Updated DOH Return to Work Guidance Aligns with September CDC Guidance

The Department of Health (DOH) issued updated "return to work" guidance on Nov. 30, 2022 for health care personnel (HCP) exposed to, or infected with, COVID-19. The new guidance aligns with guidance issued in September by the Centers for Disease Control and Prevention (CDC). It applies to all health care settings, including nursing homes, home care, hospice, and diagnostic and treatment centers. The new guidance does not apply to adult care facilities (ACFs), which will be subject to separate guidance anticipated in the near future.

The updated DOH guidance instructs providers to follow CDC Interim Guidance for Managing HCP with SARS-CoV-2 Infection or Exposure, which was updated on Sept. 23, 2022. The principal change as a result of the adoption of the CDC guidance is the elimination of work restrictions for asymptomatic HCP with higher-risk exposures. These HCP do not require work restrictions, unless they are moderately to severely immunocompromised. However, the exposed HCP must be tested three times – 24 hours after exposure, if negative 48 hours later, and if negative again 48 hours later (the exposure is day 0, and HCP must be tested at days 1, 3, and 5). The CDC guidance also states that testing is not recommended for people who have recovered from COVID-19 in the prior 30 days. For HCP who have recovered in the past 31 to 90 days, providers should consider antigen testing.

Although work restrictions are not generally required for exposed personnel, the CDC recommends that they be considered when the HCP has a higher-risk exposure and is:

unable to be tested or wear source control as recommended for the 10 days following their exposure;
moderately to severely immunocompromised;
caring for, or working on a unit with, patients who are moderately to severely immunocompromised; or
working on a unit experiencing ongoing SARS-CoV-2 transmission that is not controlled with initial interventions.

For the purposes of determining whether testing or work restrictions are required, a higher-risk exposure occurs when an HCP had prolonged close contact with a patient, visitor, or HCP with confirmed SARS-CoV-2 infection and was:

not wearing a respirator (or if wearing a face mask, the person with SARS-CoV-2 infection was unmasked);
not wearing eye protection if the person with SARS-CoV-2 infection was not wearing a mask;
not wearing all recommended personal protective equipment (PPE) (i.e., gown, gloves, eye protection, respirator) while present in the room for an aerosol-generating procedure.

Another change adopted as a result of the Nov. 30^th DOH guidance relates to the testing required when an HCP tests positive for COVID-19. In order to return to work after seven days (as opposed to 10 days), the HCP must have at least two negative antigen tests within 48 hours prior to returning to work (on days 5 and 7) or one PCR test within 48 hours prior to returning. The previous guidance required only one test within 48 hours prior, regardless of the type of test.

The DOH guidance instructs providers that are experiencing an "actual or anticipated inability to provide essential patient services despite instituting contingency strategies" to notify DOH of their need to follow CDC "crisis capacity strategies" by calling the Surge and Flex Operations Center at 917-909-2676. Providers that call the Operations Center will be asked to describe the staffing shortage contingency strategies they have already implemented, a description of crisis strategies they intend to implement, and their planned prioritization of strategies. For more information about contingency and crisis strategies to mitigate staffing shortages, providers should refer to the CDC's guidance, Strategies to Mitigate HCP Staffing Shortages.

The DOH guidance also reminds providers of their obligations to provide COVID-19 paid leave for personnel who must isolate or quarantine. The guidance refers providers to the Department of Labor (DOL) website here. Additional sources of COVID-19 paid leave guidance are:

Contact: Karen Lipson, klipson@leadingageny.org