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COVID-19 Briefing - Tuesday, July 21st

Exclusion Chart Updates

  • The CDC has updated their return to work guidelines, reducing the length of time someone needs to be fever-free in order to return to work from 3 days to 24 hours.   
  • See the full chart here, new changes are highlighted in yellow. 

Today’s Recap:

  • The National Restaurant Association has a tracker for face mask & health screening regulations, found here. It’s a very handy tool that’s been updated as of 7/16. 
  • The CDC also says that the actual case counts in surging states may be between 2 and 13 times higher than daily reports show.  
  • Wide variation in how states and local jurisdictions define “fever” continues to be a source of confusion.  We’re sticking with 100.0°F or more for now in order to meet the widest range of local guidelines.
  • VA passed very strict worker protection rules related to COVID and other states are expected to follow.  
  • During COVID, the number of babies delivered prematurely has dropped by an astounding 90% in some places. No one is really sure why, but speculation is that moms are not commuting, getting more rest, have more caregivers around them, and are less stressed, translating to lower blood pressure.
  • NY has expanded quarantine requirements to travel from 31 states. KY added quarantines yesterday.  Keeping track of travel restrictions can be a full time job and an impossible one.  A theme we keep hearing from you:  People who vacationed last week are surprised when they’re now required to quarantine for fourteen days on their return.
  • Just so we don’t think foodborne illness has gone away, this afternoon several agencies  including the FDA are reporting a multistate outbreak of Salmonella Newport infections, according to Foodtrack. This investigation is ongoing and a specific food item, grocery store, or restaurant chain has not been identified as the source of infections.

Best Questions:

The employee thinks they need two negative tests to return to work. Is that true?

We advise against requiring a negative test or two consecutive negative tests to return to work.  It isn’t clinically necessary and getting testing can be very challenging due to testing shortages and unreliable results.

Here’s the science behind it: the viral load is highest on two days prior to onset of symptoms and first day of symptoms and then drops each consecutive day. By day 10, the viral load has dropped to below a level that will infect others (although it may still be detectable which could still produce a positive result). Although clinically insignificant, some people are testing positive 80-100 days later, while there is no reason to keep them out of work that long .

Based on the new CDC guidelines, are we still excluding if someone has a lingering cough or shortness of breath?

Yes, even though CDC guidelines now say “symptoms improved,” we are still strongly recommending  that respiratory and gastrointestinal symptoms are fully resolved before someone returns to work. This is more about optics of having a person coughing at work in front of co-workers and customers, for example, than about the science of their ability to infect others (very unlikely after 10 days). 

Employees seem to be reporting symptoms continuing beyond ten days.  How long should we continue to exclude them?

We’re generally excluding in three day increments. There isn’t great guidance here and we’ve already discussed our concerns with returning employees who are coughing or having diarrhea. 

When an employee goes on vacation with other employees and then one gets sick, do they all need to be excluded from work?

Well - that is without the doubt, the issue of the last few days (and probably the next several weeks).  The guidance on this one isn’t clear, and not every situation is the same.  Here’s how we generally would handle it:  If the sick person tests positive, then the answer is clearly yes, the employees will need to be excluded.  But if the person who is sick has not been seen by a medical professional who gave them a presumptive COVID diagnosis, or if that person hasn’t tested positive, we would only exclude a coworker if they live with, care for, or are intimate with the person who is sick.  If later the sick person tests positive, then we would go back and exclude folks who had close contact that meets the criteria (6ft, 15+ straight minutes while the sick person was symptomatic, or in the 2 days before they became symptomatic or tested positive).

If the employee is a minor and their parents won’t give them permission for the employee to discuss their COVID exposure or status with us, how should we handle it?

Well, we can’t give legal advice but we also can’t communicate with a minor whose parents have specifically not provided consent. We would exclude the employee indefinitely until parental consent is obtained (or get HR and legal advice).

Why did the CDC change guidelines for allowing employees to return to work after ten days if only 24 hours fever free (instead of the previous 72 hours)?  

Although they didn’t provide a specific explanation, we believe it is because they have clearly documented that someone is no longer infectious ten days after onset of symptoms (or an initial positive test if asymptomatic).  Working to help you get employees back to work, we now have a better feel for how many employees regularly take Tylenol or Advil (for back pain, old sports injuries and other chronic medical conditions).  So getting someone to go three days without that pain relief can be difficult.  This is a welcome change that will help get some people back to work sooner. 

If someone was excluded for close contact exposure and then develops symptoms themselves, how do we adjust the exclusion?

Symptoms always trump exposure.  So if the employee was excluded for 14 days and on day 10 they develop symptoms, their new exclusion is 10 days from the symptom onset date (yes we know,,.that’s a long time).

An employee received an email, text or message from a…. car dealership they stopped into, a restaurant where they ate, a store they made a purchase… informing them that the business had an employee who tested positive, do we need to exclude our employee?

In most of these situations, the transaction would not have resulted in close contact within six feet for 15+ straight minutes. Except in specific situations where the employee knows that they were definitely in close proximity for 15+ consecutive minutes, or they are contacted by an actual contract tracer from a local department of health, we generally don’t need to exclude for casual contact in a retail environment. 

Best Read: 

We’re still all looking for COVID immunity.  Even with the incredible case counts, we’re not yet near herd immunity.  This really excellent read addresses what we know and don’t about COVID-19 immunity.

How Long Does COVID-19 Immunity Last?

Best Laugh:  

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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.