The agency identified five population categories for which testing may be appropriate.
On July 2 and 3, the CDC updated its website to provide information related to recommended testing for SARS-CoV-2, the virus that causes COVID-19, for five different categories of populations. The agency also provided information targeted to employers, which should be helpful across the board, whether the employer has remained open throughout the pandemic, recently reopened, or is contemplating reopening with appropriate safety measures in place.
Five testing populations. The CDC identified these five testing categories, describing the populations for which SARS-CoV-2 testing with viral tests (i.e., nucleic acid or antigen tests) is appropriate:
|1.||Individuals with signs or symptoms consistent with COVID-19;|
|2.||Asymptomatic individuals with recent known or suspected exposure to control transmission;|
|3.||Asymptomatic individuals without known or suspected exposure for early identification in special settings;|
|4.||Individuals being tested to determine resolution of infection (i.e., test-based strategy for Discontinuation of Transmission-based Precautions, HCP Return to Work, and Discontinuation of Home Isolation); and|
|5.||Individuals being tested for purposes of public health surveillance.|
Diagnostic testing. The CDC explained that, generally, viral testing for SARS-CoV-2 is “diagnostic” when conducted among individuals with symptoms consistent with COVID-19 or among asymptomatic individuals with known or suspected recent exposure to SARS-CoV-2 to control transmission, or to determine resolution of infection.
Screening and surveillance. On the other hand, viral testing is “screening” when it is conducted among asymptomatic individuals without known or suspected exposure to SARS-CoV-2 for early identification, and “surveillance” when conducted among asymptomatic individuals to detect transmission hot spots or characterize disease trends.
Testing for those with signs and symptoms. As to testing individuals with signs or symptoms consistent with COVID-19, the CDC said that employers may consider conducting daily in-person or virtual health checks (e.g., symptom and/or temperature screening) to identify employees with signs or symptoms consistent with COVID-19 before they enter a facility, in accordance with CDC’s General Business FAQs.
- Immediate separation. Workers with COVID-19 symptoms should be immediately separated from other employees, customers, and visitors, and sent home or to a healthcare facility, depending on how severe their symptoms are.
- Screening should be private. To prevent stigma and discrimination in the workplace, the CDC recommends that employee health screenings be made as private as possible. Consistent with CDC’s recommendations, workers with COVID-19 symptoms should be referred to a healthcare provider for evaluation and potential testing. Preferably, the test results should be received before the worker returns in order to keep potentially infected workers out of the workplace.
- Flexible sick leave and supportive policies. The CDC encouraged employers to implement flexible sick leave and supportive policies and practices as part of a comprehensive approach to prevent and reduce transmission among employees. Here the agency pointed to the Families First Coronavirus Response Act and its requirements.
- Positive tests. The agency reminded employers that positive test results using a viral test means that the employee has COVID-19 and should not come to work, but instead should isolate at home. Decisions to discontinue home isolation for workers with COVID-19 and allow them to return to work may follow either a symptom-based, time-based, or a test-based strategy.
Asymptomatic with known or suspected exposure. Where a person is asymptomatic but has had recent known or suspected exposure, to control transmission, the case investigation is typically initiated when a health department receives a lab report of a positive viral test result or a healthcare provider report of a patient with a confirmed or probable diagnosis.
- Close contacts. The CDC recommends viral testing for all close contacts of persons with COVID-19. Because of the potential for asymptomatic and pre-symptomatic transmission, it is important that individuals exposed to people with known or suspected COVID-19 be quickly identified and quarantined. Here, the CDC encouraged employers to work with public health departments investigating cases of COVID-19 and tracing contacts to help reduce the spread in their workplaces and communities.
- Serial testing. The agency noted that because there may be a delay between the time of the person’s exposure and the time that the virus can be detected by testing, early testing after exposure at a single time point may miss many infections. Testing repeated at different points in time (serial testing) may be more likely to detect infection among close contacts of a COVID-19 case than testing done at a single point in time.
- Other preventative measures. Even where close contacts are monitored with serial testing, it is critical that other preventive measures are strictly adhered to, including social distancing, wearing cloth face coverings for source control where the hazard assessment concludes they do not require personal protective equipment, such as a respirator or medical facemask for protection, and practicing hand hygiene.
- Collaborating with health department. The CDC also suggested considering testing for possible close contacts of persons diagnosed with COVID-19 in collaboration with the local health department, where resources permit. A risk-based approach to testing possible contacts of a person with confirmed COVID-19 may be applied. This approach would take into consideration the likelihood of exposure, which is affected by the characteristics of the workplace, and the results of contact investigations.
- Broader testing. Broader testing (beyond individually identified close contacts to those who are possible close contacts), may be considering in some settings to control workplace transmission, such as targeting workers who worked in the same area and during the same shift. Here, the rationale is that identification of contacts may be imprecise.
- High-risk settings. The CDC pointed to high-risk settings that have demonstrated potential for rapid and widespread dissemination of SARS-CoV-2:
- Workplaces where employees live in congregate settings (e.g., fishing vessels, offshore oil platforms, farmworker housing, or wildland firefighter camps); and
- Workplaces with populations at risk for severe illness if they are infected, such as nursing homes.
Asymptomatic without known or suspected exposure. Turning to testing of individuals who are asymptomatic without known or suspected exposure to the virus, the CDC said that viral testing may be useful to detect COVID-19 early and stop transmission quickly, particularly in areas with moderate to substantial community transmission In those areas, workplace settings for which these approaches may be considered include:
- Workplaces where physical distancing is difficult and workers are in close contact (within six feet for 15 minutes or more) with coworkers or the public;
- Workplaces in remote settings where medical evaluation or treatment may be delayed;
- Workplaces where continuity of operations is a high priority (e.g., critical infrastructure sectors); and
- Workplaces providing congregate housing for employees (e.g. fishing vessels, offshore oil platforms, farmworker housing, or wildland firefighter camps).
Testing approaches. Here the approaches may include initial testing of all workersbefore entering a workplace, periodic testing of workers at regular intervals, and/or targeted testing of new workers or those returning from a prolonged absence.
These factors may be helpful in determining the interval for periodic testing:
- The availability of testing;
- The latency between exposure and development of a positive viral test;
- Businesses that fall into one of the workplace categories described above;
- The rate or change in rate of people getting infected in the surrounding community;
- The number of employees who tested positive during previous rounds of testing; and
- Relevant experience with workplace outbreaks
Before testing a large group of asymptomatic workers without known or suspected exposure, employers should have a plan in place for how they will modify operations based on test results and manage a higher risk of false positive results in a low-prevalence population.
Determining resolution of infection. As to testing conducted to determine resolution of infection, the CDC said that the decision to discontinue home isolation and return to work for employees with suspected or confirmed COVID-19 should be made in the context of local circumstances. Options include a symptom-based (time-since-illness-onset and time-since-recovery strategy), time-based, or a test-based strategy. The agency also noted that viral tests have detected viral RNA in some people’s respiratory samples after they have recovered from COVID-19. The determination of which strategy to use should be made in consultation with healthcare providers and public health professionals.
Health provider documentation. The CDC reminded employers that under the ADA, they are permitted to require a healthcare provider’s note to verify that employees are healthy and able to return to work. But, practically speaking, healthcare provider offices and medical facilities may be extremely busy during periods of community transmission and may not be able to provide documentation in a timely manner. In those cases, employers should consider not requiring a healthcare provider’s note for employees who are sick to validate their illness, qualify for sick leave, or to return to work. The agency observed that most people with COVID-19 have mild illness, can recover at home without medical care, and can follow CDC recommendations to determine when to discontinue home isolation and return to work.
Public health surveillance. Turning to public health surveillance, which is conducted to detect transmission hot spots, or to better understand disease trends in a workplace, the CDC said these goals are consistent with employer-based occupational medicine surveillance programs. These programs may use testing to assess:
- The burden of SARS-CoV-2 in the workforce;
- Assess factors that place employees at risk for workplace acquisition of SARS-CoV-2; or
- Evaluate the effectiveness of workplace infection control programs.
The CDC said that surveillance should only be undertaken when the results have a reasonable likelihood of benefiting workers.
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