Episode 9: COVID-19 testing protocols in the workforce
In our latest podcast we are joined by Talita Radin from Australian Clinical Labs and Amanda Tulloch from EBM Insurance & Risk to discuss the differences between PCR and RAT tests and how some workplaces are implementing their COVID-19 testing protocols.
Speaker 1 - Disclaimer
In this podcast, we have provided general advice only and not personal advice. In giving this advice we have not considered your personal circumstances.
Welcome to EBM Insights.
By now I think we all must feel like experts when it comes to pronouncing medical terminology and acronyms!
DELTA, OMICRON, TGA, symptomatic, asymptomatic, positive, negative, PCR, and don’t forget RATs are all part of our daily vocabulary.
What better time than now to discuss the differences between PCR and RAT and which test should be used for different situations.
Today we will also discuss testing regime examples for workplaces and provide examples on how different industries are managing the risks associated with COVID-19.
I’d also like to confirm that we are recording this podcast via Microsoft Teams to meet social distancing protocols.
Joining me today from separate locations are Amanda Tulloch, EBM Insurance & Risk’s National Manager for Injury Management and we would also like to welcome Talita Radin, the Commercial Manager for Australian Clinical Labs.
Welcome to you both.
Talita, you are speaking to this topic as part of your role as the Commercial Manager for Clinical Labs.
What we will just clarify with our listeners is that you are not a clinician. However, you will provide general commentary around how Clinical Labs has been operating under COVID-19 and some of the plans the business has implemented to assist sectors to protect their workforce.
Can you tell us a bit about Clinical Labs and and your role?
Well, Clinical Labs are a private pathology provider. We're a national organisation and we have 86 laboratories across Australia, and we process over 8,000,000 episodes a year through our laboratories.
My role with Clinical Labs is at the moment, liaising with our commercial clients, so they're clients that aren't GPs.
Our specialists are assisting with any of their pathology needs.
So traditionally this has been around things like drug and alcohol screening, immunity testing, heavy metal monitoring, but of course what we find now is it's all about the pandemic response and how can these organisations protect their staff and their sites to try and prevent the spread of the virus and I think you mentioned a really important point there.
I'm not a clinician, but I do work with these tests daily in a clinical environment of a private pathology lab, and therefore have a responsibility to keep up to date with not only the government regulations, but also the advice around COVID and the testing methods available, so hopefully I can provide some insight.
I'm sure you will.
Right, and so for our listeners, and I think this will be a really important discussion.
Can you describe the differences between a PCR test and a RAT test?
Sure, I think this is probably one of the most interesting and important questions that we're going to discuss today, and the reason being is, this gives you some background as to when and where these tests become appropriate. So, they both play a really important part against the spread of COVID, but it's really important to use the right one at the right time, so PCR is a test that we were using in the laboratory to actually amplify the virus in the sample that we collect.
So that's a really important point to note because it means that this test is actually diagnostic.
It is much more reliable and at that point in time that you are being tested, it will tell you if you do or you don't have the virus provided the samples are collected correctly of course.
We sample the back of the throat as well as the nose to make sure that we're collecting as many viral particles as possible.
There's been some studies that suggest that the virus can be detected in saliva before it moves into the nasal mucosa, so by testing in this way, we're having the best chance of grabbing as much virus as we can.
And the other thing with PCR is because it amplifies those viral particles it can find much smaller what we call viral loads.
So, you can have a much lower number of particles in that sample and the test will still pick them up.
And that's really important to remember when we talk about the difference with RATs.
So, RAT stands for Rapid Antigen Test.
I'm sure we've all heard that a million and one times. Antigens are substances that cause the body to produce an immune response. So, they trigger the generation of antibody. So that's what we're looking for.
We call them Rapid Antigen Tests because they're fast. It's all the same thing.
The thing with RAT is you test the sample you get.
There is no amplification of that sample.
So, if your sample is insufficient and there aren't enough viral particles on that sample, it's very easy to get more well Easy, it's a subjective word, to get a false negative.
So, one of the analogies I know I've spoken about that seems to resonate with people is cordial.
When we're looking at pouring a glass of cordial for your kids, so if I have a full glass of water and I put one or two drops of cordial in that glass and then I have a taste it's going to be really difficult for me to pick up the flavour of that cordial.
I, however put a giant glob of cordial in there, and I've got like 1/2 half mix. Not a problem, I can taste it very strongly, so a Rapid Antigen Test is a little bit like that.
If you think of the cordial as the viral particles or the viral load of the patient.
If there aren't enough viral particles, it's very easy for the test to miss them.
Right, so I mean there's a study that I read recently that said that the time from a first positive PCR test to a first positive antigen test was three days, so I could be very early in my infection. I have a very low viral load and the PCR will test and find me positive and it could take up to three days before an antigen test on the same person would return a positive result.
Yeah, that ability of the PCR to amplify the virus and to pick up the much lower viral loads is really important to consider when you're looking at the differences between the two tests.
There's also more interference with the RAT test, so I read, and I don't know how true this is, but I read a piece about a group of kids in the US who discovered that if they drank orange juice right before they did their rapid test, they would return a positive result, so they all shared this information, so no one had to go to school.
So, RAT is a little bit more susceptible to these external factors as well.
It's not a laboratory test, it's a test that's designed for mums and dads to be able to buy from the pharmacy and run themselves.
So, it's not as accurate as as a PCR.
Hopefully those kids use their methods to grow up and become perhaps lab technicians or something when their thinking about that sort of testing at this age especially.
And look the other thing to keep in mind with children is a lot of people are opting for saliva-based RAT testing for children and early on the Chief Health Officer in Australia said that they didn't like saliva testing and they didn't want to approve saliva testing for PCR because the cells in the saliva are much more diluted.
So, 90% of tests fail at point of collection, so PCR of the throat and the nose really mitigates this dilution factor that you have with a saliva sample.
So, you know that's another factor that we need to consider as well, right?
Thanks Talita, that was fantastic information.
I've heard it can be quite difficult to read a RAT test result.
Are there any tips on how to do this correctly?
So, there's quite a few a few risks.
I guess with not reading, a RAT test correctly or not undertaking the tests correctly and it's really, really important that people take the time to familiarize themselves with the instruction sheet that comes inside a RAT kit.
First and foremost, you have to wait the correct amount of time.
So, the way that the antigen test works is that you're putting droplets of your sample onto a test strip and the fluid has to soak along the strip to return a result.
So, if you read it too early and the fluid hasn't had time to soak along to the markers, you could get a false negative.
If you wait too late, however, and the fluid has saturated the test, there's a risk of a false positive.
OK, so there's also the concentration of the solution, so it's very specific on the instructions as to how many drops you should put into the cartridge.
Too many drops or not enough drops could make a difference.
They need to be stored at the correct temperature, so if you've left your RATs in a car on a day like we're having in Perth today where it's going to be 37 degrees and the inside of the car heats up much hotter than that, you'll RAT kit is dead, and your result is potentially going to be compromised.
And then the other thing we've seen, which was really, really interesting, we've seen in our environments is dust and interference from dust and dirt means that the fluid won't adequately flow along that strip.
So, there are lots of different things to consider and and then of course we've also if you're doing a saliva RAT you do need to take into account and take very seriously the instruction that you shouldn't eat or drink anything 30 minutes leading up to that test.
Great, so following on from that Talita which type of test should be used and when for which situation?
Yeah, this is a really contentious question, I think because there's different circumstances for everyone, I mean if if we look at the the variance of COVID’s Omicron and Delta, there's evidence that antigen tests can detect both and lab studies have detected both variants at the same viral levels.
But of course, labs are not reflective of real-world situations.
PCR will will pick up both Omicron and Delta, so from a variant perspective it doesn't really play a part anymore. Majority of rapid antigen tests have been tested and proven to test for Omicron, there are some who are still finishing their studies and you can find all of that information on the TGA website where list TGA approved Rapid Antigen Tests and the strains that they are approved for.
But in terms of RAT and PCR I mean it comes back to what we what we just talked about.
PCR is still the gold standard.
So, if you have access to PCR testing, it is going to be your most accurate diagnostic test of do you or don't you have the virus?
It will pick it up if you are at a very low viral load and and it's just going to give you that real peace of mind that you haven't got a false result or, you know, if you're an early viral load and you have a RAT test again, you have that risk of the false negative.
So, in my mind I would be going for PCR every day the week and at the moment for patients who are symptomatic or have been a close contact or are interstate travellers or returned interstate travellers, there are whole raft of situations where the PCR testing is free, it's provided by the government, so cost is no longer a barrier and you know our drive-throughs are really not that busy at the moment, so there's nothing that would would stop me from choosing a PCR first.
RATs, however, play a part where you're not able to get to a testing clinic for a PCR so if you have someone who is infirm who doesn't drive, who is remotely located, or is concerned about continual infection risk then having RAT at home to be able to continually test and reassure definitely plays a part in the strategy for this virus, but I think you know the key is repeatedly testing because, as we already discussed if your viral load is low, you risk a false negative, and that's quite dangerous.
Because you can then go out into the community and just because your viral load is low doesn't mean your infectious load is low, so you can still be spreading that virus, thinking that you're perfectly safe to another at the next day, and all of a sudden there comes the second line on the test.
So, I think you know PCR is always going to be the test of choice. But if for some reason you're not able to access the PCR, then I would I definitely be having some RATs on hand.
Thanks Talita, given the popularity of these RAT tests, what are some of the do’s and don'ts for these tests, including how do we dispose of all these tests that have been undertaken in a safe manner?
Yeah, that's a really good question.
So, in the laboratory environment and in our testing clinics we have biohazard waste disposal, but obviously you don't have that in the home, so one of the recommendations is to use your good old zip lock bags.
So as soon as you've completed your test, you need to be really careful with personal hygiene while you're undertaking the test.
And as soon as you've completed the test, put all of the components into a zip lock bag and seal it up, and then you can dispose of that in your general waste bin.
And of course, again, make sure you thoroughly wash your hands after conducting the tests.
You also need to remember these tests have a lifespan so keep an eye on the expiry date and we already talked about storing them correctly.
The other thing is to make sure you keep them lying flat when you're waiting to read the test.
Because, as we mentioned, it's about the flow of the fluid on the test strips, so keep it lying nice and flat on a desk and again just make sure you follow the instructions inside really, really carefully.
Talita just on that further. Does RATs tests for all strains of the COVID-19?
Yes and no.
So, the TGA website is the best resource for that.
So, the TGA website will list the tests that are approved by the Therapeutic Goods Administration and will also list the strains that individual tests will pick up.
Obviously, Omicron and Delta are the key ones that we're interested in at the moment.
But there are some earlier strains and I'm sure there will be some future strains, but the TGA is the best place to keep up to date and just make sure that the test you're purchasing do meet both TGA requirements and you know do have that sensitivity and coverage of those strains.
As well, there's lots and lots of interesting, branded tests available that potentially aren't going to give you what you're looking.
So not all RAT tests are created equal?
No, absolutely that's correct, yeah.
How long is the lifespan of the approved RAT tests?
So, the RATs that we have in stock at the moment I think are expiring end of 2023 early 2024 and they will all be different.
And, you know, depending on what stock and how long organisations are holding stock for, you know if you go into a pharmacy and you get the one that's been on the bottom of the pile, it may have a shorter expiry
So, I'm hoping we don't need these by 2023 and 2024.
You've worked with many industries Talita during the pandemic on workplace testing protocols, and one of these industries is the resource sector. Can you take us through an example of a typical COVID-19 testing plan for the resource sector?
That's designed to help stop the spread of asymptomatic COVID-19 among staff and customers.
Yeah, sure, so a lot of the work that I've been doing lately is in the mining sector and I'm sure you've all seen there’s been a lot in the news recently about COVID making it onto site and that's pretty catastrophic for these businesses to have to shut down, remove staff from site, undertake deep cleans when you know their turnover every single day is you know, potentially millions of dollars, so we're trying to avoid that as best we can.
And a lot of the strategies we employ for mining can also be considered for smaller businesses or organizations that are based in the CBD.
So first and foremost, we want to try and prevent the virus getting to site.
So, we do that with PCR testing prior to mobilization, so a lot of the workers for these organisations are instructed to go through a PCR testing clinic 24 hours before their flight.
As we mentioned earlier, this is a really reliable test, so we know at that point in time 24 hours before they get on that plane, they don't have COVID. And if they do, heaven forbid they don't turn up to the airport the next day.
I think the challenge with that is what are they doing in that 24 hour before they get on the flight, and that's up to the organization to manage.
But we know then that we have a very safe population boarding that airplane.
And then we look at what we can do to help protect their workplace once these staff arrive at site.
So, there's a few different options available depending on the risk appetite of the organization, and obviously we talk through these options and then it's up to them to choose which way they want to go.
So, this is where RAT can become really helpful, because obviously if you're out in the in the middle of the heart of WA on a mine site you don't have the option for a PCR test necessarily.
So, by having RAT on site, anyone who becomes symptomatic can instantly be tested and isolated.
Tested again the next day.
Potentially tested again a third day before they are then released from isolation back into the workforce.
The other option that we have is what we call a point of care PCR, and this is a little more challenging to set up, but it's essentially a mini version of a PCR test.
A PCR machine that can be set up on on a mine site or on location anywhere and enable adequately trained staff to swab and run a single PCR test, so it gives them that option if they wanted to make that investment to have that on site where they don't have PCR testing available.
It's really the responsibility of the organization from there to have their strong protocols in place and how they manage their tracing and isolation.
And of course, we always support these organisations when they're doing RAT on site.
If they have a positive or if they have a negative and they're still not convinced they have trained medics who can take a PCR.
That's what it comes down to us on the next flight. A lot of these companies have daily flights. We run it straight away and give them that reassurance that worker is safe and healthy or, heaven forbid the other.
The other situation is, I hope you've got that person in quarantine.
We now need to swab everybody on site, and we have protocols in place to allow for pretty rapid turnover of tests where we have a suspected positive in a risky environment, like a mine site.
Yeah, the other one that we worked very closely with is private hospitals and public hospitals as well, but mostly private hospitals.
Being a private pathology laboratory, and so if we have a patient in a hospital who shows symptoms, we can very, very quickly have them swabbed and have that swab run a result within a matter of hours to that hospital to know what they're dealing with.
And what do they need to do next?
So the the other thing that we do sometimes for large organisations that are risk averse is we organise office swabbing so we'll bring a team in to a really large building and swab floor by floor and that again depending on the risk appetite of the organization can be RATs or it can also be swabbing people bringing their swabs back to the lab and then conducting PCR and giving those office managers the all clear that their staff are are all fine and safe to continue working together in those situations where it's not feasible for them to work from home.
When it comes to RAT self-testing within the workforce do staff need to be trained in how to do this?
The general answer for this one is no, and it's interesting.
I've had a lot of questions about this in the last week, so RAT kits have been designed for untrained people to test themselves, so the instruction sheets inside the kits are really thorough, and if they're followed correctly, then no, no training is required.
There is a point of care, rapid antigen test or there are some point of care rapid antigen tests which can involve small analysers and we use these when we're testing for example, we do some airport testing and what it does is it takes away the subjectivity of a layperson reading that cartridge and looking at the stripes and making the decision on a very faint stripe - is that there is it not?
Am I seeing things?
So, basically the RAT cartridge gets put into the analyser and the analyser very clearly gives you a tick or a cross.
Those point of care units do need some level of training and suppliers of the point of care units are responsible for supporting and training organisations they sell them into. But your standard self-test kits, no, no formal training is required for them.
But of course, if you're going to use those to protect your organization in an occupational setting, they do do present challenges.
So how do you ensure that your staff have followed the instructions?
How do you know for sure that the test has been stored correctly, that they've read it correctly, that they've waited the right amount of time?
And then of course, how do you ensure the result was negative? Because if you just leave it sitting there after that 15 minutes, you can't just bring that cartridge in four hours later and go here it is, you know.
So there there are a lot of challenges associated with using right in that environment and how organisations deal with those challenges I guess is different every time.
So, what would be some of the protocols in the workforce around a staff member receiving a positive result?
So, the protocols in the workforce, I guess depends on the individual organization and what plans they have in place.
What environment or staff are working in so are they in isolated offices or are they in open plan but essentially all positive PCR notified to the Health Department who then contact the patient, undertake contact tracing providing instructions around isolation and those sort of things in terms of RAT. Currently it's compulsory to notify a positive RAT online and I actually did this myself not all the way through, because I didn't want to falsely register one, but it it's quite a good system.
So, it does ask for your details, and obviously when you took the RAT and then the government is able to follow those up should they need to.
Currently, if a person has no symptoms after seven days since their first positive test, they can leave isolation so.
I guess with all of that knowledge it's for the workplace to really decide how they then manage if the person has been in the workplace.
If it was me, I would be asking them all to go through and have a PCR test before returning to work.
But there are also some guidelines and information around how workplaces should manage these situations on the Australian Government website.
Talita, in your opinion at what point would you recommend that the workforce transition to a PCR testing?
I think you just mentioned there before if there is a positive rapid test, that's an area where you'd consider PCR testing.
Is there any other situation where you think the workforce will need to transition into straightaway into a PC out?
It's a difficult question. It's a good question, Amanda, but it's a difficult one because the situation in WA in particular is currently changing and it's changing quite rapidly.
So I think you know, in the past we sore large organisations using PCR testing through commercial arrangements with with CHO approval to try and Prevent you know the virus from, for example in mine sites getting to site, but now that we're seeing caseloads increase, I think we've got more and more organisations concerned about how to manage these so you know, we know from experience that a lot of companies are asking people to stay home and work from home where they can, but it's not always feasible.
In my opinion, PCR is always always the better method, and if you're metropolitan base and you have testing clinics nearby that your staff can go to, I would always be choosing PCR over at having said that, it's about being, I guess, fair and reasonable.
If if no one has symptoms and no one being a close contact, is it necessary to be regularly testing staff?
And again, that's up to the organization to decide, and I am very much not qualified in HR laws and what you can and can't ask staff to do.
At Clinical Labs, we are very careful to protect our staff. We spend a lot of time obviously training in correct donning and doffing and wearing of PPE and and all our staff are very well protected.
But we also do conduct regular PCR testing on staff that are around COVID samples.
But again, I'd probably refer people to the Department of Health website they've they've recently released a new document called Guidance for the Management of COVID-19 in the Workplace, and it does walk you through what to do when you have a positive case in the workplace. But again, knowing what we know about RAT and its lower sensitivity and specificity and the risk of the the false positives and negatives. I'd always be confirming a positive rap with PCR just to be 100% sure.
Thank you to Talita and Amanda for joining us today. If you'd like more information on COVID-19 testing protocols, please go to the Department of Health website.
If you would like to learn more about Clinical Labs, please visit their website at clinicallabs.com.au.
A reminder to our listeners that all EBM Insights podcasts are available via Spotify, plus we have links to each episode on our website, being ebm.com.au.
Once again, thank you to Talita and Amanda.