This week’s COVID-19 Response Update is a featured piece written by our medical consulting partner, Cogency. For more information on medical testing in the workplace to ensure a safe return-to-work program, contact the Cogency team today.
Diagnostic and surveillance testing for COVID-19 provide important information for physicians and public health professionals. This includes guiding recommendations that promote safety and health for both individuals and the larger population.
How should we apply this to the workplace? The Occupational Health and Safety Administration (OSHA) general duty clause states that “employers should furnish a workplace that is free from recognized hazards.” So, the questions are:
- Why is COVID-19 testing important for business?
- Is COVID-19 testing the answer for you?
- What are the special considerations for employers?
The State of Testing
Stories about COVID-19 testing continue to saturate news and social media outlets. Current testing is focused on two areas:
- Diagnosis (individuals), or who has the COVID-19 infection
- Surveillance (populations), or who has been infected, who is immune and who might be susceptible
Tests to diagnose active infection use a laboratory technique called real-time reverse transcriptase polymerase chain reaction (rRT-PCR). It detects whether the COVID-19 virus ribonucleic acid, or RNA—a nucleic acid in all living cells—is present in a specimen of a patient’s respiratory secretions. The test is ordered by a physician, collected by a healthcare professional and sent to a private or Centers for Disease Control (CDC) lab for processing. While these tests are rapid, current backlogs mean it may take days to receive results.
What does this mean for you?
Identification of infected persons is important to contain the spread of disease. Individuals with possible COVID-19 symptoms can be quickly diagnosed or ruled out. Such knowledge can conserve resources and facilitate more efficient contact tracing. It may also reduce productivity loss as the number of workers lost to self-isolation should be reduced. However, because this test is a snapshot in time, it may need to be periodically repeated.
The Centre for Evidence-Based Medicine (CEBM) says that the ability to move diagnostic testing from laboratory settings to point of care (POC)—at the time and place of patient care—is potentially transformative. This is true for both the rate and quantity of testing that could be done. POC tests are processed immediately, and the results are available in most cases within 15 minutes of collecting the specimen. There are currently several POC tests available.
Estimates suggest that the POC testing sensitivity rate, which is the ability of a test to correctly identify those with the disease, is 60-70 percent. This is known as the true positive rate. While
these tests are good, they are dependent on how much virus a person is shedding, how the test is collected and how long it sits in transport before being analyzed. Additionally, important gaps remain in screening people including those who may be in the incubation phase—a period in which someone is asymptomatic but still able to spread the virus. Because of these variables and test sensitivity/ reliability issues, it should be viewed as a piece of the puzzle in your management of workplace safety program related to COVID-19.
If someone tests positive for COVID-19, then public health measures, such as quarantining and contact tracing, can begin. These actions are essential for controlling the spread of the disease. In other countries, diagnostic testing on a massive scale has been highly successful in containing COVID-19 spread. By contrast, testing in the United States has been limited to specific high-risk groups. This, obviously, means we are missing a lot of people. Without widespread COVID-19 testing beyond these high-risk groups, containment is difficult and we must supplement through nonpharmaceutical interventions (NPI), or community mitigation and social/physical distancing.
What does this mean for you?
Because this is a novel virus, our testing knowledge is incomplete and ever-evolving. We expect both diagnostic (and surveillance antibody) testing to become more reliable with rapid turnaround time that can be done on-site to assist with your workplace resiliency and continuity of business operations.
Antibody Surveillance Testing
There are newer options known as serological tests that can identify whether someone has developed COVID-19 antibodies, which means there may be immunity. Like the diagnostic tests, these currently require a physician prescription and must be collected by a healthcare provider. They may help to contribute to overall surveillance of the virus, but it’s important to understand that we must analyze the results of these tests very carefully. The mere presence of antibodies does not necessarily mean that someone is immune or that he is not actively shedding the virus. There is still a significant amount of research needed on the active long-term immunity for COVID-19.
What does this mean for you?
New POC antibody tests are being developed rapidly and the test reliability is expected to continue to improve. POC testing is expected to be widely accessible in the near future and may become an important piece to the return of the workforce. Employers need to be aware of the pros and possible issues of any testing program.
The COVID-19 pandemic continues to be fluid and evolving, and the deluge of information (and misinformation) is constant and may seem overwhelming. We are here to help you streamline and interpret this information and to guide you and your business about the best strategies for characterizing risk and reducing exposure in your workplace.
For assistance related to medical screening and testing for your COVID-19 return to work safety plan, contact Dr. Cheung and the Cogency team today.