We have read with great interest the recently published article by Aziz et al.  in which they observed that patients with a positive COVID-19 test within 2 weeks of surgery had higher probabilities of postoperative pulmonary complications (14% vs. 10%) and mortality (4.6% vs. 2.5%) when compared with patients with a negative test. Early detection of infections provides critical information when programming and planning surgeries and guaranteeing patient and health-worker safety. There are some observations we want to point out regarding our current practice after the pandemic. COVID-19 tests, in particular antigen and polymerase chain reaction tests, have demonstrated their efficacy in identifying positive cases, including asymptomatic ones.  Positive results were the basis for rescheduling policies during the pandemic for nonurgent cases, in a period in which vaccination was still not available.  Considering that patient and health-worker safety is always imperative, preoperative screening for COVID-19 is not as clear in this new sanitary context. 

The status of COVID-19 vaccination worldwide reflects both the success achieved in some countries and the gaps that persist in others. Recent data demonstrate substantial progress implementing mass vaccination against COVID-19. According to the World Health Organization more than 10 billion vaccines have been administered worldwide.  On the downside, distribution has not been equitable, and there are significant disparities in coverage between high- and low-income countries. Countries like the United States, the United Kingdom, and countries in the European Union have achieved high percentages of vaccination exceeding 50% of their population. This accomplishment has had an impact on infection rates and has allowed modifications in social restrictions. In low-income countries, the situation is less optimistic. The uneven distribution of vaccines resulted in limited access, and many countries are still struggling with vaccine acquisition and administration. Many countries report only 10% coverage, for example.

Having mentioned this and correlating with the results reported by Aziz et al.,  we consider it important to have clear recommendations for preoperative COVID-19 screening in a nonvaccinated population (individuals who have not received the number of doses of a COVID-19 vaccine corresponding to that product’s primary series ), considering that mortality is twice as high in cases in which tests are positive within 2 weeks of surgery. The World Health Organization supports herd immunity through vaccination, not through natural infection.  Countries that do not have full vaccine coverage have not achieved herd immunity and have a percentage of their population at risk for infection and transmission. These are the individuals on whom screening policies should be focused.

The results from this study are also an invitation to consider the need for screening high-risk groups (for example, unvaccinated during seasonal peaks) in the context of other viral respiratory infections such as influenza, rhinovirus, and respiratory syncytial virus. As with influenza and other viruses, COVID-19 is ever changing, and newer variants are not expected to be fully covered with our current vaccines. The seasonality of these infections can have a correlation with surgical outcomes during peaks. This phenomenon has been studied in patients with elective cardiothoracic surgery, in which postoperative mortality during influenza endemics is higher as are readmission rates within the first 30 days after surgery.  Studying the impact of preoperative screening for these infectious conditions can help us optimize our daily practice and provide better outcomes for our patients in a world in which technology and research allows us to have better diagnostic tools and protocols within our grasp.