Reminder for Daily Health Status Monitoring by all Healthcare Workers
Bay County, Michigan - Bay County Health Department (BCHD) wishes to remind all healthcare workers, especially licensed providers,to adhere to requirements for health status monitoring. Both the Centers for Disease Control and Prevention (CDC) and the Michigan Department of Health and Human Services (MDHHS) recommend self-monitoring, and on April 2, 2020, Bay County Health Officer Joel Strasz issued Emergency Order 2020-2, which requires certain critical infrastructure workers–specifically including anyone working at a healthcare facility–to self-monitor for new onset symptoms consistent with coronavirus disease 2019 (COVID-19).
Healthcare workers who experience new onset symptoms consistent with COVID-19 are not fit for duty and should not come to work. Infected healthcare workers pose an infectious hazard both to their coworkers and to uninfected patients. A high level of suspicion is critical to ensure that infections among healthcare workers do not go unrecognized as many are likely to experience mild symptoms. Daily screening should occur before each healthcare shift, and healthcare workers detecting new onset symptoms of concern (e.g., temperature>100.0°F; cough; shortness of breath; etc.) should not come to work. If symptoms develop while working, healthcare workers should immediately depart the patient care area, self-isolate, and notify their leadership.Excluding infected healthcare workers from patient care will help to avoid creating conditions that contribute to healthcare facilities becoming amplifiers of viral spread.
A recent analysis of confirmed COVID-19 cases among Bay County residents revealed that healthcare workers constituted 52% of all cases. Licensed healthcare providers (e.g., physicians, nurses, etc.) constituted 10% of all cases. Outbreak investigations reported from China, Italy, Spain, and New York indicate that health care workers were more likely to become infected and transmit the virus to others while providing care.
Healthcare workers experiencing symptoms fall into CDC’s Priority Group 1 and should be tested for COVID-19. However, the removal of a symptomatic healthcare worker from the healthcare workplace should not await a positive test result. A single negative test should be viewed with suspicion as a potential false negative if a healthcare worker’s symptoms remain highly suggestive of COVID-19 infection.
CDC has described a non-test-based strategy for determining when healthcare workers may return to work, which would be the later of either (a) 7 days after onset of symptoms or else (b) 3 days (72 hours) after resolution of fever (without the use of fever-reducing medications), substantial improvement in or absence of respiratory symptoms, and substantial improvement in or absence of gastrointestinal symptoms. Healthcare workers should notify their leadership when their symptoms have resolved so that their return to work can be anticipated. CDC’s test-based strategy for return to work, which requires two consecutive negative COVID-19 test results in addition to improving symptoms, will not be feasible until testing availability increases.
Previously symptomatic healthcare workers who return to work should:
On April 7, 2020, BCHD initiated a COVID-19 Symptom Surveillance Program for all healthcare workers serving patients in Bay County. Healthcare workers are reminded to register for this program and submit daily reports of their health status, preferably by using the online system.
- Wear a face mask at all times while working in a healthcare facility until 14 days after illness onset or until all symptoms have complete resolved, whichever is longer. This is a moot point if all healthcare workers are wearing a face mask all the time.
- Be restricted from contact with severely immunocompromised patients (e.g., transplant, hematology-oncology, etc.) until 14 days after illness onset.