated patients if upper respiratory samples are negative and other diagnosis is considered that would significantly change clinical management.”
  • “Bronchoscopy for any elective reason should be postponed until after full recovery and the patient is declared free of infection.”
  • “Bronchoscopy (Flexible and Rigid) for urgent/emergent reasons should be considered only if a lifesaving bronchoscopic intervention is deemed necessary.”