Time-plus-symptoms approach leads to faster return to work at one health system

Sept. 25, 2020

Researchers at Mass General Brigham (MGB) found that 4,000 days of lost worktime would have been gained if the organization had used a time-plus-symptom approach to determining when workers infected with SARS-CoV-2 can return to work instead of a test-based strategy, according to a press release. Their research was published in Infection Control & Hospital Epidemiology.

A guidance from the Centers for Disease Control and Prevention (CDC) in April advised either a repeat test-based strategy to determine when workers could return to their healthcare jobs or time-plus-symptoms approach. The test-based approach involves repeat testing after resolution of symptoms until two consecutive negative PCR tests are obtained 24 hours apart. In the alternative time-plus-symptoms approach, healthcare workers return to work after a set period of time since their symptom onset (or in the case of asymptomatic infection, the date of their positive test) has elapsed and symptoms, if present, have improved or resolved.

For this study, conducted between March 7 and April 22, 2020, employees from MGB (formerly Partners HealthCare) who showed symptoms of COVID-19 were referred to its Occupational Health Services department for evaluation and a nasopharyngeal (NP) sample test using viral RNA nucleic acid amplification methods.

Return to work criteria at that time required: resolution of fever without fever-reducing medications, improvement in respiratory symptoms, and at least two consecutive negative nasopharyngeal tests collected longer than or equal to 24 hours apart. There was no minimum interval of time specified between the resolution of symptoms and the first test of clearance.

Researchers analyzed the data for 1,000 infected healthcare workers to evaluate results of the two strategies and found that using resolution of symptoms and passage of time would have averted more than 4,000 days of lost worktime, or a mean of 7.2 additional days of work lost per employee compared to using a time-plus-symptom approach. About 70 percent of participants had at least one negative test result during the study, and of those, about 62 percent had a two negative test results in a row. The time-plus-symptom approach now has replaced the test-based approach at MGB.

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