Systematic application of COVID-19 nucleic acid tests in general surgery departments in China: An update of current status with nationwide survey data.

Editor,

Nucleic acid test has now become a primary approach for the screening of the COVID-19 virus in China for its high availability and quick result. It was one of the primary diagnosing methods according to the latest version of the Chinese Protocol of COVID-19 Diagnosis and Management [1], and has also become the key component in our current daily surgical workflow [2,3].

Nowadays (Jul. 20, 2020), as far as Beijing Municipality are concerned, almost all hospitals inside the city require a recent negative nucleic acid test for a patient to be ward-admitted via surgical outpatient, which serves as part of our governmental effort to “conduct medical activities in the new normal circumstances (of COVID-19)”. To get a clear and whole picture on the current application of nucleic acid test in the daily workflow of surgical departments across China, we conducted an online survey within our nationwide surgical community. A total of 1010 general surgeons from 589 hospitals responded to the survey in the first 48 hours since it was open on Jul. 5, 2020. Of all the respondents, 75% were from outside of Beijing and 25% from inside; By personal ranks 47% were chief surgeons, 27% were associate chief surgeons, and the other 26% were attendings and residents; By hospital size 87% respondents were from Class 3 hospitals (medical centers) and 13% from Class 1 or 2 hospitals (smaller hospitals). After initial analysis on the distribution of answers, we excluded answers from respondents who were the sole participant of his/her hospital, that is to say, only if a hospital has two or more surgeons participating in our survey would then the hospital be included in our in-depth analysis, so that we can assess the credibility of the answers by the in-hospital consistency.

The results from the survey were displayed in Table 1 , in which the protocols in different clinical scenarios all turned out in line with the current protocols that was strictly observed in Beijing hospitals, suggesting that hospitals across the country are more or less on the same page when adapting to the COVID-19 new normal. Considering the fact that 0 confirmed COVID-19 cases was ever discovered in all surgical departments within Beijing City, these measures might therefore be useful for colleagues around the world, despite the fact that we cannot be so sure about this “zero infection” outcome in other parts of the country. To summarize the surveyed current situation in China, majority of hospitals are equipped with a specialized fever clinic and majority of them are open 24 hours a day; majority of patients presenting fever in surgical outpatients and surgical ERs will receive mandatory COVID-19 screening (by nucleic acid test, pulmonary CT or other measures); majority of post-operative fevers will receive COVID-19 screening, where nucleic acid tests are mostly not mandatory and instead simpler measures (e.g. routine blood test) are more often applied; majority of hospitals require a negative nucleic acid test for each admission through outpatient; a small proportion (9%) of hospitals do not require a negative nucleic acid test for each admission through surgical ER though, yet most of these surgical departments set up buffer ward rooms for emergency/critical admissions; majority of nucleic acid tests across the country were conducted by throat swabs rather than nasal swabs.

Table 1

Results of the online questionnaire survey.

Total respondents/Number of hospitals involved/Number of hospitals with 2 or more respondents each	Questions	All votes	Number and proportion of hospitals with 2 or more respondents whose answers were consistent	Votes from hospitals with 2 or more consistent answers (one hospital one vote)
1010/589/148	1. Is your hospital equipped with a specialized fever clinic?	Image 1	128, 86% (128/148)	Image 2
	2. Is the fever clinic in your hospital open for 24 hours a day?	Image 3	130, 88% (130/148)	Image 4
	3. What to do with patients presenting fever symptoms at surgical outpatient?	Image 5	142, 96% (142/148)	Image 6
	4. What to do with emergent/critical patients presenting fever symptoms at surgical ER?	Image 7	130, 88% (130/148)	Image 8
	5. Do patients presenting post-operative fevers in surgical wards receive mandatory nucleic acid tests?	Image 9	58, 39% (58/148)	Image 10
	6. Are negative results of nucleic acid tests required for any and all admissions via outpatient?	Image 11	125, 84% (125/148)	Image 12
	7. Are negative results of nucleic acid tests required for any and all admissions via surgical ER?	Image 13	79, 53% (79/148)	Image 14
	8. What is the approach to conduct sample extraction for nucleic acid tests for patients waiting to be admitted in your hospital?	Image 15	96, 65% (96/148)	Image 16
	9. What is the approach to conduct sample extraction for nucleic acid tests for patients presenting post-operative fevers in your hospital?	Image 17	73, 49% (73/148)	Image 18

Provenance and peer review

Not Commissioned, internally reviewed.

Data statement

All research data are available via reasonable email request towards the correspondent author.

Funding

None.

Author contribution

K.P: study design, data analysis, writing.

L.J : data analysis,consultation.

Z.Z: study design, data collections.

Guarantor

Zhongtao Zhang.

Ethival approval

Not applicable.

Declaration of competing interest

None.