Covid-19 is changing the way we work and interact with each other.  As organizations large and small begin thinking about the next phase of the pandemic, they will need to develop policies and practices that promote a culture of health, establish trust with employees, and provide their workforces with appropriate knowledge and resources.

SidePorch is assisting organizations looking to design and implement ethical and responsible approaches for the transition back into the workplace.  We believe that testing must be considered by any organization bringing its workforce back together - though specific contexts will require different implementations of testing approaches.

We created this list of frequently asked questions regarding testing that come from the organizations we are supporting, in the hopes that it will be of service to other organizations as well. We will continue to update this list over the coming weeks.

FAQ

1. What is the difference between coronavirus, SARS-CoV-2, and COVID-19?

While sometimes used interchangeably in the media and daily lexicon, each is very distinct. Coronavirus is the name of a large family of viruses. SARS-CoV-2 stands for severe acute respiratory syndrome-cornavirus-2. SARS-CoV-2 is a member of the coronavirus family and is the virus responsible for the current pandemic. Covid-19 is the name of the disease caused by the virus, SARS-CoV-2. 

SidePorch will be using “Covid-19” in most of our publications to reference this disease and the impact of the pandemic on the world.

2. How does testing fit into the overall program?

In order to develop a culture of health and manage the risk posed by Covid-19, we recommend that organizations integrate testing as an essential part of their policies and practices.  Workplaces should consider testing alongside other precautionary measures to decrease risk and identify contagion as early as possible.

3. Should I test everyone in my organization before returning to the workplace?

When possible, we recommend designing a testing program that incorporates both viral PCR testing alongside antibody testing for all employees returning to the workplace. 

These testing plans will need to continue on a periodic basis for the foreseeable future. An example testing program is presented in SidePorch’s Testing 101 document.

4. What are the different basic types of tests available today for Covid-19?

There are three types of testing: viral PCR, antibody, and antigen testing.

Viral PCR (polymerase chain reaction) tests are used to detect the presence of SARS-CoV-2 genetic material.  If the test detects that an individual is currently shedding SARS-CoV-2 genetic material, the individual can be assumed to be contagious.

Antibody tests, also known as serological tests, are used to detect whether an individual has developed antibodies to SARS-CoV-2.  The CDC states that antibody tests should not be used to diagnose someone as being currently sick with Covid-19.  We are waiting for research to determine how results from these tests would provide insight into immunity based on the presence of antibodies.  This test can be used to know if the individual has previously been previously exposed to SARS-CoV-2, and thus can become a useful screening tool for organizations.

Antigen tests are used to detect the presence of SARS-CoV-2 proteins, as compared to viral PCR tests which measure genetic material through amplification.  If an individual currently has SARS-CoV-2 proteins, the test result should be positive and the individual should be assumed to be contagious.

5. How should I incorporate these different tests into my back to work plans?

Workplaces should include testing alongside other precautionary measures to decrease risk and identify when individuals may be contagious with Covid-19 as early as possible. Below are the ways that each type of testing can be used in returning to the workplace and into the foreseeable future.  No test should be thought of as protective to immediate or future infection.

Viral PCR: If implemented properly, this test can identify returning employees with an active SARS-CoV-2 infection. Continued, periodic viral PCR testing, when integrated into an overall organizational approach to supporting its workforce, can increase the likelihood of identifying asymptomatic and symptomatic cases if they occur within the workforce.

Antibody: The antibody test allows an organization to screen the workforce into two groups: those who have had a prior exposure and those who have not.  This information should become increasingly helpful as more research findings emerge over the coming months.  To date, there is no known association between having antibodies to the virus and immunity.

Antigen: Not enough research exists yet to fully understand how an antigen test can or should be utilized into a testing program.  The FDA just issued the first emergency use authorization (EUA) for a COVID-19 antigen test in early May 2020, so the level of sensitivity to the virus is still largely unknown.  Early research suggests that antigen tests can show results within minutes, but the results have lower sensitivity than viral PCR tests.  This question will be updated as more information becomes available.

6. Why are viral PCR tests important for a testing program?

Viral PCR tests aim to identify anyone with an active SARS-CoV-2 infection so they can be isolated from uninfected employees. These tests can also be used as a periodic screen of employees to try to discover people without symptoms who can be assumed to be contagious. 

Because of the role a viral PCR test plays in a testing program, it is important to understand that there is some variability across different test vendors. This variability is based on the components of the test, the process of collecting the sample, the type of machinery used to analyze the samples, and other elements of the process. 

A recent study of various viral PCR tests showed a wide range in accuracy, with tests having a sensitivity ranging between 85 and 100%. For example, a test sensitivity of 95% means that 5% of people who actually have SARS-CoV-2 and can assume to be currently contagious will test as negative (when in fact they are a positive).  This phenomenon is known as a false negative, and a test’s false negative rate is an important number to consider when procuring tests for a testing program.  False positives, a positive result for someone who actually does not have SARS-CoV-2, is also an important factor to take into account.

When considering purchasing viral PCR tests for your organization, we recommend asking the vendor for information about the sensitivity of their tests and then reviewing that data to fully understand the accuracy of the test that you are procuring.

7. How is a PCR test administered?

Viral PCR tests utilize a swab of the cheek, nasal cavity, or throat — or some combination of all three.  Additionally, the FDA recently approved saliva-based tests.

Most viral PCR tests require the sample to be sent to a lab, where large volumes of patient samples can be analyzed at the same time. Other tests can be administered on site at the point of care. They require special equipment (essentially a mobile lab kit) and can often return more immediate test results but with a lower throughput.

8. I have read there is some uncertainty around antibody testing. Are they reliable?

A recent study of various antibody tests showed a wide range in accuracy, with tests being able to detect antibodies 81 to 100% of the time. We recommend asking your testing vendors to share what data they have on the efficacy of testing resources. 

While studies are still underway to determine the extent to which antibodies indicate any future resistance to Covid-19, antibody testing provides an indication of who within an organization has been exposed to SARS-CoV-2. This information is helpful for managing risk and providing ongoing epidemiological surveillance. This, in turn, is helpful for organizations to assess the overall risk profile of their employee base.

9. What is the difference between a lab and testing kit? What should I be looking for in both?

The testing kit contains all of the consumable materials needed to conduct a test. For example, a standard PCR test kit may include a few swabs, a sample storage tube, and a few labels, all contained within a ziplock bag. A lab is the facility (and the people who work there) that package the kits together, send them to clients, and then process the samples once they return. The lab is also responsible for reporting the test results to the client after they have been processed.  

When considering the testing kits, it is important to know who will deliver the batch of kits, which lab will end up processing the kits, and how the lab will notify your organization. For lab-based companies, it is important to ask about their supply chains, the current turnaround time, and their reporting methods. It is also essential to provide protection for the healthcare providers administering the test as well as a practice that does not infect employees as they receive the test.

Where can I purchase high-quality tests for my organization?

There are high-quality viral PCR and antibody tests on the market, and testing services have created solutions aimed at specific communities and users. It is important to identify the logistics, costs, and repeatability needed for your specific organization.

SidePorch can connect your organization with reliable Covid-19 testing companies to help get your company back to the workplace. Contact us at backtowork@sideporch.co for help.