COVID-19 & workplace safety: vaccines & antibodies

In early May 2021, the Centers for Disease Control and Protection (CDC), relaxed their face masking and social distancing restrictions for people who were fully vaccinated against SARS-CoV-2, the virus that causes COVID-19 illness. The CDC stated that people who were fully vaccinated (14 days past their second shot) were no longer required to wear face masks or stay 6-feet-apart from others indoors or outdoors. However, vaccinated people still needed to abide by the safety rules of local governments and certain environments (i.e., when traveling on airplanes).

The CDC issued their announcement before many people had been able to receive even the first dose of a COVID-19 vaccine, and before the United States and other countries had achieved their goal of vaccinating at least 65% of their populations before relaxing safety measures.

Changing Guidelines, Mixed Messages

Although the CDC's new guidelines caused widespread confusion and concern, a few local governments announced that they, too, were loosening their restrictions. Many businesses responded by eliminating their face masking and social distancing requirements. In anticipation of people returning to the workplace, officials in some US counties announced new rules for employers in regard to keeping employees safe. For example, on May 19, 2021, health officials in Santa Clara County, California announced new COVID-19 workplace requirements that may soon be followed in other counties as well. The new rules in Santa Clara County require all business and government employers to check the COVID-19 vaccination status of their employees, contractors and volunteers before they return or enter the workplace.

Santa Clara county administrators are mandating workplaces to track their employees' vaccination status. Workers refusing to share their vaccination status will not be allowed to re-enter the workplace. They will be asked again every 14 days to share this information. They must be vaccinated before returning to work. In a press conference about the new rule, County Public Health Officer Dr. Sara Cody announced that remote working practices as a safety measure are no longer necessary, since their region has reached a high vaccination rate and a relatively low COVID-19 infection rate.

"...I am rescinding the October risk reduction order, and I'm replacing it with a very simple order," said Dr. Cody. The primary component of the new order, Dr. Cody said, was that employers will have to verify whether employees are vaccinated. The new health order in Santa Clara also requires businesses to define safety rules for employees who are unvaccinated, and requires workplaces and schools to continue reporting when they have a COVID-19 case.

Santa Clara's announcement arrives in advance of the June 15, 2021 date previously set by the State of California as part of its tier-based safety timeline for relaxing its current face mask and social distancing mandate. CA State officials had announced that a mid-June date would allow more citizens in California, particularly teens and young adults, the time needed to get the two shots required to be fully vaccinated.

In line with California's state guidelines, employers in many other counties of California, and in other states in the United States, are opting to wait until mid-June before reducing their face mask and social distancing restrictions out of concern for their employees' health and well-being.

Are COVID-19 vaccination requirements legal?

The new mandate in Santa Clara County raised questions about its legality, but law experts say that employers can require COVID-19 vaccinations, but with exemptions for health and disability reasons, as well as for religious objections. Employers and companies in the county must move quickly to comply with the new mandate, while also making sure they understand the exemptions.

Both the requirements and exemptions are expected to impact workplace culture. Many people ask: What about those employees who are exempted from the vaccine requirement for health or religious reasons? Will others be safe working alongside them?

In those cases, employers can refer to advice from Dr. Anthony Fauci, the director of the US National Institute of Allergy and Infectious Diseases (NIAID) and the chief medical advisor to the US President, who recently said that it is reasonable for businesses to keep face mask mandates in place. Dr. Fauci's comments were related to the new CDC guidelines. Continuing to wear face masks in many environments would offer some protection against non-vaccinated people who may ignore the honor code the CDC proposed, and simply stop masking and social distancing despite their non-vaccinated status, placing others at greater potential risk. This extra precaution may be wise in light of the facts — in many places around the world, case rates are increasing, death rates are increasing, and variants are spreading.

What about workers who have recovered from COVID-19?

The immunity status of people who have recovered from COVID-19 illness is still unknown, unless they undergo antibody testing. Serology studies conducted using blood samples taken from people who had recovered from COVID-19, showed that their antibodies developed a short time after recovery and lasted for about 7-8 months. Would those antibodies protect them from reinfection by a newer variant of SARS-CoV-2? That is still unknown. People in recovery from COVID-19 have been advised to get vaccinated since any antibodies they develop post-COVID-19 may not confer full immunity and will eventually diminish. However, COVID-19 survivors may feel that their natural immunity precludes them from vaccination. Will they be exempted from showing proof of vaccination? Or, will they be required to show proof of blood testing for antibodies, with results that show they carry antibodies against SARS-CoV-2?

Can routine antibody screening be paired with vaccines for greater safety?

Many health experts believe that pairing routine antibody testing with COVID-19 vaccines and booster shots is the safest way forward. Requirements for antibody testing and so-called "immunity passports" may help to alleviate uncertainty and anxiety for many people. How would these work?

Decision-makers — those who must make safety decisions for businesses, schools, public transport and travel — may take a step beyond requiring proof of vaccination by requiring people to show proof of their antibody status. In other words, in addition to showing a COVID-19 vaccination card, they may have to also show an antibody test result. According to an article by Dr. Deepak Nath, Ph.D., Siemens Healthineers AG for Healthcare Business Today, the data provided by systematic antibody testing is likely to be a critical piece in solving the complicated puzzle of how to keep everyone safe now that COVID-19 is here. We don't definitively know how long each vaccinated individual or recovered individual will stay protected from future infections and variants, or if and when they’ll need booster shots. However, systematic antibody testing (paired with vaccines) could provide many answers.

A program of routine antibody testing and vaccines will help us understand the duration and persistence of each individual’s immune response. It will help us identify when and if we reach herd immunity, and will help us determine if or when booster shots are needed. This combination of testing is commonplace for some other vaccines, says Dr. Nath. Antibody testing alongside the hepatitis B vaccination, for example, enables us to assess the need to deliver a booster shot against Hep B. 

What would antibody screening look like?

During the coronavirus pandemic, many research groups have utilized finger-prick blood collection to conduct remote COVID-19 studies. Thousands of study participants in a United States serology study conducted by the National Institutes of Health (NIH) received Mitra^® devices in Mitra^® Collection Kits from Neoteryx. These portable devices enabled people sheltering at home to self-collect "microsamples" of blood using a lancet to prick their fingertip.

Participants then mailed their samples in the prepaid packaging directly to the research lab for analysis. Other organizations used the same devices to perform "drive-through" antibody screening for community immunity surveillance programs. In these cases, healthcare workers wearing protective equipment performed the specimen collection as people lined up in their cars at designated outdoor areas. 

Similar programs could be carried out on behalf of employers and other organizations for antibody screenings that might occur at specific intervals moving forward: 4-6 weeks after people recover from COVID-19 illness or receive their second COVID-19 vaccine, and then again 9-12 months later. In his article, Dr. Nath suggests that this type of antibody screening would furnish researchers, employers, and health departments with important data.

The data gathered from antibody screening would be used to track public health and immunity trends, identify people who did or did not develop sufficient immunity, and determine who would need booster shots, and when. It could also guide a safe and efficient return to the workplace and a return to some form of "normalcy" in other settings without causing people undue anxiety and uncertainty about their safety.

Related reading: https://calmatters.org/newsletters/whatmatters/2021/06/california-masks-work-calosha/ 

Image credit: Renee Schiavone/Patch, NY

For information on microsampling to research vaccines, visit our infectious disease resources.