AUSTIN, Texas — People who have recovered from COVID-19 should not be required to get re-tested to go back to work or school, according to the Texas Medical Association (TMA).
On Tuesday, the TMA announced its support for the CDC's recommendation that people should not be required to show a negative coronavirus test result or a note from a physician to return to the office or classroom after being sick, with a few exceptions.
“We know that time and reduction of symptoms are the most accurate indications that a person is no longer infectious,” said Valerie B. Smith, a Tyler pediatrician and TMA COVID-19 Task Force member.
“People diagnosed with COVID-19 can shed [inactive and noncontagious] viral particles for several weeks after they are no longer infectious and may continue to have a positive test,” she said, because it could reveal those viral particles. “Requiring a test to return to work or school would potentially require a person to stay in isolation while no longer infectious.”
The CDC no longer recommends testing to end self-quarantine in most cost cases because some tests can yield false negatives when taken too soon. False positives can also occur on tests when patients continue to test positive even after the infectious period has passed. Repeated testing can also add even more strain on testing facilities that are already experiencing high volumes, limited availability and longer wait times.
Instead, the CDC adopted a symptom-based strategy to decide when patients who tested positive should end their self-quarantine.
People with a mild to moderate case remain infectious no longer than 10 days after their symptoms began, CDC researchers say. And those with more severe cases who are severely immunocompromised remain infectious no longer than 20 days after their symptoms began.
"Testing is not as effective as we'd like it to be," said Dr. John Carlo, the CEO of Prism Health North Texas, who is also on the TMA COVID-19 Task Force. "You know, there are a number of examples that we studied in the last couple months. Number one, somebody that is with the coronavirus infection, has a negative test. Or number two is in this situation that we're talking about with returning to work, somebody is recovered, likely not infectious, but still has a lingering positive test as a result of that lingering, you know, material that's still left behind, causing no infection."
Carlo added that it becomes a case-by-case basis when it has to do with returning to schools.
"You know, you have to look at the particulars around, number one, what's happening in your particular community. You know, what is going on in terms of the number of cases that are happening in the environment all around you? Number two, what is that facility environment going to look like perhaps in a classroom setting?" Carlo said.
The few exemptions mentioned above include those who are severely immunocompromised and whose infectious disease physician recommends a test, or people seeking to end their isolation or other precautions earlier than what would occur under the symptom-based strategy. They would need two consecutive negative tests taken at least a full day apart.
“The symptom-based strategy allows COVID-19-positive patients to return to work or school after 10 days of isolation as long as they have been without fever for 24 hours and have improvement of their other symptoms,” said Dr. Smith. “The TMA approach to return to school and work is consistent with the CDC guidance that will allow us to protect our community and allow those infected with COVID-19 to return to their daily lives as soon as possible.”
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