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

[Mindy T. Dube]

We actually just had this conversation with our Infectious Disease team the other day.  What that CDC guideline is referring to is the testing of asymptomatic healthcare workers who test positive for covid-19 and returning them to work 10 days after the positive test providing they do not develop any symptoms.

For symptomatic healthcare workers who test positive using the test-based strategy for return to work it still states the recommendation is for two negative tests 24 hours apart after there has been improvement in respiratory symptoms and resolution of fever.  That recommendation has not changed from their original guidance.

Mindy Dube, MSN, APRN, FNP-C
Nurse Practitioner
Occupational and Environmental Medicine
Dartmouth-Hitchcock Medical Center
Lebanon, NH  03756
603-653-3850
Fax: 603-650-0928

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From: MCOH-EH <mcoh-eh-bounces at mylist.net> On Behalf Of Abhijay Karandikar via MCOH-EH
Sent: Thursday, April 23, 2020 9:36 AM
To: 'MCOH-EH' <mcoh-eh at mylist.net>
Cc: Abhijay Karandikar <dr_abhik at yahoo.com>
Subject: Re: [MCOH-EH] Use COVID antibody results for return to work management? **EXTERNAL**

For those who are using test based strategies for COVID-19 return to work or are intending to, CDC guidelines state that HCP with laboratory-confirmed COVID-19 who have not had any symptoms be excluded from work until 10 days have passed since the date of their first positive COVID-19 diagnostic test assuming they have not subsequently developed symptoms since their positive test.

https://www.cdc.gov/coronavirus/2019-ncov/hcp/return-to-work.html<https://urldefense.com/v3/__https:/www.cdc.gov/coronavirus/2019-ncov/hcp/return-to-work.html__;!!Eh6P0A!EbI0S5tNaxrazj58EdjZvoSvYSfcrjqYTds1v3g5QLwy5-PpYiL__SayOEscQbRSS8HjMA$>

Abhijay


On ‎Monday‎, ‎April‎ ‎20‎, ‎2020‎ ‎03‎:‎30‎:‎30‎ ‎PM‎ ‎EDT, William. Scott <william.scott at carle.com<mailto:william.scott at carle.com>> wrote:



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<mailto: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<mailto:mcoh-eh at mylist.net>>
Cc: Swift, Melanie D., M.D., M.P.H. <Swift.Melanie at mayo.edu<mailto:Swift.Melanie at mayo.edu>>
Subject: [EXT] Re: [MCOH-EH] Use COVID antibody results for return to work management?



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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<https://urldefense.com/v3/__https:/imsva91-ctp.trendmicro.com:443/wis/clicktime/v1/query?url=https*3a*2f*2fwww.biorxiv.org*2fcontent*2f10.1101*2f2020.03.13.990226v1.abstract&umid=6EB643BA-A3BC-E205-B566-DE7BA0E34AD9&auth=093a4b527975060589a391772a3e2db55fc9b3cf-58ff5a4303370645d79d6b1296fc453ad2e30201__;JSUlJSUl!!Eh6P0A!EbI0S5tNaxrazj58EdjZvoSvYSfcrjqYTds1v3g5QLwy5-PpYiL__SayOEscQbQ-c85_eA$>, 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<https://urldefense.com/v3/__https:/imsva91-ctp.trendmicro.com:443/wis/clicktime/v1/query?url=https*3a*2f*2fwww.mayoclinic.org*2fdepartments*2dcenters*2fpreventive*2doccupational*2daerospace*2dmedicine*2fphysician*2dhealth*2dcenter*2freferrals&umid=6EB643BA-A3BC-E205-B566-DE7BA0E34AD9&auth=093a4b527975060589a391772a3e2db55fc9b3cf-fda1b866014c3a026340728b4033d6e6988a13d0__;JSUlJSUlJSUlJSUlJQ!!Eh6P0A!EbI0S5tNaxrazj58EdjZvoSvYSfcrjqYTds1v3g5QLwy5-PpYiL__SayOEscQbQH5POQNg$>

Associate Medical Director, Occupational Health Service

Senior Associate Consultant

Assistant Professor of Medicine

Division of Preventive, Occupational, and Aerospace Medicine

Phone 507.284.2560

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Mayo Clinic
200 First Street SW
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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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