[MCOH-EH] Use COVID antibody results for return to work management?

[Abhijay Karandikar]

 Bill,

Our COVID-19 return to work criteria have rapidly evolved over the past few weeks as the pandemic has spread. Due to all of the issues related to testing until now (we are following antibody testing keenly), we have deliberately kept testing out of our return to work algorithms from the start. Additionally, in discussion with and as recommended by our IP folks and based on CDC guidelines, we discontinued contact tracing and quarantining based on exposure some time ago. Since there is community transmission in our area/state and since we have a mandatory masking policy and expect everyone to abide by our infection control policies (strict hand hygiene, N-95s while performing aerosolization and other high risk procedures, etc.), we only isolate employees based on symptoms. 

Abhijay

Abhijay P. Karandikar, MD, MPH, FACOEM
Reading Hospital, PA     On Monday, April 20, 2020, 03:30:30 PM EDT, William. Scott <william.scott at carle.com> wrote:  
 
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Thanks for opening up on this discussion. I agree with many of these point. We are about ready to start Ab testing HCWs in our institution but we do not know how yet to interpret the testing. We hope like in other viral IgG responses there will be protection.
 
  
 
Additionally my institution will start test asymptomatic HCWs via PCR (since it is readily available now) . How would one dealing with asymptomatic Positive PCR COVID-19. Do you take then off work/isolate for stand 7 days (CDC guideline) or let them work with masks?
 
  
 
Curious what other would do?
 
  
 
Bill
 
  
 
William Scott, MD, MPH, FACOEM
 
Clinical Assistant Professor, Carle Illinois College of Medicine,
 
Clinical Assistant Professor, University of Illinois College of Medicine at Urbana-Champaign 
 
Head, Occupational & Envionmental Medicine & Employee Health
 
Carle Foundation Hospital, Carle Physician Group.
 
  
 
O 217-383-5383
 
M 217-372-4819
 
  
 
From: MCOH-EH <mcoh-eh-bounces at mylist.net>On Behalf Of Swift, Melanie D., M.D., M.P.H. via MCOH-EH
Sent: Monday, April 20, 2020 1:15 PM
To: 'mcoh-eh at mylist.net' <mcoh-eh at mylist.net>
Cc: Swift, Melanie D., M.D., M.P.H. <Swift.Melanie at mayo.edu>
Subject: [EXT] Re: [MCOH-EH] Use COVID antibody results for return to work management?
 
  
 
| _______________________________ *****EXTERNAL EMAIL SOURCE*****  |


Good question and one we are all grappling with I think. We have a tool available, but aren’t quite sure if/how/when to use it.
 
  
 
·        About 80% of COVID-infected individuals develop IgG by day 14, and almost 100% develop it by day 30.
 
·        Some people with a new positive IgG still have detectable viral RNA by PCR in nasopharyngeal swabs.
 
·        The PCR can’t tell whether that viral RNA represents viable, replication-competent virus; so we have to assume a person who is PCR-positive may be still communicable.
 
·        We don’t yet know whether a positive IgG always represents neutralizing antibody and thus presumptive immunity.
 
o  One study, in preprint and not peer-reviewed, found that 2 macaques who had recovered from COVID-19 and developed IgG were rechallenged 28 days later with the same strain and remained asymptomatic.
 
o  Promising but a far cry from feeling comfortable that we can declare someone immune.
 
·        We don’t know how durable any immunity, if present, lasts.
 
  
 
So my personal take on this is:
 
·        IgG is not helpful in determining safety to RTW.
 
·        IgG may be helpful diagnostically, especially when an individual was not tested with PCR early in their illness course, and now appears to have late complications of COVID-19. The virus may be only replicating in the lower airway and nasal PCR could be negative. An IgM or IgG that was positive would help make the diagnosis.
 
·        If we find evidence of neutralizing antibodies and durable immunity, and we have a vaccine that is in short supply, the test could help us develop a vaccine prioritization.
 
·        If we find evidence of neutralizing antibodies and durable immunity, and we have another wave of hospitalized patients, IgG could help us identify HCP at lower risk, and this could be used in some sort of cohorting strategy. 
 
  
 
My 2 cents only,
 
  
 
Melanie
 
  
 
Melanie Swift, MD, MPH
Medical Director, Mayo Clinic Physician Health Center
 
Associate Medical Director, Occupational Health Service
 
Senior Associate Consultant
 
Assistant Professor of Medicine
 
Division of Preventive, Occupational, and Aerospace Medicine
 
Phone 507.284.2560
 
_______________________________
Mayo Clinic
200 First Street SW
Rochester, MN 55905
www.mayoclinic.org
 
  
 
From: MCOH-EH [mailto:mcoh-eh-bounces at mylist.net]On Behalf Of Thorne, Craig
Sent: Monday, April 20, 2020 12:01 PM
To: 'mcoh-eh at mylist.net'
Subject: [EXTERNAL] [MCOH-EH] Use COVID antibody results for return to work management?
 
  
 
Good afternoon everyone,
 
  
 
I am curious about current opinion on how you plan to use COVID antibody results for return to work management?  
 
  
 
At this point in the pandemic, we are not requiring home isolation for exposed essential HCWs regardless of their source of exposure.
 
  
 
Given all the literature about the uncertainties with COVID antibody testing, a discussion about this on this list serve could be interesting.
 
  
 
Thank you,
 
  
 
Craig Thorne
 
  
 
Craig D. Thorne, M.D., MPH, MBA
Chief Medical Director, Occupational Medicine and Business Health Services
 
Yale New Haven Health System
 
Cell: 203-687-5281
 
  
 
  
 
  
 



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