ACEP COVID-19 Field Guide

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 (either strategy is acceptable depending on local circumstances):

Symptom-based strategy. Exclude from work until:

• At least 3 days (72 hours) have passed since recovery defined as resolution of fever without the use of fever-reducing medications and improvement in respiratory symptoms (e.g., cough, shortness of breath); and,
• At least 10 days have passed since symptoms first appeared

Test-based strategy. Exclude from work until:

• Resolution of fever without the use of fever-reducing medications and
• Improvement in respiratory symptoms (e.g., cough, shortness of breath), and
• Negative results of an FDA EUA 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). 
• For more information: CDC Interim Guidelines for Collecting, Handling, and Testing Clinical Specimens for 2019 Novel Coronavirus (2019-nCoV).
• Of note, there have been reports of prolonged detection of RNA without direct correlation to viral culture.
• All test results should be final before isolation is ended

Asymptomatic HCP with laboratory-confirmed COVID-19 (either strategy is acceptable depending on local circumstances):

Time-based strategy. Exclude 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 they develop symptoms, then the symptom-based or test-based strategy should be used.  
• Note, because symptoms cannot be used to gauge where these individuals are in the course of their illness, it is possible that the duration of viral shedding could be longer or shorter than 10 days after their first positive test.

Test-based strategy. Exclude from work until:

• Negative results of an FDA EUA 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). 
• Note, because of the absence of symptoms, it is not possible to gauge where these individuals are in the course of their illness. There have been reports of prolonged detection of RNA without direct correlation to viral culture.

Note that detecting viral RNA via PCR does not necessarily mean that infectious virus is present.

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

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.