COVID-19

SARS-CoV-2 testing in transplant patients with respiratory tract symptoms

  • 1.  SARS-CoV-2 testing in transplant patients with respiratory tract symptoms

    Posted 03-16-2020 17:24
    Dear,
    Just want to ask what is the opinion/what are people thinking about/doing with patients (already transplanted) who present with upper respiratory tract symptoms/lower respiratory tract symptoms or community acquired pneumonia?
    Are you only testing for SARS-CoV-2 (virus) in those with symptoms or given there is now community spread and asymptomatic people in the community should we convert to testing all transplant patients for SARS-CoV-2 (virus) with symptoms regardless of the epidemiological link (travel to risk area or direct contact with a known or suspected case)?

    I am increasingly asked to assess and decide on testing in this setting (transplant and no epidemiological risk factor but with respiratory tract symptoms) and in asked for permission to test. It is a trick situation and want to develop local guidelines around this.

    The ISHLT guideline is excellent but is not covering this scenario. Once we develop an opinion then we should this into the guideline.
    Will keep looking to see if there are any updates.

    Thanks,
    Orla


    Prof. Orla Morrissey MB, BCh, FRACP, Grad Dip (Clin Epi), PhD, AFRACMA

    Infectious Diseases Physician,

    Department of Infectious Diseases, Alfred Health

     

    Adjunct Professor, 

    Department of Infectious Diseases, Monash University

     

    Postal address

    Level 2, Burnet Building, 85 Commercial Road, Melbourne, Victoria, 3004, Australia

    T: +61 3 9076 2631 (Office)  T: +61 9076 3009 (PA)  F: +61 3 9076 2431





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    Catherine Orla Morrissey
    Melbourne
    0390762631
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  • 2.  RE: SARS-CoV-2 testing in transplant patients with respiratory tract symptoms

    Posted 03-16-2020 21:27
    Hi Orla,

    At this point, in Canada (54 cases as of March 16th), we have not documented a case of community acquisition (all sample from covid contact or travel related). Nevertheless, i agree, it is most certainly happening. Therefore, we still screen based on risk factors and test those with symptoms AND risk factors. One of the reason being, the testing capacity of our labs is overwhelmed. We currently have 3000 tested sampled waiting to be analyzed and since the demand increased so fast within one week, the lab has not had enough time to adapt. The lab is working on increasing through put but this takes some time and the world crisis limits the supplies available (transport media, swabs, PCR reagents). This is not something physicians readily think about but it is a reality and the lab is trying to compensate but it's a challenge.

    So for now, while the virus is still spread at a small scale in our community, we are NOT screening asymptomatic or those with no overt risk factors (travel, or Covid contact).
    but this will likely change as we find more transmission in the community. To be reassessed in real time.

    Best,

    Me-Linh

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    Me-Linh Luong
    *************************************
    Microbiologiste infectiologue
    Professeure agrégé de clinique
    Microbiologie médicale et infectiologie
    CHUM - Pavillon F
    1050, rue Sanguinet, porte F06.1102F
    Montréal (Québec) H2X 0C1
    Phone : 514 890-8000 poste 36210
    Fax : 514 412-7412
    Email : me-linh.luong.chum@ssss.gouv.qc.ca
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  • 3.  RE: SARS-CoV-2 testing in transplant patients with respiratory tract symptoms

    Posted 03-17-2020 10:42
    Orla,
    The decision has to consider testing capacity at your hospital. In Pittsburgh, we don't have capacity to test everyone yet. We are hoping to ramp up testing availability to 100 tests/day by the end of the week, but access to testing is limited at this point and we are only able to test those who have an epidemiological link.
    Fernanda

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    Fernanda Silveira
    Pittsburgh PA
    (412) 648-6601
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  • 4.  RE: SARS-CoV-2 testing in transplant patients with respiratory tract symptoms

    Posted 03-16-2020 21:46
    Edited by Stuart Sweet 03-16-2020 21:46

    Orla,

    Thank you for this challenging question.  The situation in St. Louis is similar - testing is prioritized to those with an epidemiologic link.  If we had unlimited testing available I suspect we'd support testing anyone with the clinical syndrome.

    I'll ask Me-Linh and others to help me answer the following question that has troubled me.  Although I think I understand the rationale for testing patients with an epidemiologic link (to maximize the value of the testing for containment purposes), if our approach to testing and containment would change if we were certain that community transmission is occurring, why are we reducing the likelihood of finding evidence of community transmission by deferring testing of patients without an epidemiologic link?

    Thanks.

    Stuart Sweet



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    Stuart Sweet
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