[MCOH-EH] COVID-19 symptom based strategy

Charles Hackett dickenshackett at gmail.com
Wed Jul 29 07:12:05 PDT 2020

Our EOHS is responsible for all employee covid testing.
We work closely with our Infection Control Team and our DOH
There has been a consistent message that employees should not work if sick
and to call us.
We determine who gets tested. We only test symptomatic employees unless we
have had a cluster of positive employees or in our group homes where the
DOH has said to test all employees wehether symptomatic or not.
We also have been responsible for determing those employees RTW date.
We have always used the sympom based approach as outlined by the CDC.
We have not requested testing and a negative test prior to a RTW.
The most recent guidance is as you have pointed out
We use our clinical judgement and follow the CDC discussion about what is
an immunocompromised employee or how sick an employee is.
One challenge that has occurred is when an employee decides to see their
provider in the community and that provider wants to test until their
patient (our employee) is negative. The employee wants to work, they fit
all of the symptom based criteria but they get tested.
We all know that employees/patients can test +ve for a long period of time
and not be infectious
Sometimes a collegial call to the provider works and sometimes it doesnt.
We do not go to battle.
We have full alignment with the RODOH and our other Infection Control
We have not to date have had any cluster of cases after any employee has
We watch the CDC every day because they chnge periodically
Charlie Hackett MD, MPH Lifespan, Providence RI

On Tue, Jul 28, 2020 at 10:40 PM Abhijay Karandikar via MCOH-EH <
mcoh-eh at mylist.net> wrote:

> Now that the CDC has issued guidelines strongly in favor of using a
> symptom based strategy to RTW (
> https://www.cdc.gov/coronavirus/2019-ncov/hcp/return-to-work.html) 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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