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ACEP COVID-19 Field Guide

Table of Contents

Return to Work Criteria With Confirmed or Suspected COVID-19

Home Safety

Guidance from the CDC on return to work criteria for HCP with confirmed or suspected COVID-19

Use one of the following strategies to determine when health care personnel (HCP) may return to work in health care settings (Figure 2.1).

Symptomatic HCP with suspected or confirmed 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 20 days have passed since symptoms first appeared
    • 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 20 days have passed since the date of their first positive viral diagnostic test.

Except for rare situations, the CDC is  no longer recommending a test-based strategy to determine when to allow HCP to return to work. Additional information can be found on the CDC’s Guidance on Return to Work Criteria for Healthcare Workers

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, 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:

 

 

  • 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. For more information please refer to the CDC’s Interim Guidelines for Collecting, Handling, and Testing Clinical Specimens for 2019 Novel Coronavirus (2019-nCoV).

Figure 2.1 When can I return to work? Credit: Michael Macias, MD.

When can I return to work?

After returning to work, HCP should:

  • Wear a face mask for source control at all times while in the health care facility until all symptoms are completely resolved or at baseline. A face mask 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 face mask for source control does not replace the need to wear an N95 or higher-level respirator (or other recommended PPE) when indicated, including when caring for patients with suspected or confirmed COVID-19.
    • Of note, N95 or other respirators with an exhaust valve might not provide source control.
  • Self-monitor for symptoms, and seek re-evaluation from occupational health if respiratory symptoms recur or worsen.

For further information, review the CDC’s "Criteria for Return to Work for Healthcare Personnel With Confirmed or Suspected COVID-19 (Interim Guidance)."

Figure 2.2 Recommendations for monitoring and work restrictions based on risk category. Credit: Michael Macias, MD.

Figure 2.2

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