Faculty of Occupational Medicine COVID-19 update

COVID-19 testing for companies – important information

The Faculty of Occupational Medicine has released updated COVID-19 testing guidance for employers and occupational health providers, following a recent meeting of the Faculty’s Ethics Committee.

Much confusion and misunderstanding about the implications and reliability of COVID-19 testing and its limited role in informing work placement decisions is apparent. There are many examples of commercial sale of tests and approaches that are not supported by the official Public Health England advice, which represent a clear risk to employers and employees.

Guidance from the Faculty

The Faculty has reminded all occupational health providers and practitioners and providers of the need to act ethically and to clearly inform clients and customers of the true facts in relation to testing and interpretation of results.

It is hugely important to recognise the clear difference between testing for Public Health infection control reasons (which both PCR Antigen testing and Antibody Tests are being used to inform) and testing for purposes of informing work placement decisions.

Currently, whilst both PCR and Antibody Test kits can be legally acquired and used by businesses and occupational health providers, it remains important to understand the meaning and context of any testing outcomes.

PCR testing kits are widely available and, subject to correct technique and timely processing, can provide an accurate indication of current infection (via the presence of an antigen). If positive, this enables clear advice on periods of self- isolation and advice about any subsequent return to work after a suitable period – which is informed by well publicised Public Health England advice.

With regards to Antibody Testing it is important, however, for occupational health practitioners to be clear in advice to employers to not support a view that a positive test will infer any future reliable level of immunity to infection or disease transmission – the evidence base for any such immunity remains disputable.

The value of a negative COVID-19 result

However, a negative PCR test is also relatively meaningless in terms of work placement as it simply suggests that the individual has not got meaningful levels of COVID-19 infection at the point in time at which they were tested. Infection may well occur subsequently, or may have happened previously, and it is impracticable to test workers repeatedly before each work shift.

Delays in processing results and variations in application of testing also impact on reliability; decisions on work placement should rely on the published advice and clinical symptoms.

Whilst occupational health providers may offer antibody testing (often with disclaimers on their accuracy) – most such tests do have false positives and false negatives and PHE advice does not currently support their use by employers or individuals. The presence of antibodies may suggest past or present infection with COVID-19, however, does not reliably confirm future immunity and does not replace a need for workplace risk assessment and control.

Test, Track and Trace

The government’s Test, Track and Trace programme is designed to find those that may be at risk and enable a period of quarantine to reduce spread of Covid-19. If an official contact advises a person to isolate for a specific period this should be supported – testing before return to work at the end of a period of isolation is not normally required.

OH practitioners should avoid involvement in unreliable testing programmes with limited value.

Current official advice on testing for COVID-19 is easily accessible on the government website, specifically here and here.