Considerations for Protecting and Managing Healthcare Personnel (HCP)
Many facilities have already experienced staffing shortages due to HCP exposures, illness, or need to care for family members at home. Plans and processes to mitigate staffing shortages can always be improved and current recommendations are described below.
Facilities and organizations providing healthcare should implement sick leave policies for HCP that are non-punitive, flexible, and consistent with public health guidance.
As part of routine practice, HCP should be asked to regularly monitor themselves for fever and symptoms of COVID-19.
HCP should be reminded to stay home when they are ill.
Screen all HCP at the beginning of their shift for fever and symptoms consistent with COVID-19*
Actively take their temperature and document absence of symptoms consistent with COVID-19*. If they are ill, have them keep their cloth face covering or facemask on and leave the workplace.
*Fever is either measured temperature >100.0°F or subjective fever. Note that fever may be intermittent or may not be present in some individuals, such as those who are elderly, immunosuppressed, or taking certain medications (e.g., NSAIDs). Clinical judgement should be used to guide testing of individuals in such situations. Respiratory symptoms consistent with COVID-19 are cough, shortness of breath, and sore throat. Medical evaluation may be warranted for lower temperatures (<100.0°F) or other symptoms (e.g., muscle aches, nausea, vomiting, diarrhea, abdominal pain headache, runny nose, fatigue) based on assessment by occupational health.
If HCP develop fever (T≥100.0°F) or symptoms consistent with COVID-19* while at work they should keep their cloth face covering or facemask on, inform their supervisor, and leave the workplace.
HCP with suspected COVID-19 should be prioritized for testing. See updated CDC guidance (August 24, 2020) on Overview on Testing for SARS-CoV-2 (COVID-19) as well as April 29, 2020 Health Alert: Recommendations for Health Care Providers to Test All Patients with Acute Respiratory Illness for COVID-19.
Healthcare facilities should consider foregoing contact tracing in favor of universal source control for HCP and screening for fever and symptoms before every shift.
Return to Work Criteria for HCP with Confirmed or Suspected COVID-19
As of August 10, 2020, CDC recommends new criteria for return to work for HCP with confirmed or suspected COVID-19 which include a symptom-based (i.e., time-since-illness-onset and time-since-recovery strategy), time-based strategy or a test-based strategy (symtom-based preffered). Of note, there have been reports of prolonged detection of RNA without direct correlation to viral culture. Detecting viral RNA via PCR does not necessarily mean that infectious virus is present.
Symptomatic HCP with suspected or confirmed COVID-19:
Symptom-based strategy. Exclude from work until:
At least 1 days (24 hours) have passed since recovery defined as resolution of fever without the use of fever-reducing medications and improvement in respiratory symptoms (e.g., cough, shortness of breath); and,
At least 10 days have passed since symptoms first appeared
Test-based strategy. Exclude from work until (not recommended):
Resolution of fever without the use of fever-reducing medications and
Improvement in respiratory symptoms (e.g., cough, shortness of breath), and
Negative results of an FDA Emergency Use Authorized COVID-19 molecular assay for detection of SARS-CoV-2 RNA from at least two consecutive nasopharyngeal swab specimens collected ≥24 hours apart (total of two negative specimens). Of note, there have been reports of prolonged detection of RNA without direct correlation to viral culture.
HCP with laboratory-confirmed COVID-19 who have not had any symptoms:
Time-based strategy. Exclude from work until:
10 days have passed since the date of their first positive COVID-19 diagnostic test assuming they have not subsequently developed symptoms since their positive test. If they develop symptoms, then the symptom-based or test-based strategy should be used.
Note, because symptoms cannot be used to gauge where these individuals are in the course of their illness, it is possible that the duration of viral shedding could be longer or shorter than 10 days after their first positive test.
Test-based strategy. Exclude from work until:
Negative results of an FDA Emergency Use Authorized COVID-19 molecular assay for detection of SARS-CoV-2 RNA from at least two consecutive nasopharyngeal swab specimens collected ≥24 hours apart (total of two negative specimens).
Note, because of the absence of symptoms, it is not possible to gauge where these individuals are in the course of their illness. There have been reports of prolonged detection of RNA without direct correlation to viral culture.
Consider consulting with local infectious disease experts when making decisions about discontinuing Transmission-Based Precautions for individuals who might remain infectious longer than 10 days (e.g., severely immunocompromised).
For Clinical Questions Or To Report Suspect Cases, Contact: