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

Paul Winkel spwinkel54 at gmail.com
Tue Apr 28 08:41:05 PDT 2020
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Hello JoAnn

I am in Springfield, MA.  Our parent corporation is holding back on the
serology testing due to high false positives when prevalence is fairly
low.  Do you know the prevalence of COVID in Tampa?

I would be interested in your results.

Thank you,

Paul Winkel, D.O., FACP
Trinity Health of New England

On Tue, Apr 28, 2020, 11:25 AM Shea, Joann via MCOH-EH <mcoh-eh at mylist.net>
wrote:

> We stopped using the test based strategy as all were PCR + for more than
> 3-4 weeks and infectivity at that point was not clear.     We started
> IgM/IgG testing in-house last week  and require IgG + in addition to  14
> days OOW from onset  of symptoms and 7 days symptom free to RTW. Since last
> week, we have been drawing   serology on all PCR COVID+ healthcare workers
> to validate our testing and to assist with RTW decisions.
>
>
>
> We also started drawing serology on HCW  with classic COVID-19 symptoms in
> addition to the PCR.     Yesterday we had a positive IgM on a nurse  with
> classic COVID-19 symptoms ( cough, SOB, fever, loss of smell/taste) but had
> two previous negative PCR from our screening clinic.
>
>
>
> Today, we opened up IgG testing to all HCWs in the organizations  and
> offer 100 appts per day in our TMH clinic.   We hope this testing will
> allow us to identify how many of our HCW may have had asymptomatic
> infection and how many are susceptible.   We reiterate to our HCWs that a
> positive IgG does not indicate the amount or duration of immunity or if
> they are protected from reinfection.
>
>
>
> Our Infectious Disease physicians plan to conduct a retrospective study on
> IgG testing of healthcare workers once we have a large enough sample.   We
> have already scheduled over 2500 for IgG testing and are hoping for at
> least 5,000 by July.  We included data points such as history of exposure,
> perform aerosolizing procedures, work in high risk unit,  history of
> symptoms but never tested, and random selection of HCWs.
>
>
>
> Will be happy to share results with this group.
>
>
>
> JoAnn Shea, APRN, MS, COHN-S
>
> Director, Team Member Health and Wellness
>
> Tampa General Hospital
>
> Office: 813-844-7692
>
> Cell:      813-789-3441
>
> jshea at tgh.org
>
> [image: imageTGH]
> <https://health.usnews.com/best-hospitals/area/fl/tampa-general-hospital-6391060>
>
>
>
> *From:* MCOH-EH <mcoh-eh-bounces at mylist.net>*On Behalf Of *William.Scott
> *Sent:* Thursday, April 23, 2020 1:58 PM
> *To:* 'Swift, Melanie D., M.D., M.P.H.' <Swift.Melanie at mayo.edu>;
> 'MCOH-EH' <mcoh-eh at mylist.net>
> *Subject:* Re: [MCOH-EH] Use COVID antibody results for return to work
> management?
>
>
>
> 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?
>
>
>
> _______________________________
>
> ******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://urldefense.proofpoint.com/v2/url?u=https-3A__imsva91-2Dctp.trendmicro.com-3A443_wis_clicktime_v1_query-3Furl-3Dhttps-253a-252f-252fwww.mayoclinic.org-252fdepartments-252dcenters-252fpreventive-252doccupational-252daerospace-252dmedicine-252fphysician-252dhealth-252dcenter-252freferrals-26umid-3D604BAE66-2DA3F5-2D1605-2D83DE-2DB7F3592D0C29-26auth-3D093a4b527975060589a391772a3e2db55fc9b3cf-2Ddd004df379831bc7f524fccf01f0a69de7f32f86&d=DwMGaQ&c=WxSiHUljzaZa6AO7gfNF1nsjLMo-cFTcJAt_xkKy0sg&r=i5vd-CpfKk0L54XwZivpPw&m=T5pByKvorHb5kXsDmAP-FBDAAylEYjfZLN1w-Owgwkk&s=Q3IK_ZgBO2ZjwAcbOTenlV6Ild_92sW3EUctIpdCo58&e=>
>
> 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://urldefense.proofpoint.com/v2/url?u=https-3A__imsva91-2Dctp.trendmicro.com-3A443_wis_clicktime_v1_query-3Furl-3Dhttp-253a-252f-252fwww.mayoclinic.org-26umid-3D604BAE66-2DA3F5-2D1605-2D83DE-2DB7F3592D0C29-26auth-3D093a4b527975060589a391772a3e2db55fc9b3cf-2D0856e0ff7ca42aaca14c9c1e4ef85ab2c4dc95bf&d=DwMGaQ&c=WxSiHUljzaZa6AO7gfNF1nsjLMo-cFTcJAt_xkKy0sg&r=i5vd-CpfKk0L54XwZivpPw&m=T5pByKvorHb5kXsDmAP-FBDAAylEYjfZLN1w-Owgwkk&s=eCOjGmbLXJBCqn_aBRtWyFVRGNEspx51JZapHq01C8I&e=>
>
>
>
> *From:* William.Scott [mailto:William.Scott at carle.com
> <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:* 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>*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.
>       - One study
>       <https://urldefense.proofpoint.com/v2/url?u=https-3A__imsva91-2Dctp.trendmicro.com-3A443_wis_clicktime_v1_query-3Furl-3Dhttps-253a-252f-252fwww.biorxiv.org-252fcontent-252f10.1101-252f2020.03.13.990226v1.abstract-26umid-3D604BAE66-2DA3F5-2D1605-2D83DE-2DB7F3592D0C29-26auth-3D093a4b527975060589a391772a3e2db55fc9b3cf-2Dc054de8b68d2a4ab2bf6dfaea9b549e8bd608cda&d=DwMGaQ&c=WxSiHUljzaZa6AO7gfNF1nsjLMo-cFTcJAt_xkKy0sg&r=i5vd-CpfKk0L54XwZivpPw&m=T5pByKvorHb5kXsDmAP-FBDAAylEYjfZLN1w-Owgwkk&s=xiJ2CN9vtAAohMlqO7p_u7SorQHh77JPxJz6lSpZEgU&e=>,
>       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.
>       - 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.proofpoint.com/v2/url?u=https-3A__imsva91-2Dctp.trendmicro.com-3A443_wis_clicktime_v1_query-3Furl-3Dhttps-253a-252f-252fwww.mayoclinic.org-252fdepartments-252dcenters-252fpreventive-252doccupational-252daerospace-252dmedicine-252fphysician-252dhealth-252dcenter-252freferrals-26umid-3D604BAE66-2DA3F5-2D1605-2D83DE-2DB7F3592D0C29-26auth-3D093a4b527975060589a391772a3e2db55fc9b3cf-2Ddd004df379831bc7f524fccf01f0a69de7f32f86&d=DwMGaQ&c=WxSiHUljzaZa6AO7gfNF1nsjLMo-cFTcJAt_xkKy0sg&r=i5vd-CpfKk0L54XwZivpPw&m=T5pByKvorHb5kXsDmAP-FBDAAylEYjfZLN1w-Owgwkk&s=Q3IK_ZgBO2ZjwAcbOTenlV6Ild_92sW3EUctIpdCo58&e=>
>
> 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://urldefense.proofpoint.com/v2/url?u=https-3A__imsva91-2Dctp.trendmicro.com-3A443_wis_clicktime_v1_query-3Furl-3Dhttp-253a-252f-252fwww.mayoclinic.org-26umid-3D604BAE66-2DA3F5-2D1605-2D83DE-2DB7F3592D0C29-26auth-3D093a4b527975060589a391772a3e2db55fc9b3cf-2D0856e0ff7ca42aaca14c9c1e4ef85ab2c4dc95bf&d=DwMGaQ&c=WxSiHUljzaZa6AO7gfNF1nsjLMo-cFTcJAt_xkKy0sg&r=i5vd-CpfKk0L54XwZivpPw&m=T5pByKvorHb5kXsDmAP-FBDAAylEYjfZLN1w-Owgwkk&s=eCOjGmbLXJBCqn_aBRtWyFVRGNEspx51JZapHq01C8I&e=>
>
>
>
> *From:* MCOH-EH [mailto:mcoh-eh-bounces at mylist.net
> <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:* [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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