Return to Work Information to Share with Employers During COVID-19

WHAT SHOULD THE GOAL BE FOR COMMUNICATING WITH EMPLOYERS FOR RTW?

The goal is to ensure your employees have a safe workplace environment and they know this and feel safe. You should have clearly identified sources for employees to contact if they have questions, concerns or are in need of support. While doing this, you want to maintain as normal a workflow and productivity as possible. Of course, for many employers productivity has taken a major hit, even for those who didn’t have to actually close.

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1. WHAT SHOULD THE GOAL BE FOR COMMUNICATING WITH EMPLOYERS FOR RTW?

The goal is to ensure your employees have a safe workplace environment and they know this and feel safe. You should have clearly identified sources for employees to contact if they have questions, concerns, or are in need of support. While doing this, you want to maintain as normal a workflow and productivity as possible. Of course, for many employers, productivity has taken a major hit, even for those who didn’t have to actually close. Physical distancing is difficult for some occupations, especially healthcare, law enforcement, and critical service providers who must interact with the general public or large numbers of people. Innovative changes in workflows and procedures may be necessary.

2. WHAT GENERAL RECOMMENDATION SHOULD BE DEVELOPED AND SHARED WITH CLIENT COMPANIES?

The goal is to implement a program that is as barrier-free as possible for quarantining, evaluating and treating individuals, while not overburdening the medical system or subjecting individuals to additional risk of exposure in the management process.

• No “doctor’s excuse” to leave work for home quarantine or to return to work.
• No laboratory test required to leave work for home quarantine or to return to work.
• Institute process changes and engineering changes in the workplace to facilitate physical distancing: spread workspaces out; tape lines on floors to indicate 6′ spacing, place plexiglass shields (or other barriers amenable to easy cleaning and sanitizing) between workers, etc.

3. WHAT EDUCATION SHOULD YOUR CLIENTS PROVIDE TO THEIR EMPLOYEES?

They should be given the same advice I gave for employers, with the additional points:

• If they have fever or symptoms of a respiratory infection, they should stay home to quarantine and notify the appropriate person at work of the situation. They do not need to go to the doctor unless they have symptoms severe enough to warrant a visit.
• Those who do need to go to the doctor, urgent care center, or emergency room should call the facility before leaving home and follow the instructions they are given.
• In addition, they should be instructed in the basic behaviors that can reduce the spread of the infection. The instructions should be repeated regularly and enforced:
  • Physical distancing: stay six feet apart.
  • Wear a face mask.
  • Wash or sanitize your hands frequently.
  • Don’t touch your face.
  • Cough into your sleeve or into a tissue (which you should discard immediately after using it).
  • Sanitize high-touch surfaces frequently (e.g. – hourly). In our organization, we designate individuals on a rotating basis to do this and document it on a log.
  • STAY HOME if you have ANY symptoms of infection.

4. 
   HOW DO YOU ESTABLISH AND ORGANIZE A WORKSITE SCREENING PROTOCOL?
   • Establish a procedure for documenting, tracking, and managing your COVID-19 information and activities.
   • Identify an administrative employee or team to perform these duties.
   • They should have authority to answer questions, make decisions, institute actions, and manage situations. This person or team should be identified to all employees, and employees should be able to contact them directly. In our organization, we refer to this team as the “Command Center”.
   • Inform employees who are sick and know they should home quarantine who they should notify. This could be their supervisor. You might want them to call the Screening Team or the Command Center so appropriate documentation can be initiated and the case tracked efficiently.
   • Screen every individual before they enter the facility. Practice physical distancing in the screening area.
   • If practical, stagger employees’ work schedules so large numbers of individuals are not arriving or leaving work at the same time.
   • Ask each individual about symptoms consistent with coronavirus infection, fever and the other questions on the form.
   • Measure each individual’s temperature. Preferred method is an approved, infrared scanner so that no touch with the individuals occurs.
   • Individuals with any positive symptoms, known or possible close exposure with a known infected case or a temperature >100.4 (or whatever temperature your organization chooses) should be sent home to quarantine.
   • Complete documentation for each individual sent home. I have attached a form as an example. You may modify this to meet your needs.
5. WHO SHOULD BE ON THE EMPLOYEE SCREENING TEAM?Since the actions are driven by protocol, rather than by assessment and judgment, medical training is not required. Some employers utilize the security personnel at the entrance gate who already encounter every employee before they enter the facility. Others use human resources employees. If you have employees with designated health or first aid responsibilities (e.g. – first responders and those with AED and/or blood-borne pathogen exposure training), it makes sense to utilize those individuals. Individuals must have historically demonstrated good judgment and be conscientious and reliable. These individuals should have the authority to send workers home without entering the facility. Some employers have reservations about using their own employees for this role and have requested we provide staff to do the screening around shift change times.
6. WHAT SUPPLIES ARE NEEDED FOR THE SCREENING?
   • Infrared thermal scanner which measures temperature by scanning the temporal artery and does not touch the individual.
   • Hand sanitizer – Use this after screening any individual with symptoms or after any potentially contaminated touch (e.g. – touching an individual or taking a pen or other item from them).
   • Face mask – Consider changing mask after screening an individual who is coughing. Use hand sanitizer before and after donning or doffing a mask.
   • Gown and eye shields – Not necessary.
   • Gloves – Not necessary, but if worn should be changed after screening an individual with symptoms (fever, cough, etc).
7. WHERE DO THE EMPLOYERS GET THE NEEDED EQUIPMENT?This depends on where you are located and the availability of supplies in your area. Start by utilizing your established supply chain resources then try drug stores, large general merchandise stores (e.g. Target, Costco, medical supply stores and online (e.g. – E-bay, Amazon, medical supply warehouses).
8. WHAT SHOULD BE INCLUDED IN THE SCREENING QUESTIONNAIRE?See attached. This is a moving target. Many have dropped the travel questions.
9. WHAT IMMEDIATE ACTIONS ARE REQUIRED WHEN EMPLOYEES MEET THE CRITERIA FOR QUARANTINE?Mild Symptoms:
   • Send the employee home to self-quarantine.
   • Provide the employee with a copy of instructions on how to effectively home quarantine while protecting other household members and instructions on when to return to work. (See attached).
   • Instruct them to stay home. They should not go out in public or away from home unless it is to seek medical attention.
   • Complete the documentation form and send it to the Command Center.
   Severe Symptoms:
   • Instruct the employee to call their personal physician or an express care clinic, give their symptoms and ask for their instruction.
   • If practical, offer to make this call for them before sending them home.
   • Provide the written instructions, as above.
   • Complete the form, as above.
   Hospital Referral Protocol:
   • If the employee looks sick enough that you think they may need to be hospitalized, the safest course would be to have the individual park their car and call the emergency room. They may recommend that EMS be called. If there is any delay in reaching the emergency room, call EMS.
     
10. WHAT RETURN TO WORK CRITERIA ARE RECOMMENDED?

Symptom Based Protocol:

• Home quarantine should continue until the latest of:
  • At least 3 days (72 hours) have passed since last temperature elevation without the use of temperature-lowering medications (Tylenol, Aleve, aspirin, etc), and
  • Improvement in symptoms, and
  • At least 10 days have passed since symptoms first appeared.
• NOTE: Individual does not have to be symptom-free. This is not a recovery period; it is an isolation period.

Laboratory test based:

• Criteria 1 & 2 in the Symptom-based protocol, above, have been met, and
• Negative results from an FDA approved assay for COVID-19 performed on two consecutive specimens obtained at least 24 hours apart.

For persons who have NOT had COVID-19 symptoms but tested positive and are under isolation:

• At least 10 days have passed since the date of their first positive COVID-19 diagnostic test was obtained, assuming they remain asymptomatic.
• If they subsequently develop symptoms, they revert to the symptom-based criteria, above.
• If testing is required prior to RTD, they should have two consecutive negative tests, as above.

11. WHAT ACTIONS MUST BE TAKEN UPON RETURN TO WORK?

If the individual had elevated temperature and/or symptoms but did not have laboratory-confirmed Coronavirus infection:

• Wear a face mask at all times while in the workplace until all symptoms are completely resolved or until 14 days after illness onset, whichever is longer.
• During this period, they should wash or sanitize hands frequently.
• They may or may not have developed immunity. They must continue to take precautions against infection and participate in the same screening protocol as everyone else. If they develop symptoms or elevated temperature again, they must repeat the above process.

If the individual had laboratory tests and had a laboratory confirmed Coronavirus infection:

• They must wear a mask covering their nose and mouth at all times while they are in the workplace for a total of 14 days since the first symptom or temperature elevation occurred.
• During this period, they should wash or sanitize hands and high-touch objects frequently.
• While a history of documented infection with a specific infectious agent is generally considered to confer immunity and protection against repeat infection with that agent, the CDC maintains that this has not been established with Coronavirus infection and should not be assumed.
• Despite having known, documented infection, employees must continue to take precautions against infection and participate in the same screening protocol as everyone else. If they develop symptoms or elevated temperature again, they must repeat the above process.

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Additional Notes:

• Having documentation of negative laboratory test is not required to return to work. If you wish to use lab testing, the recommendation is to have two consecutive negative tests, collected at least 24 hours apart.
• Some individuals have had positive PCR tests for prolonged periods. The significance of this, and whether or not they remain infectious, remains uncertain.

12. WHAT ABOUT EXPOSURE TO A FAMILY MEMBER, HOUSEHOLD, OR OTHER CLOSE CONTACT?

For persons exposed by close contact to another person with symptomatic and/or laboratory-confirmed COVID-19 disease, but having no symptoms:

• Examples of contacts:
  • Household member
  • Intimate partner
  • Individual providing care in a household without using recommended infection control precautions
  • Individual who has had close contact for a prolonged period of time
• Management:
  • Home quarantine for 14 days after the last exposure. If exposure is ongoing, this means 14 days after the initial index individual has met criteria for release from quarantine.
  • Practice infection control precautions.
  • Upon release from quarantine, follow the guidelines above for actions to be taken after return to work.

Persons quarantined due to exposure who subsequently develop symptoms revert to the symptom-based protocol, above. Individuals who are exposed to asymptomatic persons who are quarantined because of exposure to an infected person (i.e. – secondary exposure) do not need to be quarantined. (This would cause a domino effect.) Note: Recommendations for discontinuing isolation in persons known to be infected with COVID-19 could, in some circumstances, appear to conflict with recommendations on when to discontinue quarantine for persons known to have been exposed to COVID-19. 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.