Joint CBC-ICT Interpretation for the pre-surgical screening of COVID 19 asymptomatic cases: A cross-sectional study

Background On 26th, February 2020, first cases of COVID 19 were confirmed in Pakistan. Since then, surgeries were halted in a bid to prevent transmission. However, since such a long halt is infeasible, a general protocol of screening the carriers, especially asymptomatic carries, is a dire need of time. The objective of our study is to propose an economically feasible protocol of COVID 19 screening. Simple but effective screening strategies can help to restore the workings of hospital surgical departments. Methods We analyzed the clinical data of patients turning up for elective surgeries at the Rawal General Hospital (RGH), Islamabad from the 24th of March to the 15th of May, 2020. Asymptomatic patients with negative COVID 19 contact and travel histories were screened with COVID 19 Immunochromatography (ICT) IgM / IgG Ab Test. Complete blood count (CBC) was done and interpreted in conjunction with the ICT results. Results 39 patients with a mean age of 49 years were studied. The result of ICT for COVID-19 was positive in 9 cases (23%). The entire positive ICT patients population expressed significantly lower lymphocyte count (p<0.01); 8 patients had high monocyte count (p<0.05) whereas only 4 patients had a combined high neutrophil and monocyte count (P<0.05). All of these four patients with high neutrophil count were females. The combined interpretation of CBC and ICT IgM / IgG Ab Test had a high accuracy in diagnosing asymptomatic COVID-19 carriers that were later confirmed by real-time reverse transcriptase-polymerase chain reaction (rRT-PCR). Conclusion We propose that joint CBC-ICT interpretation should be adopted on a large scale to help in the diagnoses of asymptomatic carriers as both tests are simple and inexpensive and thus suit the developing countries limited health budget. Future research projects should be adopted in order to assess the accuracy of the proposed protocol on a large scale. Keywords: COVID-19, Surgery, Asymptomatic carriers, ICT, CBC.