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

[William.Scott]

Hi Melanie. Thanks for the feedback at this strange time. I totally agree. Our institution after further discussion with myself, ID and Medical Director of Lab were able to convince our Quality Medical Officer that we did not want to use the PCR method for the reasons mention. Instead he will wait until we have AB (IgG) testing on asymptomatic HCWs since the rational is easier to explain and better at determine past exposure and immunological response. But again we are not sure of neutralization of infection and future protection.

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: Swift, Melanie D., M.D., M.P.H. <Swift.Melanie at mayo.edu>
Sent: Thursday, April 23, 2020 8:19 AM
To: William.Scott <William.Scott at carle.com>; 'MCOH-EH' <mcoh-eh at mylist.net>
Subject: [EXT] RE: Use COVID antibody results for return to work management?


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*****EXTERNAL EMAIL SOURCE*****

Bill, We are hearing a lot of institutions grappling with this and the desire to test asymptomatic employees is understandable. It’s prompted by an awareness of asymptomatic spread.
I would caution you to consider test frequency. A negative PCR test today does not ensure the person won’t be positive in another 2 days, which begs the question of why start doing it unless you plan to continue testing every few days.

If you find a positive PCR in an asymptomatic person, I think you are obligated to use the test-based strategy for RTW. The non-test-based strategy is to return them after 7 days from symptom onset. Pretty hard to calculate if there are no symptoms!

Melanie

Melanie Swift, MD, MPH
Medical Director, Mayo Clinic Physician Health Center<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=604BAE66-A3F5-1605-83DE-B7F3592D0C29&auth=093a4b527975060589a391772a3e2db55fc9b3cf-dd004df379831bc7f524fccf01f0a69de7f32f86>
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<https://imsva91-ctp.trendmicro.com:443/wis/clicktime/v1/query?url=http%3a%2f%2fwww.mayoclinic.org&umid=604BAE66-A3F5-1605-83DE-B7F3592D0C29&auth=093a4b527975060589a391772a3e2db55fc9b3cf-0856e0ff7ca42aaca14c9c1e4ef85ab2c4dc95bf>

From: William.Scott [mailto:William.Scott at carle.com]
Sent: Monday, April 20, 2020 2:16 PM
To: 'MCOH-EH'
Cc: Swift, Melanie D., M.D., M.P.H.
Subject: [EXTERNAL] RE: Use COVID antibody results for return to work management?

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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*****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<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=604BAE66-A3F5-1605-83DE-B7F3592D0C29&auth=093a4b527975060589a391772a3e2db55fc9b3cf-c054de8b68d2a4ab2bf6dfaea9b549e8bd608cda>, 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://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=604BAE66-A3F5-1605-83DE-B7F3592D0C29&auth=093a4b527975060589a391772a3e2db55fc9b3cf-dd004df379831bc7f524fccf01f0a69de7f32f86>
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<https://imsva91-ctp.trendmicro.com:443/wis/clicktime/v1/query?url=http%3a%2f%2fwww.mayoclinic.org&umid=604BAE66-A3F5-1605-83DE-B7F3592D0C29&auth=093a4b527975060589a391772a3e2db55fc9b3cf-0856e0ff7ca42aaca14c9c1e4ef85ab2c4dc95bf>

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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