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If I have employees who are being tested or have confirmed COVID-19, when can they return to work?

There are two CDC strategies for determining when to allow healthcare personnel (HCP) to return to work (RTW):

  • Symptom-based strategy (preferred)
  • Test-based strategy (only recommended for use in rare situations, such as:
    • Discontinuing HCP isolation or precautions earlier than would occur under the symptom-based strategy
    • For severely immunocompromised HCP if there is concern of a continued infectious state beyond 20 days)

Refer to Curi’s Return-to-Work Guidance for Healthcare Personnel After COVID-19 Infection flowchart (test-based and symptom-based), and Curi’s COVID-19 Process for Employee Exposures flowchart for specific steps to take when employees are exposed to COVID-19.

Symptom-Based Strategy for Determining When HCP Can Return to Work

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 disease 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:

HCP who are not symptomatic:

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. These HCP should use a facemask instead of a cloth face covering 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 personal protective equipment (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.

Definitions:

  • Mild Illness: Individuals who have any of the various signs and symptoms of COVID 19 (e.g., fever, cough, sore throat, malaise, headache, muscle pain) without shortness of breath, dyspnea, or abnormal chest imaging.
    Moderate Illness: Individuals who have evidence of lower respiratory disease by clinical assessment or imaging and a saturation of oxygen (SpO2) ≥94% on room air at sea level.
  • Severe Illness: Individuals who have respiratory frequency >30 breaths per minute, SpO2 <94% on room air at sea level (or, for patients with chronic hypoxemia, a decrease from baseline of >3%), ratio of arterial partial pressure of oxygen to fraction of inspired oxygen (PaO2/FiO2) <300 mmHg, or lung infiltrates >50%.
  • Critical Illness: Individuals who have respiratory failure, septic shock, and/or multiple organ dysfunction.
  • Severely Immunocompromised: For the purposes of this guidance, CDC used the following definition that was created to more generally address HCP occupational exposures:
    • Some conditions, such as being on chemotherapy for cancer, untreated HIV infection with CD4 T lymphocyte count < 200, combined primary immunodeficiency disorder, and receipt of prednisone >20mg/day for more than 14 days, may cause a higher degree of immunocompromise and require actions such as lengthening the duration of HCP work restrictions.
    • Other factors, such as advanced age, diabetes mellitus, or end-stage renal disease, may pose a much lower degree of immunocompromise and not clearly affect occupational health actions to prevent disease transmission.
    • Ultimately, the degree of immunocompromise for HCP is determined by the treating provider, and preventive actions are tailored to each individual and situation.
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All Curi recommendations are based on current CDC criteria at the time of publication. CDC guidance for SARS-CoV-2 infection may, or may not, be adopted by state and local health departments to respond to rapidly changing local circumstances. Providers should always check with their local health department to see if the CDC’s guidance on any given topic has been modified (particularly if more restrictive) from the CDC’s recommended guidelines. Follow this link https://www.cdc.gov/publichealthgateway/healthdirectories/index.html for contact information to your state/local health department. If local recommendations vary from those of the CDC, and you are unsure what recommendations to follow, then it is safer to follow the more restrictive guidelines/recommendations.