Occupational Spirometry and Fit Testing in the COVID-19 Era: 2021 Interim Recommendations from the American College of Occupational and Environmental Medicine

Spirometry is an essential component of occupational health clinical practice, surveillance, and research. Since the start of the COVID-19 pandemic, ACOEM has supported safe spirometry testing. On March 16, 2020, the College recommended that routine spirometry be postponed due to the pandemic. On April 16, 2020, OSHA issued an Enforcement Memo, instructing its inspectors to avoid citing or fining employers who made good-faith efforts to obtain spirometry tests. Reduced respirator fit-testing was also allowed by OSHA if NIOSH-approved respirators and qualitative testing reagents were scarce. In July 2020, in the midst of the pandemic surge, ACOEM updated its statement to recommend deferring spirometry except in unusual circumstances in which it was urgently necessary.
Subsequently, effective vaccines have become widely available and there has been increasing return-to-work activity. The temporary OSHA relaxation of enforcement activity and U.S. Food and Drug Administration (FDA) relaxation of respirator certification criteria have been rescinded. Though the pandemic persists, and the impact of viral mutation-driven variants remains uncertain, ACOEM is updating its guidance for performing more widespread spirometry. The guidance remains interim due to the rapidly evolving understanding of how SARS-CoV-2 can be best controlled. In addition, experience during the COVID-19 pandemic may lead to long-term modification of some clinic practices for other seasonal and epidemic respiratory illnesses such as influenza. Furthermore, SARS-CoV-2 infection may become endemic at low levels rather than disappearing completely.
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