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A 53-year-old woman was referred to the gastroenterology clinic for endoscopy because of a submucosal gastric nodule. She had not received a COVID-19 vaccination and lived in Maryland, which had a 7-day cumulative COVID-19 case rate of 70 per 100 000 individuals at the time of her visit. Review of systems was unremarkable except for intermittent abdominal pain. She had no fever, cough, shortness of breath, difficulty breathing, muscle aches, headache, sore throat, anosmia, dysgeusia, or diarrhea. SARS-CoV-2 reverse transcriptase–polymerase chain reaction (RT-PCR) testing prior to the procedure was performed, in accordance with the American Society of Anesthesiologists Statement on Perioperative Testing1 for monitored anesthesia. Results of preoperative testing are shown in Table 1.
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C. Proceed with endoscopy, the patient is clinically recovered and not contagious
SARS-CoV-2 RT-PCR is the primary diagnostic test for COVID-19 (Medicare reimbursement, $75). The test amplifies targeted nucleic acid sequences to detect SARS-CoV-2 RNA. RT-PCR testing detects SARS-CoV-2 RNA at low levels, with analytic sensitivity of 98% and specificity of 97%.2 Analytic sensitivity and specificity refer to RT-PCR detection of SARS-CoV-2 RNA in laboratory samples, while clinical sensitivity and specificity refer to identifying patients with and without COVID-19. Clinical sensitivity is approximately 90% and clinical specificity is approximately 95%.3- 5 Time from symptom onset, specimen source, and user error all affect clinical sensitivity (Table 2). Sensitivity of RT-PCR to detect patients with SARS-CoV-2 that can be cultured and infect others is 99%; however, specificity is limited by persistent detection of noninfectious viral RNA.4,5,7
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Corresponding Author: KC Coffey, MD, MPH, University of Maryland School of Medicine, 10 S Pine St, MSTF 257-B, Baltimore, MD 21201 (email@example.com).
Published Online: September 17, 2021. doi:10.1001/jama.2021.16146
Correction: This article was corrected on October 6, 2021, to correct an error in the Discussion that presented an incorrect positive predictive value for a SARS-CoV-2 test. The Discussion has been corrected and indicates that the positive predictive value of the test for the patient was 6.5%.
Conflict of Interest Disclosures: Dr Diekema reported receiving grants from bioMerieux, Inc for clinical research and personal fees for consulting from Inflammatix, Inc and OpGen, Inc for consulting outside the submitted work. Dr Morgan reported receiving grants from the Veterans Association, Agency for Healthcare Research and Quality, and Centers for Disease Control and Prevention and having an editorial role at Nature Springer outside the submitted work. No other disclosures were reported.
Additional Contributions: We thank the patient for granting permission to publish this information.
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