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
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
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
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.