To the Editor: The New South Wales Department of Health has taken necessarily stringent steps to reduce the risk of workplace outbreaks during the coronavirus disease 2019 (COVID‐19) pandemic. Currently, two nasopharyngeal samples, analysed by polymerase chain reaction (PCR), negative for severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) are required before asymptomatic individuals can return to high risk workplaces (eg, hospitals, schools and prisons) or close proximity living arrangements (eg, residential aged care facilities, military barracks, and group homes).1,2,3
In Newcastle, existent hospital in the home services have been redeployed as part of a tiered pandemic response under the banner “COVID Care at Home”. COVID Care at Home offers daily telehealth monitoring and efficient clearance certification for patients in isolation or excluded from workplaces. In our experience with 45 patients with COVID‐19 admitted to COVID Care at Home, increased PCR surveillance also uncovered cases of prolonged RNA detection. One passenger from the vessel Ruby Princess tested positive for COVID‐19 52 days after the initial swab and more than 60 days after the first day of symptoms.
A review of international data showed that PCR positivity usually persists for 20–30 days regardless of symptomology.4 Cases of SARS‐CoV‐2 RNA detection persisting for 60 or even 80 days have been recorded in the literature.5,6 In the case of our patient, the ongoing exclusion from the workplace created significant psychological and financial burden due to lack of leave entitlement. Similar policies in countries with less worker security are likely to have even greater workforce impact. To tackle the issue of prolonged positivity, we have convened a panel of clinicians in the disciplines of infectious diseases, population health, and microbiology to make informed decisions about patients with prolonged viral RNA detection in regard to their ongoing need for isolation and exclusion from high risk environments.
PCR positivity is not synonymous with infectivity.7,8 Regardless, to maintain the good results Australia has enjoyed thus far, we will need to persevere with a high level of vigilance. Making informed and safe decisions about clearance for high risk environments and supporting patients with prolonged exclusions from their workplace will be an ongoing challenge for Australian clinicians during the COVID‐19 pandemic.
- 1. Eisen D . Employee presenteeism and occupational acquisition of COVID‐19. Med J Aust 2020; 213: 140. https://www.mja.com.au/journal/2020/213/3/employee-presenteeism-and-occupational-acquisition-covid-19
- 2. Communicable Diseases Network Australia. Coronavirus Disease 2019 (COVID‐19) CDNA national guidelines for public health units. Version 2.7. https://www1.health.gov.au/internet/main/publishing.nsf/Content/7A8654A8CB144F5FCA2584F8001F91E2/$File/COVID-19-SoNG-v3.10.pdf (viewed Nov 2020).
- 3. Greenhalgh T , Choon Huat Koh G , Car J . COVID‐19: a remote assessment in primary care. BMJ 2020; 368: m1182.
- 4. Zhou F , Yu T , Du R , et al. Clinical course and risk factors for mortality of adult inpatients with COVID‐19 in Wuhan, China: a retrospective cohort study. Lancet 2020; 395: 1054– 1062.
- 5. Li J , Zhang L , Liu B , Song D . Case report: viral shedding for 60 days in a woman with COVID‐19. Am J Trop Med Hyg 2020; 102: 1210– 1213.
- 6. Liu WD , Chang SY , Wang J , et al. Prolonged virus shedding even after seroconversion in a patient with COVID‐19. J Infection 2020; 81: 318– 356.
- 7. Tang YW , Schmitz JE , Persing DH , Stratton CW . Laboratory diagnosis of COVID‐19: current issues and challenges. J Clin Microbiol 2020; 58: e00512– e00520.
- 8. Atkinson B , Petersen E . SARS‐CoV‐2 shedding and infectivity. Lancet 2020; 395: 1339– 1340.
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