AMGA CMO Council: Testing Asymptomatic Workers
July 6, 2020
This summary is based on a discussion via AMGA’s Chief Medical Officer/Medical Director Council listserv as of July 6, 2020. For more information about the CMO Council, please click here.
We are considering testing asymptomatic healthcare workers who have been exposed to a COVID-19 person at least three to four times over two weeks. Have any of you adopted this process? If so, what is the time interval between each test? If you are not doing this, what is your protocol for asymptomatic healthcare workers with COVID-19 exposure?
- We just started this process. We chose to test at baseline and then at day 5-7. We understood that this may miss some conversions, but with the delay in test results, this would capture the majority. We may increase frequency once we are able to start and ramp up point of care testing. (Group based in Texas)
- We are testing after exposure, then follow up with a second test after 24 hours. If both negative, we monitor temperatures twice daily for 14 days. (Group based in Illinois)
- We are not doing that. All staff has temp screen and two questions about exposure every morning. For those with significant exposure, we check temps twice daily and record for two weeks. All staff and patients (over age 2) are masked, with clinical staff in surgical or N95 masks. In addition, we are have a shortage of test kits here, so we couldn't test if we wanted to. We have been fortunate that since we added that patients must be masked, we have had no staff cases. (Group based in Florida)
- We too have switched to symptoms-based approach vs. testing-based approach due to shortage of testing. Tests based on twice-a-day temps. Exception is known mask- lowering with COVID+ employee (lunches, etc.). This was enough of a problem that we closed all breakrooms in clinics, stagger lunches, and ask for isolation at lunch when mask is lowered. We have no employee exposures to date when PPE was in place. (Group based in Texas)
- We risk-stratify the exposure by high-risk and low-risk based on time of exposure, distance (6 feet apart), symptoms of the index case, etc. We encourage anyone with a high-risk exposure to be tested. (Group based in Texas)
- We have the same process of risk stratification (low/medium/high), testing medium- and high- risk at five to seven days [after exposure.] That's where the "money" is on sensitivity, according to our data. We don't retest unless the asymptomatic healthcare worker develops symptoms. At 14 days post-exposure, we consider the employee in the clear, again, if asymptomatic. We are still learning and revising. (Group based in Utah)
- We are also using a risk-based protocol. Universal masking and use of eye protection/face shields have shifted our few exposures into the low- and medium-risk category. Most of our employees are using a time- and symptom-based strategy and are allowed to stay at work with active twice-daily monitoring. Working well so far in central Minnesota. (Group based in Minnesota)
- We are using risk-based protocol. We did do some asymptomatic testing of employees on a voluntary basis when we had adequate capacity to do so. We have had no positives and, therefore, have ceased [after two months]. We are testing asymptomatic who have been or are: exposed to COVID, pregnant, health department-directed, at large social gatherings (including recent demonstrations), and pre-procedure [surgery and aerosol-generating procedures]. Fortunately, due to universal masking, all of our employees who have had close contact or exposure have done so outside our organization. (Group based in Washington)
- We have not been routinely testing asymptomatic healthcare workers with exposures, unless it was a workplace exposure—specifically with aerosolization. We are primarily monitoring employees with daily temperature and symptom screening and requiring mandatory PPE for staff, physicians, patients, and visitors. We are now looking at different strategies for symptomatic employees, since we are concerned about some abuse of our generous leave policies (administrative leave when you are put off-work for COVID-19), that would include more of a test-based strategy for return to work, particularly for those with more significant symptoms that resolved quickly. (Group based in California)