Should Symptom-based Strategy or Test-based Strategy be Used for Allowing Workers Who were Previously Infected with COVID-19 to Return to Work? A Living Systematic Review

  • Paoline Nicole P. Villanueva None
  • Eva I. Bautista
  • Howell Henrian G. Bayona
Keywords: COVID-19, SARS-CoV-2, return to work criteria, return to work clearance, systematic review

Abstract

Objective. This review aimed to synthesize data on the accuracy, benefits, and harms of symptom-based and test-based strategies.

Methods. A comprehensive search until March 22, 2021, was done in MEDLINE, Cochrane Library, UpToDate,and medrxiv.org, using keywords related to "COVID-19," "symptom-based strategy," and "test-based strategy." Data were qualitatively synthesized. Quality of evidence was evaluated using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach.

Results. Eight studies with very low certainty of evidence were included. COVID-19 has not been cultured ten (10) days post-symptom onset in patients with the mild-moderate disease and 21 days post-symptom onset in patients with severe disease. For severely immunocompromised patients, viral shedding was noted several months post-symptom onset. Test-based strategies yielded 40% excess cost, a median of 8 days of excess acute-care-length-of-stay, and ~7.2 excess days-of-work lost compared to symptom-based strategies. A high false negativity rate (98.8%) of RT-PCR was noted among asymptomatic patients.

Conclusion. A symptom-based strategy is more cost-effective than a test-based strategy. For workers who had asymptomatic or mild-to-moderate COVID-19, a 10-day symptom-based approach may be indicated. For those who had severe-critical COVID-19, a 21-day symptom-based process is suggested. Conversely, a test-based strategy is recommended for workers who have recovered and are severely immunocompromised.

Published
2022-03-07
How to Cite
1.
Villanueva PNP, Bautista EI, Bayona HHG. Should Symptom-based Strategy or Test-based Strategy be Used for Allowing Workers Who were Previously Infected with COVID-19 to Return to Work? A Living Systematic Review. Acta Med Philipp [Internet]. 2022Mar.7 [cited 2024Mar.29];. Available from: https://actamedicaphilippina.upm.edu.ph/index.php/acta/article/view/4231
Section
Articles