Last Updated: Sep 17, 2021
PA DOH released updates to the Interim guidance related to returning health care personnel (HCP) to work after COVID-19 exposure or infection. The guidance remains largely the same with the exception of the following minor changes:
- The definition of “immunocompromised” has changed based on evolving science, and now refers to the CDC guidance.
- When using a symptom-based strategy to determine when HCP with severe to critical illness or who are moderately to severely immunocompromised can return to work, the language has changed to rely more on clinical judgement. In brief, HCP in this category can return to work when at least 10 days and up to 20 days have passed since symptoms first appeared.
For the purposes of this guidance, moderate to severely immunocompromising conditions include, but might not be limited to, those defined in the CDC Interim Clinical Considerations for Use of COVID-19 Vaccines.
- Other factors, such as end-stage renal disease, may pose a much lower degree of immunocompromise and not clearly affect decisions about need for work restriction if the health care provider had close contact with someone with SARS-CoV-2 infection. However, fully vaccinated people in this category should consider continuing to practice physical distancing and use of source control while in a healthcare facility, even when not otherwise recommended for fully vaccinated individuals.
- Ultimately, the degree of immunocompromise for HCP is determined by the treating provider, and preventive actions are tailored to each individual and situation.
HCP who are moderately to severely immunocompromised may produce replication-competent virus beyond 20 days after symptom onset or, for those who were asymptomatic throughout their infection, the date of their first positive viral test. For these HCP:
- Consultation with infectious diseases and infection prevention and control specialists is recommended. • Consider use of a test-based strategy in consultation with occupational health for determining when these HCP may return to work.
RETURN TO WORK CRITERIA FOR HCP WITH CONFIRMED OR SUSPECTED COVID-19
HCP with even mild symptoms of COVID-19 should be prioritized for viral testing with approved nucleic acid or antigen detection assays regardless of vaccination status. When a clinician decides that testing a person for SARS-CoV-2 is indicated, negative results from at least one FDA Emergency Use Authorized COVID-19 viral test indicates that the person most likely does not have an active SARS-CoV-2 infection at the time the sample was collected. A second test for SARS-CoV2 RNA may be performed at the discretion of the evaluating clinician, particularly when a higher level of clinical suspicion for SARS-CoV-2 infection exists. For HCP who were suspected of having COVID-19 but following evaluation another diagnosis is suspected or confirmed, return to work decisions should be based on their other suspected or confirmed diagnoses
SYMPTOM-BASED STRATEGY FOR DETERMINING WHEN HCP CAN RETURN TO WORK
A symptom-based strategy for determining when HCP with SARS-CoV-2 infection could return to work is preferred in most clinical situations. The criteria for the symptom-based strategy are: HCP with mild to moderate illness who are not moderately to 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. HCP who were asymptomatic throughout their infection and are not moderately to severely immunocompromised:
- 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 moderately to severely immunocompromised:
- At least 10 days 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. • Consider consultation with infectious diseases and infection prevention and control specialists
If you have additional questions about this guidance or would benefit from discussion to support infection prevention and control decisions in your facility, please contact DOH at 1-877-PA- HEALTH (1-877-724- 3258.)