What are the practice’s responsibilities if we find out a patient or employee tested positive?

If an employee (including physicians) or patient tests positive for COVID-19, you need to first determine the level of exposure. Potential exposure occurs two days prior to the onset of illness, lasting through 10 days from the onset of infection.

Next, you’ll need to determine who needs to quarantine and who needs to be tested.

Vaccinated employees who have been exposed to someone with suspected or confirmed COVID-19 are not required to quarantine if they meet ALL of the following criteria:

• Are fully vaccinated (i.e., ≥2 weeks following receipt of the second dose in a 2-dose series, or ≥2 weeks following receipt of a single-dose vaccine)
• Are within three months following receipt of the last dose in the series
• Have remained asymptomatic since the COVID-19 exposure.

Persons who do not meet all three of the above criteria should continue to follow current quarantine guidance after exposure to someone with suspected or confirmed COVID-19.

For specific steps to follow, refer to Curi’s COVID-19 Process for Employee Exposures flow chart.

Take these protective measures to minimize potential exposure to non-exposed employees/patients:

Anyone who was exposed should follow universal source control for 14 days past exposure (beginning the date of last contact with infected individual or the date the test was performed for asymptomatic individuals). If you are unsure who was exposed, include all staff present on that day.

• Exposed employees who are asymptomatic and allowed to continue to work should follow these extra precautions for 14 days past the last date of exposure:
  • While in the office, continue wearing a mask around employees and patients.
  • Practice social distancing as much as possible, including limiting the number of people in the breakroom.
  • Practice good hygiene, wash hands frequently, use hand sanitizer, and avoid touching the face.
  • Self-monitor for symptoms, which include:
    • Fever (temperature higher than 100 degrees)
    • Cough
    • Difficulty breathing
    • Sudden loss of taste or smell
    • Vomiting
    • Diarrhea
    • Sore throat
• Have visitors and patients wear cloth or regular masks. If patients or visitors show up without a mask, provide them one if available. (To preserve medical masks for your healthcare workers, consider purchasing bandanas to give patients to use as a face covering.)
• Actively monitor your exposed employees for COVID-19-related symptoms.
  • At the beginning of every workday, station someone at points of entry to screen exposed employees for signs of infection before they enter, or have affected employees report their temperature and absence of symptoms to the designated contact prior to entering facility for the duration of the self-monitoring phase (14 days past date of last exposure).
  • Document screenings of exposed employees. A universal source tracking log is available to document employee checks for active monitoring.
  • Consider adding a pulse oximetry check for oxygen (O2) saturations. (Low O2 saturations have been shown to detect pre-symptomatic positive COVID-19 cases.)
• If, during their workday, employees develop a fever higher than 100 degrees, a cough, difficulty breathing, sudden loss of taste or smell, or any other COVID-19-related symptoms, immediately instruct them to 1) find someone to cover for them, 2) report the incident to a designated leader (usually the practice manager, HR director, or occupational nurse), and 3) leave the workplace.
• If the employee develops symptoms outside of his/her work schedule, they should contact the designated leader as soon as possible and self-isolate while awaiting further instructions.
• The designated leader needs to coordinate getting the affected employee tested, and the affected employee should self-isolate until he/she is cleared from infection.
• If employees test negative, recommend continuing precautions until 14 days past the last exposure. A negative test means an individual was not infected at the time the sample was collected. However, that does not mean an individual will not get sick later. It is possible that an individual was very early in his/her infection when the sample was collected; that could result in a positive test later. Some providers are testing on days 5 and 7 post exposure. Refer to the CDC for current information on testing and interpreting COVID-19 test results.
• Employees who develop symptoms and/or test positive for COVID-19 should remain out of work until all CDC “return-to-work” criteria are met (see symptom-based return-to-work flowchart):
  • HCP with mild to moderate illness who are not severely immunocompromised:
    • At least 10 days have passed since symptoms first appeared, and
    • At least 24 hours have passed since last fever without the use of fever-reducing medications, and
    • Symptoms (e.g., cough, shortness of breath) have improved
    • Note: HCP who are not severely immunocompromised and were asymptomatic throughout their infection may return to work when at least 10 days have passed since the date of their first positive viral diagnostic test.
  • HCP with severe to critical illness or who are severely immunocompromised:
    • At least 10 and up to 20 days have passed since symptoms first appeared, and
    • At least 24 hours have passed since last fever without the use of fever-reducing medications, and
    • Symptoms (e.g., cough, shortness of breath) have improved
    • Note: HCP who are severely immunocompromised but who were asymptomatic throughout their infection may return to work when at least 10 and up to 20 days have passed since the date of their first positive viral diagnostic test.
• Test-Based Strategy for Determining when HCP Can Return to Work
  • In some instances, a test-based strategy could be considered to allow HCP to return to work earlier than if the symptom-based strategy were used. However, as described in the Decision Memo, many individuals will have prolonged viral shedding, limiting the utility of this approach.
  • A test-based strategy could also be considered for some HCP (e.g., those who are severely immunocompromised) in consultation with local infectious diseases experts if concerns exist for the HCP being infectious for more than 20 days.
  • The criteria for the test-based strategy are:
    • HCP who are symptomatic:
      • Resolution of fever without the use of fever-reducing medications, and
      • Improvement in symptoms (e.g., cough, shortness of breath), and
      • Results are negative from at least two consecutive respiratory specimens collected ≥24 hours apart (total of two negative specimens) tested using an FDA-authorized molecular viral assay to detect SARS-CoV-2 RNA. See Interim Guidelines for Collecting, Handling, and Testing Clinical Specimens for 2019 Novel Coronavirus (2019-nCoV).
    • HCP who are not symptomatic:
      • Results are negative from at least two consecutive respiratory specimens collected ≥24 hours apart (total of two negative specimens) tested using an FDA-authorized molecular viral assay to detect SARS-CoV-2 RNA. See Interim Guidelines for Collecting, Handling, and Testing Clinical Specimens for 2019 Novel Coronavirus (2019-nCoV).
    • Notify health department of infected employee(s).

Other considerations:

• After returning to work, HCP should:
  • Wear a facemask for source control at all times while in the healthcare facility until all symptoms are completely resolved or at baseline. A facemask instead of a cloth face covering should be used by these HCP for source control during this time period while in the facility. After this time period, these HCP should revert to their facility policy regarding universal source control during the pandemic.
    • A facemask for source control does not replace the need to wear an N95 or equivalent or higher-level respirator (or other recommended PPE) when indicated, including when caring for patients with suspected or confirmed SARS-CoV-2 infection.
  • Self-monitor for symptoms, and seek re-evaluation from occupational health if symptoms recur or worsen
• Clean your facility post exposure:
  • Close off areas used by the person who is sick.
  • If possible, increase ventilation in the area by opening outside doors and windows.
  • Wait 24 hours before you clean or disinfect. If that’s not feasible, wait as long as possible and a minimum of two hours.
  • Anyone who is cleaning is required to wear gown, gloves, mask, and goggles, and may use any EPA-registered disinfectant to clean surfaces. Some practices have hired cleaning crews to professionally disinfect their offices.
  • Clean and disinfect all areas used by the person who is sick, such as offices, doorknobs, bathrooms, common areas, and shared electronic equipment (e.g., tablets, touchscreens, keyboards, remote controls).
  • Vacuum the space if needed. If available, use a vacuum equipped with a high efficiency particulate air (HEPA) filter.
    • Do not vacuum a room or space with people in it. Wait until the room or space is empty to vacuum (at night for common spaces or during the day for private rooms).
    • Consider temporarily turning off room fans and the central HVAC system that services the room or space so that particles that escape from vacuuming will not circulate throughout the facility.
  • Once the area has been appropriately disinfected, it can be opened for use.
  • Workers without close contact with the person who is sick can return to work immediately after disinfection.
  • If more than seven days passed since the person who is sick visited or used the facility, additional cleaning or disinfecting is not necessary.
• Once the office is disinfected post exposure, continue routine cleaning and disinfection.
• If the potential infected area is widespread and cannot be isolated to a room or rooms where doors can be shut, it may be prudent to temporarily close your office, send staff home, and divert patients to other locations if they cannot be rescheduled.
  • In the event you need to contact patients to reschedule or divert them to another location, implement a process for allowing access to patient schedules and contact information.
  • Once your facility is cleaned and disinfected and staff have been cleared, your office may reopen.
• Throughout the process, you will be coordinating the care of your affected patients and staff, communicating to reassure needs are being met, and keeping patients informed on when your office is cleared to reopen.
• To help allay fears, remind everyone that most who get infected do recover fully and that many have mild symptoms.
• Use enhanced precautions for any staff or patients who fall into the high-risk category to keep them out of the path of potential exposure areas and allow them to self-quarantine if they desire.
• Curi advises you to continue following existing leave policies (PTO, vacation, sick, short-term disability, leave of absence, FMLA, and ADA). If the employee was exposed at work, then you will need to contact your workers’ compensation carrier regarding lost wages. At this point, you are under no obligation to pay beyond your policies, but you may do so if you choose.
• For more specifics on employee concerns, members may visit our website resources under HR|Experts and contact Dee Brown at dee.brown@callhrexperts.com or 919-431-6096.

Practices can take these steps to be proactive in preventing unnecessary exposure and avoid closures:

• Call patients prior to visit to screen for risk of COVID-19.
• Practice universal source control for patients and employees.
  • Check temperature before entry.
  • Encourage patients to wear face coverings when entering facility.
  • Provide face coverings to patients who show up without one.
  • Limit number of visitors.
  • Have patients call upon arrival to the office and remain in their car until cleared to come into the office.
  • Have employees wear masks, especially when social distancing cannot be practiced.