Explained: Sweden’s new guidelines for people who test positive for Covid-19 antibodies

Explained: Sweden's new guidelines for people who test positive for Covid-19 antibodies
A positive result can make it easier to spend time with elderly relatives. File photo: Elisabeth Edén/imagebank.sweden.se
A positive coronavirus antibody test means you've previously been infected by the virus, but it doesn't mean you can return to life as normal.

Antibody tests have been available privately and through some employers for over a month, and some regions have begun offering them widely to the general public for free.

If you test negative, it means that your body has not developed the proteins to fight off coronavirus, although it doesn't necessarily mean that you have not had the infection. If you test positive, it means you have definitely been infected by the virus and you do have these proteins.

But what does that actually mean for you?

Antibodies often mean you are immune from the particular virus they developed to protect you from. Scientists still don't know for certain if that's the case with the coronavirus, because it's a new disease — it might only give you a certain level of immunity, or only for a set time period.

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In updated guidelines published on June 30th, the Public Health Agency said that based on current knowledge, a positive test with all likelihood means that the person is protected from reinfection for up to six months from the date of receiving the test result. This assessment may change as further research is done on the coronavirus and antibodies.

But put simply, the authorities believe that if you have the antibodies, you have a lower risk of being infected and therefore a lower risk of spreading the infection.

“The new coronavirus has only been studied for a limited number of months and therefore it is reasonable to have an estimated time period of up to six months,” said Karin Tegmark Wisell, head of the Public Health Agency's department for microbiology. “There are no confirmed re-infections today. But to be able to use the test results, this requires that the tests have a very high performance that gives a reliable result.”

I've had a positive result. What can I do differently now?

The big change applies to people in risk groups, including those aged over 70.

At the moment, everyone is encouraged to limit the number of people they interact with. There is no set limit on the number of people or other households you're advised to have close contact with, but there is a general recommendation to keep that as low as possible. People aged over 70 or belonging to risk groups meanwhile are urged to avoid all non-essential close contact with people outside their household. 

Under the new guidelines, people belonging to risk groups who test positive for the antibody can now meet people outside their household, for example close friends and relatives. In other words, they can socialise in the same way as people outside risk groups can do — in small groups.
 
Photo: Henrik Montgomery / TT

People aged under 70 and not belonging to a risk group are now advised that if they test positive, they can have close contact with people who do belong to risk groups, even if the person in question has not tested positive for the antibody. So in other words, that means a chance for people who test positive for the antibody can hung parents, grandparents and friends after months of separation.

This shouldn't be seen as entirely risk-free however, and the Public Health Agency stressed the importance of individuals making a judgment based on each situation, and to take responsibility.

And when it comes to visiting relatives who live in a care home, it's important to follow the rules at that specific care home. Care homes across Sweden still have a national ban on visitors, but there are guidelines for exceptions, including in compassionate situations such as end-of-life visits, and visits under safe conditions such as outdoors with plexiglass barriers.

What can't I do after testing positive?

The Public Health Agency has said they still expect people to continue to follow the general recommendations still in place to limit the spread of the virus.

That includes maintaining good hand hygiene, staying at home if you develop any symptoms or feel unwell, and keeping a distance from people outside your social circle when in public places.

A guideline to avoid large social gatherings (again, there's no number specified, but for organisers of public event the limit is 50) is still in place, and the Public Health Agency as well as the World Health Organisation have said that meeting outside rather than indoors reduces the risk of infection.


Photo: Johan Nilsson/TT

Can my employer make me return to work if I test positive?

This wasn't addressed directly, but the new guidelines do state that antibody tests can be used at a group level, including by companies.

“If a high proportion of staff at a workplace have antibodies for Covid-19, it can be assumed that a small proportion of staff would get sick in any outbreak if it occurs within a few months of the previous infection. In this way, the workplace would have relatively good conditions to maintain its workforce during a period of increased spread of infection,” the guidelines state. 

What's more, your employer does not have any right to access your test result, unless this has been negotiated either by your union in a collective bargaining agreement, or in an individual contract. 

Have there been any other changes?

Yes. In their new guidelines, the Public Health Agency recommends that regions use prioritisation when allocating antibody tests, with highest priority to people belonging to Covid-19 risk groups.

That's because these people are currently subject to the greatest restrictions on how they can live their lives, including the advice against all social contacts outside their household. 

What about home tests?

Home or self tests, which are carried out by the individual themselves, are not included in these guidelines. The Public Health Agency has said these tests are less reliable than those carried out in laboratories, and the guidelines only refer to those tests which have a high reliability and sensitivity.


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