Feasibility of Establishing a Return-To-Work Protocol Based on COVID-19 Antibodies Testing

  1. Jennifer Okungbowa-Ikponmwosa
  2. Yijia Mu
  3. Gerard Job

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Abstract

Introduction

Prior to the diagnosis of the first SARS-CoV2 patient in Florida, the Miami Dade Fire Rescue developed and implemented its return-to-work protocol based on guidelines from the CDC and Florida Fire Chiefs Association. As of February 17, 2020, all asymptomatic employees exposed to PCR-confirmed positive SARS-CoV2 individuals would be excluded from work for 14 days and report absence of symptoms to a delegated supervisor every 24 hours. We postulated that if COVID-19 transmission rate continues at the current rate in the absence of systemic vaccination strategy for SARS-CoV2, then a safer and more efficient return-to-work policy is needed for exposed first responders who are identified as low-risk for disease transmission.

Objectives

We sought to establish a safe and shortened return-to-work protocol to maintain our workforce. We evaluated the utility of serological antibody testing in predicting negative seroconversion of first responders at 7 days post low-risk exposure to confirmed COVID-19 individuals.

Methods

All exposed, asymptomatic employees underwent serology testing for SARS-CoV2 one week after the initial exposure. Participants who were serologically negative had follow-up RT-PCR within 24 hours and serology testing 14 days after the initial serological test.

Results

Overall, of the 71 firefighters who have had documented exposures to SARS-CoV2 positive individuals in the fire rescue agency, 41 of 71 had initially negative serology studies. Of the 41 patients with negative serology studies, 20 voluntarily underwent confirmatory PCR testing within one day after serology testing and all 20 participants were negative. Subsequently, out of the 20 participants who underwent serology and PCR testing, 10 participants followed up and underwent repeat serology testing 14 days after exposure and all 10 participants had negative repeat serology tests. The other ten who chose not to retest remained asymptomatic 14 days after exposure.

Conclusions

Although serology testing has limitations, it correlated with negative prediction of disease in low-risk participants with exposures in this study. Serology testing may offer a feasible, alternative return-to-work strategy for fire agencies.

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  1. ScreenIT

    SciScore for 10.1101/2020.09.03.20187823: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    Institutional Review Board Statementnot detected.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.
    Sex as a biological variableThis study included 2038 sworn firefighters (79% males and 53% white) from Miami Dade Fire Rescue ranging in age from 20 −70 years.

    Table 2: Resources

    No key resources detected.

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    Initial limitations to our study include small sample sizes. Although the inclusion criteria allowed for the eligibility of 71 participants out of a group of 2038 firefighters, 21 from the negative serology group did not enrol in the PCR testing following serological testing. It is unclear whether or not a lower number of participants in this group lead to a high negative predictive value. Nevertheless, given negative initial serology it is unlikely that this was the case. Further studies could investigate how return to work protocols can be developed for employees who have serologic and PCR testing with discordant results. Other limitations involve the utility of serological markers. Many questions remain unanswered including how soon does seroconversion occur after positive exposure, how accurate is antibodies testing for identification of acute SARS-CoV2 infection vs convalescence from prior infection, the implication of positive serology markers for the SARS-COV-2 reinfection and duration of immunity. Most pressing of these concerns is serology test validation. To date, there are more than a 100 commercially available serology tests for SARS-CoV2 in the United States with variable reliability and accuracy for the diagnosis of SARS-CoV2. While the Food and Drug Administration (FDA) has begun overseeing a validation process for serological tests, it is still unclear when this investigation will be completed. Second it is still unclear whether specific antibody level as meas...

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

    About SciScore

    SciScore is an automated tool that is designed to assist expert reviewers by finding and presenting formulaic information scattered throughout a paper in a standard, easy to digest format. SciScore checks for the presence and correctness of RRIDs (research resource identifiers), and for rigor criteria such as sex and investigator blinding. For details on the theoretical underpinning of rigor criteria and the tools shown here, including references cited, please follow this link.

  2. Version published to 10.1101/2020.09.03.20187823v1 on medRxiv