COVID-19: CDC Issues New Return to Work Guidelines Following Infection or Exposure

On July 20, 2020, the U.S. Centers for Disease Control (CDC) revised its guidelines for when employees may return to work following infection or exposure to COVID-19. For non-healthcare settings, changes were made to the symptom-based strategy:

• Persons with COVID-19 who have symptoms and were directed to care for themselves at home may discontinue isolation under the following conditions:
• At least 24 hours have passed since resolution of fever without the use of fever-reducing medications; and 
• Improvement in other symptoms (e.g., cough, shortness of breath); and,
• At least 10 days have passed since symptoms first appeared.

The CDC notes that, following this method, duration of isolation for up to 20 days after symptom onset may be warranted for patients with severe illness. Additionally, isolation and other precautions can be discontinued 10 days after the date of their first positive viral COVID-19 test for individuals who never develop symptoms.

Interestingly, a test-based strategy is no longer recommended to determine when to discontinue home isolation, except in certain circumstances. Specifically, the test-based strategy may be considered for individuals who are severely immunocompromised (as determined by the treating healthcare provider), or to discontinue isolation or other precautions earlier than would occur under the symptom-based strategy. So, employers may still permit employees to return to work prior to completing the recommended self-isolation period if desired by the employee and testing supplies are available. The test-based strategy still requires negative results of a viral test for COVID-19 from at least two consecutive respiratory specimens collected at least 24 hours apart.

Additionally, the CDC recommends 14 days of quarantine after exposure based on the time it takes to develop illness if infected. Thus, it is possible that a person known to be infected could leave isolation earlier than a person who is quarantined because of the possibility they are infected.

For healthcare settings, the CDC made similar changes to the symptom-based strategy, and no longer recommends a test-based strategy to determine when to discontinue Transmission-Based Precaution, except for rare situations. Also, for patients with severe to critical illness or who are severely immunocompromised, the recommended duration for Transmission-Based Precautions was extended to 20 days after symptom onset (or, for asymptomatic severely immunocompromised patients, 20 days after their initial positive viral COVID-19 test).

On June 13, 2020, the CDC issued a new testing strategy for high-density critical infrastructure workplaces after a COVID-19 case is identified. Specifically, employers should categorize workers into tiers depending on the level of risk for infection and implement testing strategies based on the level of risk. The CDC created a flow chart demonstrating the recommendations. Workers in critical infrastructure sectors may be permitted to work if asymptomatic after potential exposure to a confirmed case of COVID-19, provided that worker infection prevention recommendations and controls are implemented.

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