New York updates return-to-work protocols for medical workers

The New York City Department of Health has circulated a revised recommendation on return-to-work protocols for healthcare workers after infection or exposure to COVID-19. The new November 30 protocols will replace the department’s previous February 4 protocols and align New York with the current Centers for Disease Control and Prevention (CDC) recommendations.

The department’s recommendation, which has been distributed to providers but has not yet been published in the department’s COVID-19 guidance directory, provides return-to-work protocols that depend largely on whether the healthcare facility is using traditional emergency or crisis mitigation strategies of personnel requirements is operated shortage.

Asymptomatic medical workers who have been exposed to COVID-19 are no longer subject to work restrictions, including quarantines, based on vaccination status. However, according to CDC guidelines, employees who have been “at higher risk” for COVID-19 should be screened for potential work restrictions.

After infection

Healthcare workers with mild to moderate illness who are not immunocompromised may return to work after:

  • At least 7 days have passed since onset of symptoms if a negative virus test was performed within 48 hours before returning to work (or 10 days if no test is performed or if the test was positive on days 5-7).
  • At least 24 hours have passed since the last fever without taking antipyretic medication.
  • Symptoms such as coughing or shortness of breath have improved.

Healthcare workers who have been asymptomatic and not immunocompromised throughout the infection may return to work after at least seven days have elapsed since the date of their first positive virus test if a negative virus test is performed within 48 hours of returning to work (or 10 days if no test is done or if the test was positive on days 5-7).

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Healthcare workers with severe to critical illness who are not immunocompromised may return to work after:

  • At least 10 days and up to 20 days have passed since the onset of symptoms.
  • At least 24 hours have passed since the last fever without taking antipyretic medication.
  • The symptoms have improved.

The test-based strategy outlined in the CDC guidelines for immunocompromised health care workers can be used to obtain information about the duration of the work restriction. Healthcare workers who are moderately to severely immunocompromised may return to work after using the test-based strategy. It is recommended that an infectious disease specialist or other expert and occupational health specialist be consulted to determine when these medical personnel can return to work.

After exposure

Work restrictions are not necessary for most asymptomatic health workers after a “higher risk exposure” regardless of vaccination status. An “exposure with increased risk” exists when:

  • Healthcare workers have had prolonged close contact with a patient, visitor or other healthcare worker with a confirmed case of COVID-19.
  • Healthcare provider’s eyes, nose or mouth were exposed to material containing the COVID-19 virus.
  • The healthcare worker was not wearing a respirator (or, if he was wearing a face mask, the person with the infection was not wearing a face mask).
  • Medical staff were not wearing eye protection and the person with the infection was not wearing a face mask.
  • Medical personnel did not wear all of the recommended PPE (ie gown, gloves, eye protection, respirator) while in the room for an aerosol generation procedure.

A case-by-case analysis should be considered by any healthcare provider wishing to promptly return healthcare workers who have had a high-risk exposure to the workplace. When a work restriction is recommended for a high-risk exposure, medical staff may return to work after one of the following periods:

  • After the seventh day after exposure if they develop no symptoms and all virus tests are negative.
  • If no virus test is done, after the 10th day after exposure if they do not develop symptoms.
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Upon returning to the workplace from infection or high-risk exposure, medical personnel should self-monitor for symptoms and seek re-evaluation if symptoms recur or worsen. If symptoms recur, medical staff should be removed from work and follow recommended practices to prevent transmission until they meet return-to-work criteria.

contingency strategies

Contingency strategies should be considered if the facility faces staffing shortages. Facilities that adhere to emergency strategies may allow health workers to return to work despite not meeting the general criteria.

Health workers who have been asymptomatic and not immunocompromised throughout the infection can return to work if at least five days have passed since the date of their first positive virus test. Healthcare workers with mild to moderate illness who are not immunocompromised may return to work if it has been at least five days since the onset of symptoms, at least 24 hours have passed since the last fever without taking antipyretic drugs, and themselves the symptoms have improved.

Healthcare workers who are allowed to return to work under these exemptions should wear a well-fitting face mask at all times, separate from others if they need to remove the face mask, and maintain physical distancing as much as possible.

Crisis strategies may only be implemented if, despite the establishment of emergency strategies, the facility is actually or likely to be unable to provide essential patient services. Prior to implementing crisis strategies, the facility must inform the department of the need to move to crisis status, implement strategies to mitigate staffing shortages, and ensure that the criteria used to identify high-risk staff exposures are properly applied.

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As a last resort, facilities may consider allowing employees with suspected or confirmed COVID-19 infection to return to work even if they have not met all criteria of the emergency return to work strategy. Such personnel should be banned from contact with immunocompromised patients and prioritized tasks with a lower risk of transmission.

Next Steps

With the apparent resurgence of COVID-19 over the winter months, providers should review CDC guidance carefully to ensure a clear understanding of when their medical staff can work after being infected or exposed to COVID-19.

Providers are reminded that staff may be eligible for NY COVID-19 paid sick leave if the individual is subject to a mandatory or precautionary isolation or quarantine order issued by the state, department, local public health department, or authorized governmental agency was to issue such an order. Employees who are placed under work restrictions following a high-risk exposure may be entitled to their statutory paid sick leave.

Ira Wincott, Sanjay Nair and Joseph Gusmano are attorneys with Littler in Long Island, NY. © 2022. All rights reserved. Reprinted with permission.

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