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Antibody testing vs Positive Test

Posted

Specializes in kids. Has 25 years experience.

OK School nurse peeps, help a girl out...

Have a kid who needs to be quarantined r/t close contact. Parent states student had C19 in November (but was not tested). Parent claims student has antibodies due to said illness. State says antibodies cannot negate the quarantine as there is no time frame to work from (90 days being the standard per CDC). Parent has a + antibody test and doesn't want to student to test if we will not accept results  for student. (I agree with that)

Has anyone run across this? Parent is not happy that student is in Q.

Thx!! Happy Friday!

GetBackToClassRN

Specializes in Pediatrics, Hematology Oncology, School Nurse. Has 15 years experience.

If the student does not have proof of a positive COVID test within the last 90 days, then my district would expect for them to quarantine.  I don't believe my district would even allow having an antibody test to get out of doing quarantine.

NutmeggeRN, BSN

Specializes in kids. Has 25 years experience.

22 minutes ago, GetBackToClassRN said:

If the student does not have proof of a positive COVID test within the last 90 days, then my district would expect for them to quarantine.  I don't believe my district would even allow having an antibody test to get out of doing quarantine.

Agreed, just looking for what others have experienced. Thanks!

BrisketRN, BSN, RN

Has 4 years experience.

Per our state guidelines the student would only get out of quarantine if proof of positive COVID test in the 90 days before possible exposure.  We've had to quarantine students and teachers who had COVID more than 90 days before exposure.  Bummer, but we have to follow the guidelines from the state dept of health.

Queen of Icepacks, RN

Has 42 years experience.

I had  a case just before Christmas that the positive test was 97 days before the exposure.  Because it was so close I did ask the DOP for a decision and they said that we had to quarantine the individual. 

 

NutmeggeRN, BSN

Specializes in kids. Has 25 years experience.

32 minutes ago, BrisketRN said:

Per our state guidelines the student would only get out of quarantine if proof of positive COVID test in the 90 days before possible exposure.  We've had to quarantine students and teachers who had COVID more than 90 days before exposure.  Bummer, but we have to follow the guidelines from the state dept of health.

Yup...but my answer is not a satisfactory one. Have referred to a being higher than myself on the food chain!

JenTheSchoolRN, BSN, RN

Specializes in School nursing.

Yep, mine is the same as other folks. Positive PCR test done in the past 90 days would be the only thing letting a child out of quarantine completely.

Also, had this happened today. Student tested positive during my surveillance testing on site on Monday. Retested by doctor on Wednesday. Was negative. Both PCR. Per my state DPH, the first one stands no matter how many negative tests happen after and student must complete 10 day isolation period. 

(This was a student whose parents tested positive the month prior and had tested negative during their quarantine, completed the quarantine. No symptoms developed. I suspect student may have been positive just after the last negative test and I may be looking at a situation that shows me why we don't test again for 90 days after a positive result.)

ruby_jane, BSN, RN

Specializes in ICU/community health/school nursing. Has 10 years experience.

In my district we are not supposed to test out of quarantine. Ever. Even the nurses.

Having said that....we are unsure if the titers for antibodies wane past 90 days (we just don't have enough experience). And there have been anecdotal reports about people who had COVID and titer negative for antibodies. I've had FOUR HBV vaccines (three in the 90s and a booster for nursing school) and I still titer negative. The CDC tells me that if I am for reals exposed to HBV I will produce an antibody reaction.

Having said all that....I never go wrong when I follow policy even when it makes the parents angry. We probably need a second line study following people with COVID to see what happens to them when they're re-exposed and/or how long immunity seems to last.

JenTheSchoolRN, BSN, RN

Specializes in School nursing.

10 minutes ago, ruby_jane said:

In my district we are not supposed to test out of quarantine. Ever. Even the nurses.

Having said that....we are unsure if the titers for antibodies wane past 90 days (we just don't have enough experience). And there have been anecdotal reports about people who had COVID and titer negative for antibodies. I've had FOUR HBV vaccines (three in the 90s and a booster for nursing school) and I still titer negative. The CDC tells me that if I am for reals exposed to HBV I will produce an antibody reaction.

Having said all that....I never go wrong when I follow policy even when it makes the parents angry. We probably need a second line study following people with COVID to see what happens to them when they're re-exposed and/or how long immunity seems to last.

I can test staff out of quarantine for return on day 8 if they are a staff member that absolutely needs to work in person. (Per the CDC and my state guidelines). But they need to test after day 5 post exposure and not be living in a situation where they could potentially be re-exposing themselves (I.e. spouse tests positive and they live in a one bedroom apartment tiny apartment - or more commonly kid tests positive. Parent can say they will isolate kid away - it will not happen.)

But we made the decision to not do so with kids. We go with the 10 day option with the CDC now. 

But not even a repeat negative test will overturn an initial PCR positive test. It can, however, overturn an initial positive antigen test as all positive antigen tests in my state need to be confirmed by a repeat PCR. 

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