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Screening all pregnant women admitted to labor and delivery for the virus responsible for coronavirus disease 2019

      To the Editors:
      We read with great interest the study of Vintzileos et al and their call for universal obstetrical coronavirus disease 2019 (COVID-19) screening to conserve limited personal protective equipment (PPE) and to allow appropriate triage, adequate obstetrical and neonatal management, and safe patient transport in overcrowded hospitals.
      • Vintzileos W.S.
      • Muscat J.
      • Hoffmann E.
      • et al.
      Screening all pregnant women admitted to labor and delivery for the virus responsible for COVID-19.
      However, we disagree with their call for universal COVID-19 testing of asymptomatic pregnant women, rather we suggest continued adherence to the public health guidelines for COVID-19 diagnostic testing.
      World Health Organization (WHO)
      Advice on the use of point-of-care immunodiagnostic tests for COVID-19.
      ,
      Centers for Disease Control and Prevention (CDC)
      Testing for COVID-19. 2020.
      The COVID-19 test is extremely specific because it identifies the viral RNA to which the individual has been exposed during the preceding 21 days. The viral load peaks between 7 to 10 days after onset of symptoms and declines throughout the next 3 weeks. Detection is performed by the highly specific (96% specificity) polymerase chain reaction.
      • Cheng P.K.
      • Wong D.A.
      • Tong L.K.
      • et al.
      Viral shedding patterns of coronavirus in patients with probable severe acute respiratory syndrome.
      The false-negative test rates for this test range from 30% to 3% in asymptomatic and symptomatic populations, respectively.
      • Wang W.
      • Xu Y.
      • Gao R.
      • et al.
      Detection of SARS-CoV-2 in different types of clinical specimens.
      A positive COVID-19 test result provides no information regarding the individual’s current or future ability to transmit the virus. We therefore recommend continued use of universal PPE during testing, limited to diagnosis in disease management, and as the foundation of a contact public health tracing program. We ask the authors whether there was any difference in the temperature upon admission between women who received positive test results for COVID-19 and women who received negative test results for COVID-19.

      References

        • Vintzileos W.S.
        • Muscat J.
        • Hoffmann E.
        • et al.
        Screening all pregnant women admitted to labor and delivery for the virus responsible for COVID-19.
        Am J Obstet Gynecol. 2020; ([Epub ahead of print])
        • World Health Organization (WHO)
        Advice on the use of point-of-care immunodiagnostic tests for COVID-19.
        (Available at:)
        • Centers for Disease Control and Prevention (CDC)
        Testing for COVID-19. 2020.
        (Available at:)
        • Cheng P.K.
        • Wong D.A.
        • Tong L.K.
        • et al.
        Viral shedding patterns of coronavirus in patients with probable severe acute respiratory syndrome.
        Lancet. 2004; 363: 1699-1700
        • Wang W.
        • Xu Y.
        • Gao R.
        • et al.
        Detection of SARS-CoV-2 in different types of clinical specimens.
        JAMA. 2020; 323: 1843-1844

      Linked Article

      • Screening all pregnant women admitted to labor and delivery for the virus responsible for coronavirus disease 2019
        American Journal of Obstetrics & GynecologyVol. 223Issue 2
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          The coronavirus disease 2019 (COVID-19) pandemic sharply escalated in the United States in March and April of 2020. General medical and obstetrical guidelines for managing suspected or confirmed COVID-19 cases mostly rely on maternal symptoms or close proximity to positive contacts to trigger testing and subsequently diagnose COVID-19.1 However, it has become apparent that most cases of COVID-19 are the result of viral dissemination from asymptomatic individuals.2 Persons who may unknowingly spread COVID-19 are often young and healthy, which fits the demographic of many obstetrical patients.
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      • Reply
        American Journal of Obstetrics & GynecologyVol. 223Issue 3
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          We would like to thank Dr Henderson et al for their interest in our article and for raising some interesting points. Dr Henderson et al disagree with our proposal for universal coronavirus disease 2019 (COVID-19) testing of women admitted to labor and delivery. To support their position, they cited the Centers for Disease Control and Prevention (CDC) report produced in the early stages of the COVID-19 pandemic.1 However, at that time, testing capacity was limited, and the degree of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) transmission from asymptomatic patients was uncertain.
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