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The CDC has issued specialized guidance on employers’ obligations when health care practitioner (HCP) employees are exposed to COVID-19. The guidance covers obligations related to four different circumstances:

  1. The HCP is exposed without adequate personal protection equipment;
  2. The HCP is symptomatic and returns to work;
  3. An infected HCP returns to work; and
  4. Staffing shortages result from confirmed or suspected infections among HCPs.

Due to the importance of HCPs continuing to provide medical care throughout the pandemic, the guidance is flexible to account for staffing shortages and COVID-19 exposures that occur among HCPs.

 

1.    HCP Unprotected Exposures
If the HCP has prolonged (“prolonged” means 15 or more minutes or any duration if the exposure occurs during performance of an aerosol-generating procedure) close contact with a patient or another employee who is confirmed as having COVID-19 and any of the following are true the HCP was not wearing:

  • A respirator or face mask during the contact; or
  • Eye protection and the patient with COVID-19 was not wearing a face covering; or
  • All recommended PPE while performing an aerosol-generating procedure.

Then, an “unprotected exposure” has occurred and the employer must:

  • Exclude the exposed HCP from work for 14 days after last exposure;
  • Advise the HCP to monitor themselves for fever or symptoms consistent with COVID-19; and
  • If the HCP develops fever or symptoms consistent with COVID-19, follow the strategies for returning symptomatic HCPs to work and prioritize the HCP for testing.
  • And see the Guidance (link at end of this update) on mitigating staffing shortages.

In all other instances of HCP potential exposure:

  • There are no work restrictions.
  • Follow all recommended infection prevention and control practices, including wearing a facemask for source control while at work, monitoring themselves for fever or symptoms consistent with COVID-19, not reporting to work when ill, and undergoing active screening for fever or symptoms consistent with COVID-19 at the beginning of their shift.
  • If the HCP develops fever or symptoms consistent with COVID-19, follow the strategies for returning symptomatic HCPs to work and prioritize the HCP for testing.

In the event of an unprotected exposure, perform contact tracing if:

  • The HCP does not have symptoms, the HCP should be considered potentially infectious beginning 2 days after the exposure until criteria to discontinue Transmission-Based Precautions or Home Isolation are met.
  • The HCP had COVID-19 symptoms, the HCP is considered potentially infectious beginning 2 days before symptoms first appeared until the HCP meets criteria to discontinue Transmission-Based Precautions or Home Isolation.
  • The date of exposure cannot be determined, use a cutoff of 2 days before the specimen testing positive for COVID-19 was collected as the starting point, continuing until the criteria to discontinue Transmission-Based Precautions or Home Isolation are met.

 

2.    Returning Symptomatic HCPs to Work
If the HCP is symptomatic for COVID-19, employers may use one of two return to work strategies:

  • Symptom-based strategy
    • Exclude the HCP from work until:
      • At least 3 days (72 hours) have passed since recovery – “recovery” is defined as resolution of fever without the use of fever-reducing medications and improvement in respiratory symptoms; and,
      • At least 10 days have passed since symptoms first appeared.
  • Test-based strategy
    • Exclude the HCP from work until:
      • Resolution of fever without the use of fever-reducing medications and;
      • Improvement in respiratory symptoms, 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 respiratory specimens collected ≥24 hours apart (total of two negative specimens).

 

3.    Returning HCPs Confirmed with COVID-19 to work
If the HCP is asymptomatic but has a laboratory-confirmed COVID-19 test, employers may use one of two return to work strategies:

  • Time-based strategy
    • Exclude the HCP 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 the HCP develops symptoms, then the symptom-based or test-based strategy should be used.
  • Test-based strategy
    • Exclude the HCP 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 respiratory specimens collected ≥24 hours apart (total of two negative specimens). 

 

 4.    Mitigating staffing shortages due to confirmed or suspected infections

If a staffing crisis occurs due to HCPs suspected or confirmed with COVID-19, employers may deviate from the HCP isolation rules:

  • First, asymptomatic HCPs who have had an unprotected exposure to COVID-19 but are not known to be infected may continue to work.
    • The HCP should report temperature and absence of symptoms each day before starting work.
    • The HCP should wear a facemask while at work for 14 days after the exposure event.
    • If the HCP develops even mild symptoms consistent with COVID-19, follow the strategies for returning symptomatic HCPs to work and prioritize the HCP for testing.
  • Second, allow the HCP confirmed with COVID-19 who is well enough to work return to work.
    • Restrict such HCPs from contact with severely immunocompromised patients and prioritize their duties in the following order:
      • If not already done, allow the HCP to perform job duties where they do not interact with others (e.g., patients or other HCP), such as in telemedicine services.
      • Allow the HCP to provide direct care only for patients with confirmed COVID-19, preferably in a cohort setting.
      • Allow the HCP to provide direct care for patients with suspected COVID-19.
      • As a last resort, allow the HCP to provide direct care for patients without suspected or confirmed COVID-19.

 

We are here to support you.

We continue to closely monitor the situation and update this information to provide the latest workplace and legal developments related to COVID-19 and HCP exposure. To view the CDC’s guidance, visit https://www.cdc.gov/coronavirus/2019-ncov/hcp/guidance-risk-assesment-hcp.htmlhttps://www.cdc.gov/coronavirus/2019-ncov/hcp/return-to-work.html; and https://www.cdc.gov/coronavirus/2019-ncov/hcp/mitigating-staff-shortages.html.

We expect your questions and our answers will change as the situation develops. For answers to your specific questions and for the newest developments, please visit our website at  www.donnellygross.com/covid-19-resources/  and contact us at Donnelly + Gross at 352-374-4001 or directly by email:

Paul Donnelly          paul@donnellygross.com

Laura Gross              laura@donnellygross.com

Jung Yoon                 jung@donnellygross.com

Jim Brantley             jim@donnellygross.com

Cole Barnett            cole@donnellygross.com

 

*This publication is for general information only and intended for clients and friends of Donnelly + Gross. It should not be relied upon as legal advice as the law related to each situation varies. Moreover, workplace law related to Covid19 is dynamic and changing daily. The sharing of this information does not establish a client relationship.