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Healthcare Practitioners Returning to Work – CDC Updates Guidance

Wed November 4, 2020 News

Healthcare Practitioners Returning to Work – CDC Updates Guidance

The CDC has updated its guidance for returning health care practitioner (HCP) employees exposed to COVID-19 back to work. The updated guidance is based on differing severities of COVID-19 symptoms and recognizes limitations of test-based return to work strategies. It also acknowledges that an estimated 95% of severely or critically ill patients no longer had replication-competent virus 15 days after onset of symptoms and no patient has had replication-competent virus more than 20 days after onset of symptoms.

Defining the Severity of Illness

The updated guidance hinges on determining the severity of illness. HCP employees who experience only mild to moderate illness may return to work sooner than those who experience severe to critical illness. The definitions are:

• Mild Illness: any signs and symptoms of COVID-19 (e.g., fever, cough, sore throat, malaise, headache, muscle pain) but without shortness of breath, dyspnea (labored breathing), or abnormal chest imaging.

Moderate Illness: 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: 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: respiratory failure, septic shock, and/or multiple organ dysfunction.

Symptom-based Strategies

Under the updated guidance, symptom-based return to work strategies are preferred and are based on the severity of illness the HCP employees experience.

• Symptomatic HCP employees who experienced only mild to moderate illness and are not severely immunocompromised may return to work after

1. 10 days have passed since symptoms first appeared,

2. 24 hours have passed since last fever without using fever-reducing medications, and

3. Symptoms (e.g., cough, shortness of breath) have improved.

• Symptomatic HCP employees who experienced severe to critical illness or are severely immunocompromised may return to work after

1. 10 days and up to 20 days have passed since symptoms first appeared,

2. 24 hours have passed since last fever without using fever-reducing medications, and

3. Symptoms (e.g., cough, shortness of breath) have improved.

*Consult with local infectious diseases experts if concerns exist for the HCP employee being infectious for more than 20 days.

Test-based Strategies

Test-based strategies may allow HCP employees to return to work earlier than if the symptom-based strategies were used, but many individuals will have prolonged viral shedding. The potential for prolonged viral shedding limits the utility of test-based strategies.

• HCP employees who are symptomatic may return to work under a testbased strategy after

1. Resolution of fever without using fever-reducing medications,

2. Improvement in symptoms (e.g., cough, shortness of breath), and

3. 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 SARSCoV-2 RNA.

• HCP employees who are asymptomatic may return to work under a testbased strategy after

1. 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 SARSCoV-2 RNA.

OR

2. Asymptomatic HCP employees who are not severely immunocompromised may return to work when at least 10 days have passed since the date of their first positive viral diagnostic test.

• HCP employees who are asymptomatic but are severely immunocompromised may return to work after

1. 10 days and up to 20 days have passed since the date of their first positive viral diagnostic test.

*Consult with local infectious diseases experts if concerns exist for the HCP employee being infectious for more than 20 days.

Find the CDC’s updated guidance at: https://www.cdc.gov/coronavirus/2019-ncov/hcp/return-to-work.html and https://www.covid19treatmentguidelines.nih.gov/overview/management-ofcovid-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. 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