Is Universal Testing for Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Needed on All Labor and Delivery Units?

A s the coronavirus disease 2019 (COVID-19) pandemic evolves across the globe, there is increasing interest in screening and surveillance for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), known to cause COVID-19 infection. The experience from two New York City hospitals at the epicenter of the pandemic in the United States has largely driven obstetric practice. These hospitals reported a 15% prevalence of SARS-CoV-2 infection among laboring women, with the majority presenting without symptoms.1 Based on these data, many centers have implemented screening protocols in which all pregnant women are tested for SARS-CoV-2 at the time of admission for labor regardless of symptoms. In this context, SARS-CoV-2 polymerase chain reaction (PCR) testing is being employed as a screening tool for COVID-19 infection among both symptomatic and asymptomatic women. In this issue of Obstetrics & Gynecology (see https://journals.lww.com/greenjournal/toc/publishahead), there is a series of Research Letters related to universal screening focusing on how screening can be tailored,2 as well as the differential prevalence of COVID-19 infection by region.3,4 These articles raise questions as to the utility of universal screening of all laboring women in the United States with SARS-CoV-2 PCR. To evaluate whether screening for SARS-CoV-2 infection is justifiable, one can return to the principles of screening as originally described by Wilson and Jungner5 in 1968 for the World Health Organization. These original screening principles focused on the importance of the health problem, natural history of the disease, availability of a suitable test, acceptability to the population, cost of case finding, and availability of a treatment. Since theWilson and Jungner publication, the principles have been expanded to include a focus on the ethics of screening and balancing the benefits and harms to the patient and society, as well as capacity to operationalize large screening programs.6 In modern-day obstetrics, one must consider all of these principles when deciding whether to implement a universal screening protocol for SARS-CoV-2 infection in laboring women. Coronavirus disease 2019 infection clearly represents an urgent public health crisis and an important disease to detect in the general community as well as the hospital. This alone may justify universal screening. Also, the benefits of universal screening are clear. Despite no efficacious treatments for mild to moderate COVID-19 infection (thereby violating one of the fundamental tenets of screening), knowledge of the disease state allows: 1) health care workers to wear appropriate personal protective equipment to avoid exposure; 2) women to be counseled about ways to decrease transmission to neonates; and 3) those with COVID-19 infection to be monitored closely, with a low threshold for clinical intervention. However, the decision to implement universal screening is extraordinarily complex at the individual facility level and Dr. Metz is from University of Utah Health, Salt Lake City, Utah; email: torri.metz@hsc.utah. edu.