By Lehlohonolo Lehana.
The National Institute for Communicable Diseases (NICD) has published new guidelines which provide clarity on re-testing for Covid-19 and returning to work.
At present, the institute said that the re-testing people who have experienced mild illness, and have recovered from Covid-19 is not recommended.
"A person is considered safe to return to the workplace and discontinue self-isolation if they are no longer infectious," it said.
"This means they developed their first symptoms more than 10 days prior and have not experienced any symptoms for at least three days (72 hours). However, returning to work is dependent on the patient’s clinical state of health."
The NICD said that the most infectious period is thought to be one to three days before symptoms start, and in the first seven days after symptoms begin.
"But some people may remain infectious for longer and this is because typically with viruses, the higher the viral load (the more virus circulating in the body), the higher the risk of transmission through known transmission pathways.
"So the more severe the illness and the higher the viral load, the longer you continue to shed the virus and are infectious."
If someone with mild disease has been symptom-free for three days and they developed their first symptoms more than 10 days prior, they are no longer considered to be infectious, the NICD said.
Do I need a negative test to return to work?
If a worker has been diagnosed with Covid-19 and isolated in accordance with the guidelines, an employer may only allow a worker to return to work on the following conditions:
- The worker has completed the mandatory 10 days of self-isolation;
- The worker may need to undergo a medical evaluation confirming fitness to work;
- The worker on returning to work then needs to wear a surgical mask for 21 days from the positive test result while at work and practices social distancing and good respiratory and hand hygiene.
"People who have been self-quarantining, because they had contact with a confirmed case of Covid-19 and have completed their 10-day quarantine period without developing symptoms, can return to work on day 11," the NICD said.
"There is no requirement to be tested prior to returning to the work. It is, however, recommended they continue to practice social distancing and good hygiene as a precaution and wear a surgical mask."
False negatives and extended positive periods:
The NICD said that a patient can have a false negative if they have very little virus up their nasal passages or perhaps the specimen was taken inappropriately.
In these cases, if a patient presents with symptoms of Covid-19 — cough, fever, shortness of breath — but they test negative, they should consult their health practitioner for further assessment, the NICD said.
Patients can also remain PCR positive (from Polymerase Chain Reaction testing) even after they are no longer infectious.
"A positive PCR test does not equate to an infectious, viable virus. Patients may be de-isolated without the need for repeat PCR tests provided the patient’s fever has resolved and their symptoms have improved.
"Those with mild disease may be de-isolated 10 days after symptom onset, while those with severe disease may be de-isolated 10 days after achieving clinical stability (e.g. once supplemental oxygen is discontinued)."
The NICD said it is common for patients to continue to have symptoms for longer than the above time periods (10 days) and that full recovery may take several weeks.
"Patients who are still symptomatic at the end of their isolation period can be de-isolated provided that their fever has resolved (without the use of antipyretics) and their symptoms have improved. If symptoms are persisting, the worker should seek medical assessment from their practitioner."
I was tested over two weeks ago and I haven’t received my results yet. Can I return to work?
Suspected Covid-19 cases who are or have mild disease, should be managed at home while awaiting test results, isolated from the workplace, the NICD said.
"These workers should communicate with their manager and not be at work until they have results. Constant communication with their employer is essential during this time so that the workplace can take steps to manage and clean as appropriate."