Viral infectivity in COVID-19 patients undergoing tracheotomy

Introduction: The purpose of this study is to establish the infectivity of COVID-19 patients at the time of surgical tracheotomy. Method: This is a prospective single-institution study across 3 hospital sites during the United Kingdom's first wave of the COVID-19 pandemic in 2020. Intubated and ventilated patients for respiratory wean tracheotomy underwent SARS-Cov-2 polymerase chain reaction (PCR) nasal, throat, and endotracheal tube swabs at the time of planned surgical procedure. These were assessed via quantitative real-time reverse-transcription PCR. The tracheal tissue windows excised during the tracheotomy were cultured for SARS-Cov-2 using Vero E6 and co2 cells. Serum taken at the time of procedure was also assessed for antibody titers against SARS-Cov-2, via neutralization assays. Results: A total of 37 patients were included in the study. PCR swab testing yielded 9 positive results. None of the 35 individuals who underwent tissue culture were positive for SARS-CoV-2. All 18 patient who had sera sampling demonstrated neutralization antibodies at a minimum titer of 1:80. There was no correlation between sample CT values nor sample quantities with the number of days since the onset of symptoms (P > .05). Conclusion: Our results did not demonstrate COVID- 19 infectivity at the time of tracheotomy. The authors agree that the data do not undermine national and international guidance on tracheotomy after day 10 of mechanical ventilation and using FFF3/N95 masks. However, given the length of time to procedure in our data, infectivity at 10 days cannot be ruled out. We do, however, advise that a preoperative negative PCR swab is not necessary. We also recognize that antibody titer levels may serve as a useful adjunct for assessment of infectivity in these patients.