To the Editor: SARS-CoV-2, the pathogen responsible for the COVID-19 pandemic, presents a spectrum of disease severity, ranging from asymptomatic infection to pneumonia and fulminant respiratory failure. Although asymptomatic SARS-CoV-2 infection has been well-documented, data regarding the prevalence of asymptomatic infection in patients scheduled for ambulatory procedures are limited.1, 2, 3, 4 However, knowing asymptomatic prevalence rates could be helpful to dermatologic surgeons at increased risk of SARS-CoV-2 transmission given their case mix, which includes a bulk of procedures performed on the head and neck. Herein we present the results of a universal COVID-19 screening protocol in asymptomatic patients scheduled for dermatologic surgery within a community-based outpatient center.
We performed a retrospective chart review assessing patients scheduled for a dermatologic surgery involving the head and/or neck from June 1, 2020, to March 1, 2022, at our outpatient center based in Glenview, Illinois, a northern suburb of Chicago. As a part of our institutional protocol, all patients underwent preprocedural SARS-CoV2 reverse transcription-polymerase chain reaction testing 3 days before their planned procedures. A patient’s asymptomatic status was subsequently confirmed through a telephone encounter 1 or 2 days after testing was performed. The primary outcome was the prevalence of asymptomatic SARS-CoV-2 infection, determined by a positive SARS-CoV-2 reverse transcription-polymerase chain reaction result. Secondary outcomes included the overall positivity rate and group demographics.
One thousand, one hundred eighteen patients, with an average age of 67.2 years, were included (Table I ). A slight majority of men (59.2%) and a large majority of patients identified as White (94.9%). Nineteen of 1118 (1.7%) patients tested positive for SARS-CoV2. Fourteen of these 19 were confirmed as asymptomatic, resulting in an overall prevalence of asymptomatic SARS-CoV-2 infection of 1.3% (Table II ). The asymptomatic group had a mean age of 63.3 years and was comprised of a slight majority of women (57.1%).
Table I.
Demographics of the asymptomatic study population
| Characteristic | All patients, n = 1118 |
|---|---|
| Age, mean (range), y | 67.2 (15-99) |
| Sex, n (%) | |
| Male | 662 (59) |
| Female | 456 (41) |
| Ethnicity, n (%) | |
| White | 1062 (95) |
| Hispanic | 15 (1) |
| African American | 1 (0) |
| Asian | 9 (1) |
| Other | 16 (1) |
| Declined | 15 (1) |
Table II.
Demographics among the 14 asymptomatic patients with positive testing
| Characteristic | Asymptomatic patients, n = 14 |
|---|---|
| Age, mean (range), y | 63.3 (21-95) |
| Sex, n (%) | |
| Male | 6 (43) |
| Female | 8 (57) |
| Ethnicity, n (%) | |
| White | 13 (93) |
| Hispanic | 1 (7) |
| African American | 0 (0) |
| Asian | 0 (0) |
Glenview, Illinois, is in North Suburban Cook County, with an estimated population of 961,000. North Suburban Cook County has had a total of 20,543 COVID-19 cases per 100,000 people since February 15, 2020, and an average COVID test positivity rate of 5.2% over the time period examined in this study.5 Our data demonstrate a higher prevalence rate of asymptomatic infection when compared with the prevalence rate of 0.5% observed in a study examining elective endoscopy procedures in a similar study setting and a rate of 0% observed in 1 study examining both ambulatory and nonambulatory otolaryngologic procedures.1 , 4 Though likely multifactorial, these differences could largely be explained by our longer study period and inclusion of the peak winter months in which most of our cases were diagnosed. Additional studies with larger sample sizes are needed to characterize better the regional prevalence of asymptomatic SARS-CoV-2 infection in the ambulatory periprocedural setting. Data derived from such studies could inform periprocedural protocols that best balance the safety of hospital staff and patients with the potential morbidity associated with delays in dermatologic surgery.
Conflicts of interest
None disclosed.
Footnotes
Funding sources: None.
IRB approval status: Reviewed and approved by Northwestern University institutional review board; approval # 214534.
References
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