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This table indicates interpretation of possible testing scenarios and suggested actions.

Viral RNA Production
shedding of antibodies
Symptomatic (RNA) (Ab) Interpretation Action
- - - Susceptible Social isolation to prevent contracting virus; risk stratification
to determine return to work (based upon public policy).
- + - Infected Quarantine, retest RNA and Ab in two weeks.
- - + Past exposure, If an individual had symptoms, then RNA and Ab test
immunity, evaluate seven days after resolution of symptoms. Return to work if
for return to work RNA negative and Ab positive. If individual never had
symptoms, repeat RNA test and Ab test and consider return
to work if RNA negative and Ab positive.
- + + Infected with Quarantine, retest RNA and Ab in seven days, return to
developing immunity work if RNA negative and Ab positive (consider additional
RNA negative test if exposure to high risk populations).
+ - - Assume infected Quarantine, consider second RNA test to confirm.
+ + - Infected Quarantine, retest RNA and Ab in two weeks.
+ - + Infected with Quarantine, consider second RNA test to confirm.
developing immunity
+ + + Infected, with Quarantine, retest RNA and Ab in two weeks.
developing immunity
• Note that return to work will be dictated by local public policy, and an understanding that positive serology has
not been proven to equate to immunity.
• The need for repeat confirmatory testing is suggested based on the sensitivity and specificity of currently
available tests, which are often not close to 100%.
• These are guidelines only. The clinician must use their judgment, based on their knowledge of the test that is used.

If negative antibody: ■ If viral RNA is negative, then perform Ab test
seven days after symptoms resolve, with
• Does the patient have immunoglobulin deficiency confirmatory Ab test in one to two weeks.
or are they immunocompromised? ■ If viral RNA is positive, perform Ab test three
• Did the patient have a positive NAA viral test? to seven days after symptoms resolve, with
• Was the sample collected greater than 7-14 days confirmatory Ab test in one to two weeks.
after symptom onset? ■ It is prudent to confirm a second negative RNA
• What isotype is being tested: IgM or IgG? (If longer test prior to considering return to work.
time since exposure, IgM is less likely positive, and • Classic symptoms:
if more recent, IgG is less likely positive). ■ Perform viral RNA test to confirm infection.
• What was the sensitivity of the test being used? ■ If viral RNA negative, perform Ab test three to
seven days after symptoms resolve, with
Clinical Scenarios confirmatory Ab test in one to two weeks.
As the clinician attempts to navigate an individual ■ If viral RNA positive, then viral RNA and Ab
patient through the muddy waters of the current testing test seven days after symptoms resolve, with
environment, it may help to imagine how one might confirmatory Ab test in one to two weeks.
approach a number of different clinical scenarios with ■ It is prudent to confirm a second negative RNA
respect to testing. test prior to considering return to work.

If a patient had: Summary
• A known exposure but was asymptomatic: The understanding of SARS-CoV-2 is continually
■ Perform viral RNA to confirm infection. evolving as more is learned about the virus and the host’s
■ Quarantine for two weeks, then test for Abs response to exposure and infection. Testing is also evolving
and viral RNA two weeks post-exposure and as this greater understanding is combined with rapid
follow the suggestions in the above table based advances in technology to create tests for both the virus
on the results of the test. and the immune response.
• Mild or non-classic symptoms: The clinician on the front lines of this pandemic will
■ Perform viral RNA test to confirm infection. find this document helpful to understand which tests are

52 Integrative Medicine • Vol. 19, No. S1 • Epub Ahead of Print Messier—Primer on SARS-CoV-2 Testing