Changing with the times: refining our mitigation strategies and policies as COVID evolves

Reviewed by Cindy Noyes, MD; University of Vermont Medical Center

As population immunity for COVID-19 has increased and treatment is widely available, some of the initial strategies used to reduce risk may warrant re-examination—specifically, recent studies have examined asymptomatic surveillance in US nursing homes and the impact of surgery deferral after COVID-19 diagnosis.

McGarry and colleagues performed a retrospective study using National Health Safety Network data reported by US nursing homes, evaluating testing frequency and risk of outbreak and attributable deaths due to COVID-19.1  Early in the pandemic and prior to vaccination, those facilities testing in the highest percentile frequency identified more healthcare worker infections and consequently reported fewer resident infections and deaths due to COVID 19 as compared to facilities who tested in the lowest percentile.1  During the Omicron era, more frequent testing was associated with fewer nursing home resident cases, but deaths were similar in both groups, suggesting that factors such as rising population immunity and availability of effective treatments may be becoming more influential in disease outcome versus serial asymptomatic testing.1   

Delay in elective procedures after COVID-19 infection was a strategy used to reduce risk of post-operative complications.  O’Brien et al describe their cohort study assessing for post-operative complications among members of the Veteran’s Administration receiving surgery from Jan 1 through Sept 31, 2021 with and without antecedent COVID infections.2  They evaluated 29,093 patients, many of whom were inpatients, who had surgeries performed in 129 different hospitals.2  They evaluated for multiple complications, including: death, cardiac and neurologic events, respiratory failure, surgical site infection and venous thromboembolic episodes, all within 30 days of surgery.2  Adverse effects in each group were not statistically significantly different from one another, suggesting that timing of surgery after COVID infection may not be a risk factor warranting delay of care at this time.2 


  1. McGarry B, et al.  Covid-19 surveillance testing and resident outcomes in nursing homes.  NEJM.  20233: 388: 1101-10. 
  2. O’Brien W, et al.  Estimated risk of adverse surgical outcomes among patients with recent COVID-19 infection using target trial emulation methods.  JAMA Network Open.  2023: 6(3): e234876. 
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