Looking Back on the Safety of Bronchoscopy at the Start of the Pandemic

Preventing Infection

COVID-19 Guidelines: Did They Work?

Healthcare workers desperate to save lives, protected themselves as best they could with PPE and carried on with their work, despite all the unknowns of the virus.

When the COVID-19 pandemic first started sweeping the globe, multiple international societies published guidelines calling for limited use of bronchoscopy in the care of suspected or confirmed SARS-CoV-2 patients — some suggesting using single-use scopes when the procedure was deemed necessary.

Among the organizations that weighed in on the conversation were CHEST, the American Association for Bronchology and Interventional Pulmonology (AABIP), and many others.

Now, more than a year into the global pandemic, Drs. Abhishek Sarkar, Abhinav Agrawai and others have reviewed a collection of studies. Their aim was to determine the safety of bronchoscopy during this period when performed using effective personal protective pquipment (PPE), namely the use of gloves, gowns, eye and hair protection, and N-95 or equivalent respirators. 

As a practical matter, doctors in places like New York City, who confronted some of the highest rates of COVID-19 in the U.S. in spring 2020, faced a difficult choice.

Bronchoscopies had all but halted and people were dying in terrifying numbers. Patients poured into the hospital filling an entire new floor the same day one would open.

Those were the days when transmission was not clearly understood, asymptomatic cases were not fully recognized, and medical personnel were staying in hotels to avoid the risk of endangering their families with the virus.

Healthcare workers, desperate to save lives, protected themselves as best they could with PPE and carried on with their work, despite all the unknowns of the virus.

Dr. James M. Horowitz, medical director of NYU’s Cardiac Care Unit and a clinical assistant professor at NYU Langone Medical Center, and his team were among those who made the decision early on to reinstate bronchoscopies, at the same time meticulously managing their PPE.

Due to shortages, they cleaned and reused masks and sometimes wore expired N-95s. But no one on their bronch teams got sick, Horowitz said in an Ambu-sponsored webinar that aired in August 2020.

Going forward, Horowitz said in a recent interview with Single-Use Endoscopy, he is also endorsing single-use bronchoscopes as a primary visualization tool in his ICU after the pandemic, citing their infection prevention and workflow efficiency benefits.

In retrospect, the recent study review published in CHEST showed similar findings from around the world regarding the power of PPE to prevent infections. In studies from Italy, Spain, and the Northwestern School of Medicine in Chicago, the use of gloves, gowns, eye and hair protection, and N-95 or equivalent respirators was found to mitigate the risk of SARS-CoV-2 infections among bronchoscopists.

Three of the studies reviewed by the doctors documented the added value of bronchoscopies in detecting superimposed infections in patients with COVID-19.

Also, wide recognition of asymptomatic spread has clarified the need for testing of clinicians before and after bronchoscopy, along with additional clinical study focused on healthcare workers’ safety, the review authors write.

“Research from the last year has provided invaluable insights into the efficacy and safety of bronchoscopy during the COVID-19 pandemic, but further prospective studies with standardized timing to screen bronchoscopists for SARS-CoV-2 infection are warranted to refine societal guidelines,’’ Sarkar and his review co-authors write.

Understanding the current pandemic is vital in preparation for possible future pandemics. The guidelines offered at the start of this pandemic were hastily made based on what was known at the time, which was scant information.

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