Because it is an aerosol generating procedure that poses substantial risk to patients and staff, bronchoscopy should have an extremely limited role in diagnosis of COVID-19 and only be considered in intubated patients if upper respiratory samples are negative and other diagnosis is considered that would significantly change clinical management. Alternative respiratory specimen collection in the intubated patient can include tracheal aspirates and non-bronchoscopic alveolar lavage (N-BAL).
Non-bronchoscopic alveolar lavage is probably the most appropriate investigation in patients with COVID-19. The risk of bronchoscopy to healthcare professionals outweighs any significant benefit over Non-bronchoscopic alveolar lavage.
I would say that when you get hit with this, everything is Covid-19. The sickest patients will have positive nasal swabs. I wouldn't go out of the way to get it unless you have very proper protection. I'd recommend a PAPR, or at least n95 plus sealed goggles. We had some people infected through conjunctiva - any mucous membrane is a potential source of entry.
I would avoid all aerosol generating procedures at all costs, unless I can be satisfied that there is a negative pressure room available, that all staff have top level PPE during the procedure, and that the most experienced medical professional is available to perform the task.
The sensitivity and specificity of a diagnostic test depend on several factors. Not just the kit. I do not have any data on the accuracy of the kit.
However the viral load varies with site of sampling. Please see:
Wenling Wang; Yanli Xu; Ruqin Gao; et al Detection of SARS-CoV-2 in Different Types of Clinical Specimens. Jama 2020 (in press).
Although bronchoscopic samples have the highest yield these are invasive and expose healthcare professionals to highest viral load. I would not do a bronchoscopy just to get a sample for SARS-Cov-2. However if I was doing a bronchoscopy on a patient for another reason I would send the sample.
Article Ultrasound in critical care
The understanding of the role of point of care ultrasound in healthcare is exploding. As healthcare systems are overwhelmed it is difficult to perform X-ray, CT, MRI and nuclear medicine. Small handheld portable Ultrasound devices have transformed the bedside assessment and diagnosis of patients with Covid-19. There is a great interest in research in this topic during the Covid-19 pandemic.
Anyone interested in an overview of POCUS may find the brief review above helpful.