Should Employers Choose COVID-19 Antibody Testing or PCR Viral RNA Testing?

As the economy reopens to a new reality of working in the midst of the ongoing COVID-19 pandemic, employers are facing the difficult choice of whether or not to test for COVID-19, and if so, which is the right test to administer. Companies have to learn the benefits and downsides of the two main types of coronavirus testing to understand which is applicable to their environment. The choice comes down to comparing the coronavirus antibody test, which can tell if a person had the infection previously, to the PCR test, which determines if a person currently has the actual disease.
Jared Rosenthal
Published on

With all states in the midst of a staged reopening of businesses, employers across the country are preparing to roll out their own reopening plans to get back to work during the COVID-19 pandemic. Thanks to advice from the Centers for Disease Control (CDC) and the World Health Organization (WHO), employers are considering administering viral RNA testing and antibody testing, establishing functional social distancing boundaries, and setting up regimented routines to disinfect workspaces. The routine that will work best for your company depends on several factors.

Deciding whether COVID antibody testing or viral testing should be part of your company’s reopening strategy is a big question on the minds of many employers. There are several issues with regularly testing any substantially-sized workforce with either type of test, but some employers have already adopted the practice. Most experts see institutionalized testing as a helpful element of safely reopening, though possibly not essential for all companies.

How does the COVID-19 test work?

Medical professionals test for active coronavirus infections through polymerise chain reaction (PCR) testing which detects the actaul viral RNA. PCR tests are typically done with a swab of the nasal cavity or, less often, via saliva sample. These tests reveal if a person has the SARS-CoV-2 virus that causes COVID-19. Viral RNA tests parse out the virus’ genetic imprint on a person’s RNA to identify an active infection. Point-of-care COVID tests produce results in as little as 15 minutes, while exams that must be processed in a lab take a couple of days or longer.

Testing for coronavirus antibodies is mostly done through serological testing. COVID antibody testing identifies key proteins that are part of a person’s immune system response to the infection. It is only useful after a person has completed an infection cycle. It determines if a person has potential immunity from becoming reinfected, but that has not been proven as yet.

Experts and leaders in Congress and the Food and Drug Administration (FDA) have sounded the alarm about the inaccuracy of many COVID viral tests and antibody tests that were available on the market early on in the pandemic, and many of which remain available today. With some testing kits producing inaccurate results about 20% of the time, employers should carefully research any test or processing lab they plan on using before contracting for testing. As a best practice, companies are advised to stick with well known, certified, national laboratories – or companies that send their specimens to these labs. (NOTE: Health Street only sends specimens to certified national laboratories).

Which COVID-19 test do employers use — the antibody test or the nucleic acid PCR test?

There are a few main differences between PCR tests and antibody tests for COVID-19. Both tests have several pros and cons. Regardless of the type of test administered, employers must make testing regular and uniform to be helpful in the workplace.

According to a May 2020 live survey from Mercer polling over 750 companies, most employers are not requiring either viral or serological testing as part of their reopening strategy. Only about 3% of employers were requiring viral RNA testing and just over 2% were using serological testing.

There are many potential reasons that COVID testing was initially catching on slowly as a component of employers’ reopening strategies. In many areas, access to testing materials was still too difficult to require employee testing. Of the tests that were available, accuracy rates varied significantly and were dependent on a person being tested at the right moment. Questions about whether coronavirus antibodies provide any type of immunity were, and remain, unanswered.

“As employers are looking in detail at testing as part of their strategy, they are realizing that antibody testing may give them information of prevalence of exposure in their population, but given the current limitations on what we know about immunity, this information doesn’t go very far in supporting impactful decision-making and actions,” says Dr. David Zieg, partner and Clinical Services Leader at Mercer. “As they look at diagnostic testing, the logistical challenges of coordinating sample collection onsite or offsite are a significant barrier, and the commonly long turn-around times lessen the value in the strategic application to their containment strategy.”

What type of COVID testing do experts recommend for employers?

The CDC and WHO have not included viral RNA testing or COVID antibody testing in their list of basic steps to take before reopening your non-essential business. However, employers can choose to implement regular testing as part of their overall reopening strategy, which should also include adequate social distancing measures, disinfecting routines, and other employee assessments.

Scientists aren’t yet sure about the level of coronavirus antibodies that are necessary to test positive in a test or to achieve any level of immunity, making the results of antibody screenings difficult to interpret. Viral RNA tests, for their part, only produce positive results if done at the right time during the virus’ life cycle, making continuous testing necessary for any results to be meaningful as well. Due to these constraints, both types of tests are currently only partially helpful to most employers.

Both COVID antibody testing and viral RNA testing can be an important part of your company’s reopening strategy and ongoing occupational health services. Depending on your specific situation and environment, it may also play a key role in maintaining a safe environment going forward. To be sure, knowing the infection status of your employees is just one of several steps that should be taken to stem the spread of the disease and avoid workplace outbreaks.

More information about safely reopening your company during the pandemic is available from many national and international organizations. The CDC’s ‘Should You Consider Reopening?‘ guide is an informative tool for deciding which preventive measures would be the most beneficial for your specific company. WHO’s ‘Getting Your Workplace Ready for COVID-19‘ is another helpful manual for employers. The FDA answers several commonly asked questions from employers on this useful ‘FAQs on Testing for SARS-CoV-2‘ webpage, offering information about both the administration and legality of COVID testing in the workplace.

Citations

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Mervosh, Sarah; Lee, Jasmine C; Gamio, Lazaro; and Popovich, Nadja. “See Which States Are Reopening and Which Are Still Shut Down.” New York Times, 21 May 2020, https://www.nytimes.com/interactive/2020/us/states-reopen-map-coronavirus.html
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“Coronavirus Disease 2019 (COVID-19): Business and Workplaces.” Centers for Disease Control and Prevention (CDC), https://www.cdc.gov/coronavirus/2019-ncov/community/organizations/businesses-employers.html
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“Getting your workplace ready for COVID-19.” World Health Organization (WHO), 3 March 2020, https://www.who.int/docs/default-source/coronaviruse/getting-workplace-ready-for-covid-19.pdf
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“Test for Current Infection.” Centers for Disease Control and Prevention (CDC), https://www.cdc.gov/coronavirus/2019-ncov/testing/diagnostic-testing.html
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“Serology Testing for COVID-19 at CDC.” Centers for Disease Control and Prevention (CDC), https://www.cdc.gov/coronavirus/2019-ncov/lab/serology-testing.html
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“The Science Behind the Test for the COVID-19 Virus.” Discovery’s Edge, Mayo Clinic, https://discoverysedge.mayo.edu/2020/03/27/the-science-behind-the-test-for-the-covid-19-virus/
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Japsen, Bruce. “Fewer Than 5% Of U.S. Employers Sold On Coronavirus Antibody Tests.” Forbes, 11 May 2020, https://www.forbes.com/sites/brucejapsen/2020/05/11/less-than-5-of-us-employers-sold-on-antibody-tests-for-workers/#6eebc1f87541
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“In the United States, how are companies adapting to the COVID-19 business and workforce environment?” Mercer, https://app.keysurvey.com/reportmodule/REPORT2/report/41488264/41196084/81161cc101fab7845b8cb499d857e8b9?Dir=&Enc_Dir=60e929fb&av=IxnIBAm77ac%3D&afterVoting=766b5e62be4f&msig=32162cb48db989d5d550fdc13ba64dc0
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Neel, Joe and Hagemann, Hannah. “FDA Cautions About Accuracy Of Widely Used Abbott Coronavirus Test.” NPR, 14 May 2020, https://www.npr.org/sections/coronavirus-live-updates/2020/05/14/856531970/fda-cautions-about-accuracy-of-widely-used-abbott-coronavirus-test
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“Coronavirus Disease 2019 (COVID-19): Workplace Decision Tool.” Centers for Disease Control and Prevention (CDC), https://www.cdc.gov/coronavirus/2019-ncov/community/organizations/workplace-decision-tool.html
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“FAQs on Testing for SARS-CoV-2.” U.S. Food & Drug Administration (FDA).” https://www.fda.gov/medical-devices/emergency-situations-medical-devices/faqs-testing-sars-cov-2
WRITTEN BY

Jared is the Founder of Health Street, the creator of the Who's Your Daddy DNA truck, and the host of VH1's Swab Stories.

WRITTEN BY

Jared is the Founder of Health Street, the creator of the Who's Your Daddy DNA truck, and the host of VH1's Swab Stories.

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Occupational Health

Read Health Street's informative articles about occupational health testing.

FEATURED IN

Occupational Health

Read Health Street's informative articles about occupational health testing.