For healthcare workers, should RTW recommendations after COVID-19 diagnosis include other objective risk assessment options i.e. antibody titers (>1:50), exposure history, job tasks, chronic conditions etc., in addition to CDC’s recommended RTW criteria?

The Centers for Disease Control and Prevention (CDC) has published return-to-work criteria for health care personnel (HCP) with suspected or confirmed COVID-19 infection1

Two alternative strategies are outlined for symptomatic individuals: a test-based strategy utilizing an FDA Emergency Use Authorized molecular assay for COVID-19 (RT-PCR for SARS-CoV-2) performed on nasopharyngeal swabs, and a symptom-based strategy using symptoms and history of illness without retesting.

The test-based strategy requires work exclusion until 3 criteria are met: resolution of fever without the use of antipyretics, improvement in respiratory symptoms, and negative results from two consecutive molecular assays from nasopharyngeal swab specimens collected at least 24 hours apart.  The symptom-based strategy requires work exclusion until 2 criteria are met: 10 days have passed since symptom onset, and 3 days have passed since “recovery” which is defined as resolution of fever without using antipyretics, and improved respiratory symptoms. On April 13, 2020, the CDC announced a preference for the test-based strategy, but on April 30, 2020 withdrew that preference, acknowledging reports of prolonged detection of viral RNA which may or may not indicate infectivity. 

For asymptomatic HCP diagnosed with COVID-19 via positive RT-PCR for SARS-CoV-2, the CDC also published two strategies: a test-based strategy with return to work following negative results from two consecutive molecular assays from nasopharyngeal swab specimens collected at least 24 hours apart, and a time-based strategy with exclusion from work for 10 days after their first positive test, assuming symptoms do not develop in that timeframe.

Regardless of the return-to-work strategy used, these HCP should wear a facemask (not a cloth mask) for source control for at least 14 days after illness onset (or first positive test result in asymptomatic cases). The facemask should be worn as long as any symptoms linger, at which point HCP should revert to following their facility’s policy for universal source control.
HCP who meet the criteria outlined above may be presumed to be non-communicable.                                    

The clinical presentation of COVID-19 varies widely, from mild to severe. As with any serious illness that may require hospitalization or even ICU care, some individuals recovering from COVID-19 may experience residual symptoms such as fatigue and loss of stamina that may impact their readiness to meet the physical and mental demands of their usual job. 
Serologic tests for SARS-CoV-2 IgG are designed to identify individuals with a prior infection.  This may be useful in epidemiologic research and seroprevalence studies.  However further studies are needed in order to determine whether a positive IgG test for SARS-CoV-2 is indicative of the presence of neutralizing antibodies. At this point we cannot make any assumptions about the protectiveness and duration of any immunity that may be present or determine whether a particular quantitative antibody level is desirable.  
A monograph released by the Infectious Diseases Society of America on April 20, 2020 provides excellent information on the background of antibody testing for SARS-CoV-2 infection and interpretation of test results2.

When HCP are placed on quarantine and removed from work after an identified medium or high-risk exposure, but have not developed COVID-19 infection, asking about interval exposures is a good practice prior to releasing them to work. However, this has little apparent utility for HCP with a diagnosed COVID-19 infection.



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The Forum does not necessarily represent an official ACOEM position. The Forum is intended for health professionals and is not intended to provide medical or legal advice, including illness prevention, diagnosis or treatment, or regulatory compliance. Such advice should be obtained directly from a physician and/or attorney. Questions are answered with the best available data or recommendations at the time.