The practicalities of COVID's impact on nuclear cardiology.

The coronavirus pandemic was labeled as “COVID-19” although the reality, as we all know, goes far beyond 2019-2020. This is all the more reason to appreciate the information statement by Thompson et al[1] which acknowledges the realities of the status quo—this is now about the evolved situation. We are now dealing with a chronic endemic state. Cardiac testing is still some way from pre-pandemic levels and deficiencies are more evident in some locations than others.[2]

This is not helped by the fact there are still many in the mindset of the containment phase, which as Thompson et al[1] mentioned, emphasised lockdowns, quarantines, and curfews. The evolution of the process is now making us highlight variants, vaccination rates, and re-infections. Simply, the changed circumstances should dictate how we approach these challenges. More importantly, as they point out, we need to have clarity on choice of stress modality. Exercise was often displaced by pharmacological methods given its propensity to aerosolization.

They rightly considered several factors in determine the stress modality including availability of personal protective equipment, room ventilation systems, local infection rates, local vaccination rates, and individual vaccination status.[1] They also alluded to pre-test COVID-19 screening. A method we have found practical in this situation is to employ rapid antigen tests (RATs) before exercise stress testing. This may alleviate anxieties—in patients, staff, and the public. RATs may be adequate to identify contagious patients.[3] The ability to deliver a result far faster than polymerase chain reaction tests may cause minimal disruption—and a practical approach—to maintaining nuclear cardiology procedures. If so, would that be appropriate to add pre-procedure RAT to the recommendations provided in Table 3?