COVID-19: Considerations For Employee Testing - AXA PPP Healthcare

COVID-19: Considerations
For Employee Testing

                Published 21/5/2020

COVID-19: Considerations for Employee Testing

INTRODUCTION
The UK Prime Minister addressed the nation on the 10th of May1 and announced a reduction in the lockdown
level from Level 4 to Level 3 which marks the first step in the modification of return to work permissions.
Those who are unable to work from home are now actively encouraged to return to work. Guidance2 for
some settings has been issued by the department for Business, Energy and Industrial Strategy (BEIS).

This document provides some insight into factors employers should consider when considering the role of
testing for coronavirus (COVID-19) in the UK and return to work as the lockdown eases. This is a developing
area which we continue to monitor carefully.

Polymerase chain reaction (PCR) testing

Who is the test for?

This test is done in people who have symptoms of COVID-19 such as high fever, new onset continuous cough
and loss of taste/smell. It is available on the NHS for people over 5 years old with symptoms. In addition, it is
available in England if you’re a social care worker or resident in a care home whether you have symptoms or
not3.

AXA PPP healthcare recommends: Make sure employees are aware of the need to get PCR testing if they
have symptoms and are looking to return to work. The test is most effective if done within 3 days of onset
of symptoms.

Consider:

           Continuing to support your employees to work from home (where possible) and remain alert for
            signs and symptoms of COVID-19. For those who have a PCR test, a negative test result is not
            conclusive of the absence of infection so additional consideration should be given to high risk or
            vulnerable populations such as employees with factors that might influence health outcomes (such
            as ethnicity, deprivation, age and obesity).
           False positive and false negative results: results should always be taken into context of an
            employee’s recent exposure and the presence of signs and symptoms consistent with COVID-19. A
            single test result (positive or negative) should be used in conjunction with other precautionary
            measures in the management of risk4.
           Repeat testing if COVID-19 is still suspected based on individual symptoms.

1
  https://www.gov.uk/government/speeches/pm-address-to-the-nation-on-coronavirus-10-may-2020
2
  https://www.gov.uk/guidance/working-safely-during-coronavirus-covid-19
3
  https://www.gov.uk/guidance/coronavirus-covid-19-getting-tested
4
  https://www.hse.gov.uk/simple-health-safety/risk/index.htm

Published 21/5/20. We continue to monitor this developing area, this document is subject to change as new information arises.
AXA PPP healthcare Limited. Registered Office: 5 Old Broad Street, London EC2N 1AD, United Kingdom. Registered in England and Wales No. 3148119.
AXA PPP healthcare Limited is authorised by the Prudential Regulation Authority and regulated by the Financial Conduct Authority and the Prudential
Regulation Authority. Write to us at: AXA PPP healthcare, Phillips House, Crescent Road, Tunbridge Wells, Kent TN1 2PL. © AXA ICAS Limited 2020.
PB77211a/0520

Not recommended:

           Using PCR tests as the sole determinant for return-to-work of a high-risk group or vulnerable
            individuals.
           Ignoring public health advice to remain at home, wash hands, use face masks or other protective
            material to prevent spread to others etc.
           Use of repeated PCR tests for symptom free employees
           Using PCR testing for indications outside its current use, which is to confirm if an individual with
            symptoms currently has the virus.

Antibody testing

There are two main sub-types of antibody testing:

                  o     Rapid tests *
                  o     Enzyme-linked immunosorbent assays (ELISA) test.

*Rapid tests are illegal for home use.

Who is this test for?

An antibody test is used to determine if someone has had the infection recently, however this does not
mean that person is immune. Immunoglobulin M (IgM) antibodies are generated early while
Immunoglobulin G (IgG) later in the course of infection. IgM and IgG antibodies can both be present in a
sample. More information5 is needed about how people develop immunity to COVID-19 and if they can
contract the infection again and more importantly if they can continue to spread it to other people without
realising.

There is a lot of information about antibody testing in the media and we appreciate it may be confusing. We
welcome the recent positive press reports regarding two new antibody tests (Roche & Abbott Laboratories)
approved by Public Health England (PHE) for use in identifying what proportion of the population have had
the virus. This has been followed by confirmation by the government on Thursday 21 May in line with the 3rd
pillar of the published testing strategy , that the Roche test will be available on the NHS "for people who
need them" – initially Health and Care workers. However, our clinical experts advise that antibody testing
currently remains of limited use to individuals. In particular:

1. The presence of antibodies does not tell us if an individual person is immune.
2. Public Health England does not currently endorse antibody tests in individuals for return-to-work
purposes.

5
    https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)30985-5/fulltext

Published 21/5/20. We continue to monitor this developing area, this document is subject to change as new information arises.
AXA PPP healthcare Limited. Registered Office: 5 Old Broad Street, London EC2N 1AD, United Kingdom. Registered in England and Wales No. 3148119.
AXA PPP healthcare Limited is authorised by the Prudential Regulation Authority and regulated by the Financial Conduct Authority and the Prudential
Regulation Authority. Write to us at: AXA PPP healthcare, Phillips House, Crescent Road, Tunbridge Wells, Kent TN1 2PL. © AXA ICAS Limited 2020.
PB77211a/0520

AXA PPP healthcare recommends: We do not support use of antibody testing in individuals for return-to-
work purposes based on current evidence. Public Health England has not validated any antibody test for
that specified use.

Consider:

           Supporting employees to remain alert and continue public health safety measures such as hand-
            washing, distancing, enhanced office hygiene.
           If an individual is showing symptoms or confirms recent contact with someone who displayed
            symptoms, use a PCR test to risk mitigate active infection.
           The presence of IgM antibodies (negative to IgG antibodies) indicates that a patient has an active or
            recent infection with COVID-19. Regard these employees as having active infection with COVID-19
            even if PCR tests are negative.

Not recommended:

           The use of antibody tests for return-to-work purposes at present until more is known about its role
            in immunity to further infection.
           Antibody tests to diagnose or exclude acute infection. Direct testing with PCR tests should be used
            in employees who show symptoms suggestive of an acute infection.
           Making return to work decisions based on antibody tests done in the community.
           The notion that the presence of IgG antibodies implies the employee is immune to the virus. This
            does not exclude current infectivity in those who are still contagious.

SUMMARY

Currently, the test being offered by the NHS to people with symptoms of COVID-19 is the PCR test. The
government is also beginning to make antibody tests available to those who wish to check if they have had
coronavirus. Capacity for testing is being ramped up in the NHS and we are seeing a new swathe of private
providers offering PCR and antibody tests with various marketing messages around its uses for return to
work. AXA PPP healthcare acknowledges that a combination of strategies (not limited to testing) can be
looked into as a strategy in reducing the risk for staff who must return to work with the loosening of the
lockdown restrictions in the UK. This would however need to be part of a properly coordinated occupational
health strategy with medical advice as even where tests are performed and repeated at frequent intervals
some cases will be missed so it would supplement not replace other measures.

Whatever programme of activity is put in place, it is essential that all employees are treated as if they are
potentially infectious even if they are well and test negative. All precautions (not limited to) including; home
working where possible, avoiding contact with other people, handwashing and hygiene, social distancing,
and all the measures recommended by PHE and guidance for specific settings prepared by the department
for Business, Energy and Industrial Strategy (BEIS) should be observed.

We are continuing to keep this situation under close review.

Published 21/5/20. We continue to monitor this developing area, this document is subject to change as new information arises.
AXA PPP healthcare Limited. Registered Office: 5 Old Broad Street, London EC2N 1AD, United Kingdom. Registered in England and Wales No. 3148119.
AXA PPP healthcare Limited is authorised by the Prudential Regulation Authority and regulated by the Financial Conduct Authority and the Prudential
Regulation Authority. Write to us at: AXA PPP healthcare, Phillips House, Crescent Road, Tunbridge Wells, Kent TN1 2PL. © AXA ICAS Limited 2020.
PB77211a/0520

To help answer your questions, click here for our latest information on Coronavirus (COVID-19)

Published 21/5/20. We continue to monitor this developing area, this document is subject to change as new information arises.
AXA PPP healthcare Limited. Registered Office: 5 Old Broad Street, London EC2N 1AD, United Kingdom. Registered in England and Wales No. 3148119.
AXA PPP healthcare Limited is authorised by the Prudential Regulation Authority and regulated by the Financial Conduct Authority and the Prudential
Regulation Authority. Write to us at: AXA PPP healthcare, Phillips House, Crescent Road, Tunbridge Wells, Kent TN1 2PL. © AXA ICAS Limited 2020.
PB77211a/0520