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COVID-19 Briefing - Friday, July 31st

Hot spots level off, but case counts stay high, kids spreading COVID, and more...

Today’s Recap:

  • While most kids don’t seem to be getting as sick with COVID, newest research shows children are likely spreading itWe now know that kids’ noses have more virus load than most adults. 
  • Yesterday, Dr. Anthony Fauci suggested that goggles may become a recommended part of PPE outside of healthcare settings (they’re already widely in use in healthcare settings).
  • Quest Labs is reporting a serious decline in requests for HgA1C tests, the primary-test used to manage diabetes.  The long term consequences (and significant costs) TBD.  
  • We’re starting to see some other illnesses pop back onto our radar: Noro, Hep A, Salmonella.  
  •  Public Health Canada is reporting that the Salmonella Newport outbreak is likely tied to red onions from the US. 

Best Questions:

If an employee’s child tests negative but is still sick with fever and other symptoms and their pediatrician suspects it is actually COVID, should we exclude the employee for 14 days?

Yes.  There are several things at play here.  One is that COVID tests remain inaccurate.  Another is that the test may have been given too soon.  If a medical professional makes a presumptive diagnosis of COVID, the right course of action is to act as if it is COVID.  Transmission within a home, and especially as a caregiver, is very high.  So we would exclude that employee for fourteen days.

If an employee tests positive and on day 10 of their exclusion, their spouse becomes sick, do we need to extend their exclusion?

No.  At this point in time, we do not believe someone can get COVID a second time right after a first illness.  We don’t know how long their antibodies will last (some studies show only 90 days), but as long as the employee is fever free for 24 hours without fever reducing medication and resolving other symptoms, they can return to work?

A health department is saying we need two negative tests to return an employee to work, which is contrary to the CDC’s guidance (and nearly impossible to get done right now).  How should we handle that?

Here’s a link to the CDC’s guidance on return to work.

We suggest contacting the health department directly, sharing this information and asking for direction.  There are a few, lesser informed departments, who aren’t budging (Wichita County, TX gave us a run for our money this week).  But most will discuss it with you and provide alternative return to work options.  We are seeing some jurisdictions draft their own new RTW guidance in the last week or two and many are opting for 14 days after onset or + test, rather than the CDC’s recommendation of 10 days. 

My employee has a fever and headache but says they know it’s a sinus infection.  Should they be excluded?

This has probably been the most common and sometimes most challenging question for our clinical team.  Technically, these meet the CDC’s symptom criteria.  We will usually require that the employee is seen by a medical professional and/or tested.  And we’d exclude until that happens. 

A customer was asked to leave our location because he refused to wear a mask. He is now calling and berating one of our home office employees saying that he is medically not allowed to wear a mask and that we have violated his HIPAA rights. Do you know of any rulings that would bar someone from having to wear a mask?

We can’t give legal advice, but this article from USA Today says they’ve done the research and you can ask why someone can’t wear a mask, and that it is not HIPAA protected.

How do I explain to an employee or manager that it’s ok to come back to work after COVID even if they’re still testing positive?

Good question.  The latest studies show that someone with COVID may continue to test positive for up to three months but the majority are no longer infectious after ten days (including 24 hours fever free without fever reducing medications).  A very small number of people (those who were very sick and hospitalized or who are immunocompromised) may be infectious for 19 days - but those employees generally aren’t ready to come back to work for a long time. See the CDC recommendation here

An employee called and said they had tested positive.  I’m in a jurisdiction that requires that I close for 24 hours.  Should I immediately close?

Well… not yet.  So here’s what happened twice this week:  The employee called and said they tested positive but didn’t have a hard copy of results (or a screenshot, or access to their clinic’s testing portal). We did some quick research and found that the urgent care they went to was only offering rapid antibody testing. The nurse gave that employee bad information, or the employee clearly misunderstood, because the employee thought they needed to isolate for ten days.  In fact, the next morning we confirmed they were antibody positive and the location didn’t need to close and the employee didn’t need to isolate.  Similar thing happened again within hours.  So our best advice is:  verify.  Do not take action until you have some confirmation that the result is positive.  Nearly all testing sites now email results, provide access to a portal, or text the result which they can screen shot.  Once you’ve verified (which may mean calling the health dept.), then you may need to close if that’s required in your area. 

Best Read:  

You know we’re huge fans of Dr. Mike Osterholm.  His interview for Market Watch is sobering but also gives us a potential view into the future and maybe a  road map. 

Dr. Osterholm: Americans will be living with the coronavirus for decades

Best Laugh:  

While we still can’t go back to gyms in many states, here’s what it might look like when we can,

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Disclaimer: This post is meant for general information and educational purposes only and does not constitute, and is not intended as, any form of medical, legal or regulatory advice or a recommendation or suggestion regarding the same.  No recipient of this information should act or refrain from acting on the basis of this information without first seeking legal advice from counsel in the relevant jurisdiction.