Health Care Worker Isolation and Exposure Recommendations

The State of Minnesota extends employment protections to people complying with MDH recommendations for isolation, Minnesota Statutes Section 144.4196. MDH recommendations for isolation during conventional staffing capacity situations align with CDC guidelines for isolation. Health care workers can choose to return to work early if asked by an employer experiencing contingency or crisis staffing capacity. However, even in contingency or crisis situations, these employment protections apply to health care workers who choose to stay home for the full conventional isolation period.

It is up to the facility to decide what phase of staffing they are in. Facilities should have a low threshold for contacting MDH to ask about staffing resources and assistance. The document below has descriptions of the staffing capacities, which can be used as a guide.

Ethical Framework for Transitions Between Conventional, Contingency, and Crisis Conditions in Pervasive or Catastrophic Public Health Events with Medical Surge Implications (PDF)

CDC's mitigation strategies offer a continuum of options for addressing staffing shortages. Contingency strategies, followed by crisis capacity, augment conventional strategies and are meant to be considered and implemented sequentially (i.e., implementing contingency strategies before crisis strategies). However, facilities can choose to be more conservative in their staffing strategies, as staffing resources allow.

Health care facilities (in collaboration with risk management) should inform patients and health care workers when the facility is using these strategies, specify the changes in practice that should be expected, and describe the actions that will be taken to protect patients and health care workers from exposure to SARS-CoV-2 if health care workers with suspected or confirmed SARS-CoV-2 infection are asked to work to fulfill staffing needs.

Any health care worker who is experiencing even mild symptoms consistent with SARS-CoV-2 infection should leave work immediately and be tested. If using a molecular Nucleic Acid Amplification Test (NAAT), a single negative test is usually sufficient. If using an antigen test, a negative result should be confirmed by a negative NAAT or a second antigen test, taken 48 hours after the first negative test, before the health care worker returns to work. If a health care worker tests negative for SARS-CoV-2 and continues to experience symptoms, the health care worker should follow the guidance below:

• If symptoms are consistent with a known, chronic health condition or if the health care worker is evaluated by a health care provider and receives an alternate diagnosis, the health care worker may return to work when appropriate. The decision to return should be based on the health care worker's symptoms and ability to work, and guidance from the health care worker's provider, manager, and occupational health department.
  • If the health care worker does not have an alternate diagnosis from a health care provider, they may return to work if symptoms are improving and they have been fever-free for at least 24 hours without the use of fever-reducing medication.

As testing resources allow, a second test at least 48 hours after an initial negative NAAT test is recommended before the health care worker returns to work in any of the following situations:

• The health care worker had a known higher-risk exposure.
• The health care worker continues to experience symptoms, especially those that would interfere with continuous mask or respirator use for source control (e.g., runny nose).
• A higher level of clinical suspicion for SARS-CoV-2 is present.

After the appropriate time and/or test-based criteria are met, CDC specifies the following criteria for symptomatic health care workers to return to work:

• At least 24 hours has passed since last fever without the use of fever-reducing medications.
• Symptoms (e.g., cough, shortness of breath) have improved.

MDH recommends these additional considerations, which will help ensure returning health care workers are able to wear a well-fitting mask or respirator continuously:

• Not have rhinorrhea (runny nose).
• Have no more than a minimal, nonproductive cough.

A subsequent positive test collected during isolation does not "reset" or lengthen the recommended isolation period of 10 days. For example, under conventional staffing, if a health care worker tests positive after day five of isolation, they may return after 10 days of isolation, provided the health care worker meets the above return-to-work criteria.

Either a NAAT or antigen test may be used. However, if using an antigen test, health care workers should have a negative test on day five and again 48 hours later.

Health care workers who return before meeting all conventional return-to-work criteria should adhere to the following recommendations:

• Self-monitor for symptoms and seek re-evaluation from occupational health if symptoms recur or worsen.
• Wear a respirator or well-fitting mask at all times, even in nonpatient care areas, such as breakrooms.
• Practice physical distancing as much as possible.
• Avoid interacting with patients who do not wear or cannot tolerate a well-fitting mask.

CDC's updated guidance for health care workers returning to work while a facility is in contingency staffing status does not apply to health care workers who are moderately to severely immunocompromised. Immunocompromised health care workers should follow conventional isolation and return-to-work guidance during contingency staffing situations. As a last resort in crisis staffing situations, health care settings may consider asking health care workers who are moderately to severely immunocompromised to work prior to meeting all conventional return-to-work guidance.

In most circumstances, there are no work restrictions, as long as the health care worker remains asymptomatic. Test immediately (but not earlier than 24 hours) following exposure and then every 48 hours, with the final test occurring five to seven days after last exposure (i.e., last day the positive household member is considered infectious). If the health care worker is not able to isolate from the positive household member, the last day of exposure is the last day the household member is considered infectious (generally 10 days).

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               Antigen tests are less likely to detect the SARS-CoV-2 virus when compared to molecular tests. Therefore, the U.S. Food and Drug Administration (FDA) recommends serial testing after receiving a negative result from any antigen test, including at-home or over-the-counter tests, and point-of-care tests.
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               Please refer to FDA for considerations before using an antigen test and information about repeat testing following a positive or negative antigen result.
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                   <a href="https://www.fda.gov/medical-devices/coronavirus-covid-19-and-medical-devices/home-covid-19-diagnostic-tests-frequently-asked-questions#negative">FDA: At-Home COVID-19 Diagnostic Tests: Frequently Asked Questions</a>
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                   <a href="https://www.fda.gov/medical-devices/coronavirus-covid-19-and-medical-devices/sars-cov-2-viral-mutations-impact-covid-19-tests">FDA: SARS-CoV-2 Viral Mutations: Impact on COVID-19 Tests</a>
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           </ul>

Health care workers who are within 30 days of infection with SARS-CoV-2 should be tested in the following situations:

• To return to work prior to completion of 10-day isolation because of SARS-CoV-2 infection.
• When experiencing symptoms consistent with COVID-19, and other etiologies have been ruled out. In this situation, an antigen test is preferred.

Testing health care workers who are within 30 days of infection is not recommended in the examples below:

• Routine testing, such as routine staff screening and point-prevalence surveys.
• Testing after a higher-risk exposure.

Testing should be considered for health care workers that have recovered in the prior 31-90 days. An antigen test instead of NAAT is recommended in this situation.