Category: Infection Control
Question: If healthcare personnel (HCP) are living with someone who has been diagnosed with SARS-CoV-2 infection, should they be excluded from work? If so, for how long?
Answer: HCP with exposures in the community should be managed in the same way that HCP with exposure in a healthcare facility are managed. HCP who have been in close contact (within 6 feet of someone for a cumulative total of 15 minutes or more over a 24-hour period) with someone who has SARS-CoV-2 infection in the community should report their exposure to their occupational health program for guidance on need for testing and work restriction. The timing and risk level of exposures in the home can be difficult to characterize. If possible, HCP should avoid contact with the individual while they are potentially infectious (e.g., avoid being in same room). If they have been able to consistently avoid close contact with the infected individual (including in the 2 days prior to symptom onset) then they would not be classified as having a higher-risk exposure. However, if close contact could not be avoided, they should generally be classified as having a higher-risk exposure. The HCP’s last exposure is considered their last day of contact with the infected individual while they were potentially infectious, which may differ from when that individual was permitted to end isolation. For example, while an infected individual in the community who is asymptomatic or mildly ill (and meets other criteria) is allowed to end isolation 5 days after their symptom onset, they may remain infectious beyond 5 days. This is why patients or residents with SARS-CoV-2 in healthcare settings are recommended to remain in Transmission-Based Precautions for 10 days following their symptom onset. For the purposes of determining an exposure period for HCP living with an infected individual, the most conservative approach is to consider the infected individual to be infectious until 10 days following their symptom onset (assuming they do not meet other criteria requiring a longer duration of isolation). However, the risk for transmission might be diminished if at least 5 days have passed from onset of symptoms, contact with the infected individual is minimized, and both the HCP and the infected individual wear well-fitting source control while together in the home. If these mitigating factors are present, facilities could consider beginning the post-exposure quarantine period after Day 5 of the infected individual’s symptom onset. HCP who have had one or more isolated exposures, but are then able to avoid ongoing contact with the infected individual living with them, should be managed as described in the Table in the Interim Guidance for Managing Healthcare Personnel with SARS-CoV-2 Infection or Exposure to SARS-CoV-2. HCP who are not able to avoid ongoing close contact with the infected individual while they are contagious, should be managed as follows: If they are not up to date with all recommended COVID-19 vaccine doses, work restriction should include the entire exposure period when their household contact is potentially infectious (generally 10 days unless mitigating factors are present) and extend through the recommended post exposure quarantine period. For example, if the infected individual developed mild symptoms on October 1 (DAY 0), they may be considered potentially infectious from September 29 through October 11 (DAY 10). Work restriction for HCP would then be recommended from the date of their initial exposure though October 21 (10 days after their last exposure when the individual was potentially infectious), or October 18 (7 days after their last exposure if a viral test is collected within 48 hours prior to their return to work and is negative for SARS-CoV-2 and they do not develop symptoms). If they are up to date with all recommended COVID-19 vaccine doses, they do not require work restriction unless they develop symptoms, test positive for SARS-CoV-2 infection, are moderately to severely immunocompromised, or are otherwise advised to be excluded from work by their occupational health program or public health authorities. If these HCP continue to work, they should be tested immediately (but not earlier than 24 hours after the initial exposure) and, if negative, again every 3 to 7 days with the final test occurring 5 to 7 days after their last exposure. If HCP develop SARS-CoV-2 infection, they should be restricted from work until they meet the return to work criteria. Work restriction and post exposure testing of asymptomatic exposed HCP who have recovered from SARS-CoV-2 infection in the prior 3 months might not be necessary. If testing is performed, an antigen test instead of a nucleic acid amplification test (NAAT) is recommended.