[MCOH-EH] COVID-19 symptom based strategy

[Eisenhauer, Julie (TCRHCC)]

 1) & 2) We have always used the symptom based strategy due to constraints of testing here on the Navajo Nation. It was called the 10-3-3 criteria and is determined by the Employee Health Staff. Now we are transitioning to the 10-1-everything improving, AND, 20-1-everything per CDC guidance. The way it is determined is by this definition:
Mild to Moderate disease -- no hospitalization and managed well at home. 10-1-everything improving utilized
Severe disease -- hospitalized and have ongoing needs. 20-1-everything utilized.
We do not have the staff or resources to have anyone else monitor this process except for Employee Health who is backed by the Epi Response Medical Provider and team. And it is truly a case by case determination. The nurses have on several occasions requested the employee to seek medical care to ensure they are able to continue to manage the illness at home. There are many questions and critical thinking is essential (and exhausting on a daily basis).

3) We have the benefit of LTI (Long Term Illness) bank that each employee builds up from the time the start work. It can only be utilized after they have finished an initial probation period. We also have them contact our FML and STD (short term disability) provider and start a claim right away as we have found in the last 5 months those who become really ill do not have the capacity to make those calls. We also have what is called Admin leave that may be taking for 30 days by approval past the LTI per our communicable disease policy.
Sincerely Your Employee Health Nurse.

4)We only do re-testing for our Oncology and Speciality Care Center due to the patient population served there is severely immunocompromised per the insistence of our Speciality Care Center Medical Director. Otherwise it is felt re-testing does not warrant wasting resources due to the scientific finding that some employees will continue to be positive for extended periods of time while others may have a false negative. With cold and flu season coming soon, we need all the reagent we can possibly get as both the COVID-19 and the flu utilizes the same. That being said, we HIGHLY discourage re-testing.

The rapid test- 48 minutes. The send out 2-3 days which has improved. Send out use to be 5-7 days at one point. We do not have the antibody testing capability yet to check for immunity response.

Julie A. Eisenhauer BSN, RN, CCM
Employee Health Nurse

Tuba City Regional Health Care Corporation
167 North Main Street, PO Box 600
Tuba City, AZ. 86045
Phone:(928)283-2432 ext. 41544
Fax: (928)283-2042
Email: Julie.eisenhauer at tchealth.org
HR Email: TCRHCC at tcheatlh.org

-----Original Message-----
From: MCOH-EH <mcoh-eh-bounces at mylist.net> On Behalf Of Abhijay Karandikar via MCOH-EH
Sent: Tuesday, July 28, 2020 8:40 PM
To: mcoh-eh at mylist.net
Cc: Abhijay Karandikar <dr_abhik at yahoo.com>
Subject: [MCOH-EH] COVID-19 symptom based strategy

Now that the CDC has issued guidelines strongly in favor of using a symptom based strategy to RTW (https://nam02.safelinks.protection.outlook.com/?url=https%3A%2F%2Fus-west-2.protection.sophos.com%2F%3Fd%3Dcdc.gov%26u%3DaHR0cHM6Ly93d3cuY2RjLmdvdi9jb3JvbmF2aXJ1cy8yMDE5LW5jb3YvaGNwL3JldHVybi10by13b3JrLmh0bWw%3D%26e%3DanVsaWUuZWlzZW5oYXVlckB0Y2hlYWx0aC5vcmc%3D%26t%3DNGh5ZWhwc0ZzTldsU0NEaEkrcGhyaWs1QVh2MDJaZlJnTGdhZGNvT1A1az0%3D%26h%3D240fb21a730e4844953cfd670b0f088d&data=01%7C01%7Cjulie.eisenhauer%40tchealth.org%7C0b307e5356da4e5fd88e08d83368c625%7C842b0edb2ac1492f85b7b48ec194bb8b%7C1&sdata=pxF84PDdLMc0FDntN5Bg%2FLsGU62PJPSI9eRNjH%2FOhRE%3D&reserved=0) for HCP with COVID-19, I am curious to know the following:

1. Are you using the mild-moderate-severe-critical illness definitions for determining duration of work exclusion (10 vs 20 days) or are you using the minimum (10 days only, with 24 hours of being afebrile, etc.) based on operating in crisis capacity?

2. Clinical judgement is of great importance when using the symptom based strategy. Who does the triaging - staff/OH-EH providers/IP?

3. Are you asking employees to use their ETO/PTO/sick time for time away due to symptoms irrespective of the duration?

4. Are you still offering testing? If so, who pays for the two tests needed 24 hours apart? What is the turnaround time for test results? Does testing result in returning employees much sooner than based on symptoms only, especially since symptoms need to significantly improve as well?

In our institution, we (as guided by IP) have always used the symptom based strategy due to the issues associated with testing. However, there has been an increased demand for testing from employees lately.

Thanks,
Abhijay

Abhijay P. Karandikar, MD, MPH, FACOEM
Chief, Section of Employee Health
Reading Hospital, PA

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