CDC Issues Updated Guidance on Return to Work After COVID-19 Exposure
The Centers for Disease Control and Prevention (CDC) updated its Interim Guidance for Managing Healthcare Personnel with SARS-CoV-2 Infection or Exposure to SARS-CoV-2 on Sept. 10th. The update consolidates the guidance on infected and exposed health care personnel (HCP) and adds some clarifying language. The guidance provides a helpful table that summarizes the information.
The guidance, which is specific to health care settings, highlights two key points:
- A symptom-based strategy for determining when HCP with SARS-CoV-2 infection can return to work is preferred in most clinical situations.
- In general, asymptomatic HCP who have had a higher-risk exposure do not require work restriction if they are fully vaccinated or if they have recovered from SARS-CoV-2 infection in the prior 90 days.
Higher-risk exposures generally involve exposure of HCP’s eyes, nose, or mouth to material potentially containing SARS-CoV-2, particularly if these HCP were present in the room for an aerosol-generating procedure.
The guidance states that following a higher-risk exposure, testing and work restriction are recommended for unvaccinated HCP.
In general, work restriction of asymptomatic HCP who have recovered from SARS-CoV-2 infection in the prior 90 days and asymptomatic HCP who are fully vaccinated is not necessary unless they develop symptoms, test positive for SARS-CoV-2 infection, or are otherwise directed to do so by the jurisdiction’s public health authority.
The guidance provides additional considerations following a higher-risk exposure for these personnel (recently recovered and asymptomatic, fully vaccinated), including:
- Testing: Fully vaccinated asymptomatic HCP should have a series of two viral tests for SARS-CoV-2 infection. In these situations, testing is recommended immediately (but not earlier than two days after the exposure) and, if negative, again five to seven days after the exposure. Testing is not recommended for asymptomatic HCP who have recovered from SARS-CoV-2 infection in the prior 90 days; this is because some people may be non-infectious but have detectable virus from their prior infection during this period (additional information is available here).
- Source control: Universal use of source control while in the health care facility is recommended for 14 days following their higher-risk exposure, then they may default to routine source control recommendations for HCP.
- Circumstances when work restrictions might be recommended:
- Among asymptomatic HCP who have recovered from SARS-CoV-2 infection in the prior 90 days:
- HCP who are moderately to severely immunocompromised and might be at increased risk for reinfection. However, data on which specific conditions may lead to higher risk and the magnitude of risk are not available. OR
- Unvaccinated HCP for whom there is concern that their initial diagnosis of SARS-CoV-2 infection might have been based on a false positive test result (e.g., individual was asymptomatic, antigen test positive, and confirmatory nucleic acid amplification test (NAAT) not performed).
- Among fully vaccinated HCP:
- HCP who are moderately to severely immunocompromised OR
- When directed by public health authorities (e.g., during an outbreak where SARS-CoV-2 infections are identified among fully vaccinated HCP)
- In the event of ongoing transmission within a facility that is not controlled with initial interventions, strong consideration should be given to use of work restriction of fully vaccinated HCP with higher-risk exposures. In addition, there might be other circumstances for which the jurisdiction’s public health authority recommends these and additional precautions.
- Among asymptomatic HCP who have recovered from SARS-CoV-2 infection in the prior 90 days:
Members are encouraged to review the updated guidance here.
Contact: Diane Darbyshire, ddarbyshire@leadingageny.org, 518-867-8828