COVID-19 Briefing - 8/18

Exclusion Chart Updates:

• This weekend, the CDC updated its definition of “close contact” and clarified exclusions for people who have had COVID in the past 90 days
• See the updated exclusion chart here.

• Update #1 : Close contact is defined as 6 feet for 15 TOTAL minutes of a confirmed COVID+ person

• Update #2: Even if less than 15 total mins, if an employee did any of these with a confirmed COVID+ person or someone who has COVID-like symptoms (according to our exclusion chart), we will exclude for 14 days from most recent exposure:
  
  Hugged/Kissed/Intimate Contact
  Shared eating or drinking utensils (we’re including cigarettes, vapes, etc.)
  Got coughed/sneezed on (or somehow got respiratory droplets on them)
  Caretaker for
  Lives with

• Here's Why:
  ‍The CDC has said that given the widespread transmission, they’re moving to a definition of 15 total minutes, rather than consecutive, to be safe.
  
  The type of interaction plays a big part in how likely someone is to catch COVID from another person. These specific situations are the high risk type that more often lead to transmission. Plus, with the widespread delays in testing, this type of extremely close contact is how we see outbreaks - so we are excluding someone for this type of contact with non-confirmed but symptomatic people who would meet our criteria for a 10-day COVID exclusion. 

• Lastly, we will not be excluding someone for close contact if they’ve had confirmed COVID in the past 90 days and they have no symptoms. After 90 days, if a person is exposed, the CDC recommends excluding them again, since there is not clear evidence that you can have immunity, how long it lasts, etc. 

Today’s Recap:

• The  COVID-19 average incubation period may be 7.7 days according to a new study from Wuhan. This is longer than the previous best guess we had, which was around 5 days.  And from the same study, the incubation period, which we’ve all thought was between 2 and 14 days, may actually be as long as 20 days.  It’s impact on exclusions could be huge if this is validated through other studies.

• In the most exciting news of the week, Yale received emergency FDA approval  for a rapid saliva test that is fast, cheap and doesn’t need testing reagents that are in short supply.  The development was in part funded by the NBA and the NBA Players Association.  Stay tuned for more info on this.  It may be a game changer.

• UNC-Chapel Hill moved all classes online - it was the first college to open and then quickly revert to remote. What was most alarming there was the rapidity of the spread with at least four separate, seemingly unrelated clusters.

• The shortage of N-95 respirators isn’t getting any better.  Alternatives which include KN-95s, surgical masks and cloth masks vary in their effectiveness, but how they fit and how you put them on makes a big difference in how well they work. 

• Governor Cuomo announced two additional states were added to the NY, NJ and CT Travel Advisory - Anyone traveling from Alaska and Delaware now must also quarantine for 14 days.

Best Questions:

The employee was excluded because they live with their mother who had symptoms consistent with COVID.  Mother has now tested negative and diagnosed with sinusitis (and has returned to work).  Can our employee return to work?

Unfortunately, in most cases, no. If the family member meets the criteria for a 10 day exclusion, even if they test negative or receive another diagnosis of strep or sinusitis, we still recommend keeping the employee out for 14 days from the most recent exposure. Testing has a high false negative rate, plus with the new information about a possible 7-8 day median incubation period means that many people may test negative if they are tested too early. We’re still hearing doctors telling patients with classic COVID symptoms (cough, shortness of breath, fever) that they have “just a virus” or “just sinusitis” without ordering tests, as well. In most cases, we’d much rather keep this person out to be safe, rather than sorry. 

An employee had a water bottle spilled on them.  Do they need to quarantine?

No.  The only water bottle-related quarantine would be if two people drank from the same water bottle and one developed symptoms or tested positive within 48 hours.  This question has come up several times in the last few days!

Should we encourage employees to get flu shots?

Yes!  Most public health experts are extremely concerned about the upcoming flu season.  There are many reasons to get a flu shot, especially this year.  One of them is that we need to carefully manage flu season this year in order to keep critical care beds open for COVID patients.  But another reason is that you’re going to want to know if you have flu or you have COVID and you certainly don’t want both - which is possible (and dangerous).  Flu shots are more important this year than ever.

An employee was excluded for 10 days for COVID-like symptoms but was never tested. They returned to work and then developed COVID symptoms again. Should we exclude another 10 days since  they never tested?

Unfortunately, the answer is yes.  The CDC is very clear on this guidance.  Here’s a good resource on this:  COVID-19: When to Quarantine.

An employee tested positive and now meets the clinical criteria for returning to work, however is nervous about developing symptoms again, infecting others (even after 10 days), or nervous about gossip from other team members…. How do we address this?

First, it’s great that the focus for many questions is now more frequently on return to work  than exclusions.  But this is a tough question and one we’re hearing often.  It’s important that the employee is no longer actively symptomatic.  The optics for co-workers and customers when the employee is still coughing feeds into their concerns. 

The employee who was sick does need to understand that the CDC clearly stated that you’re no longer infectious after 10 days from onset or positive test (even though they may test + for a long time).  If the employee feels well enough to work (many don’t even after ten days, while others feel great), then that is the leading indicator for readiness to return to work. 

A few clients are doing return-to-work testing in order to address these concerns but the CDC (and we) are not recommending that for many reasons, including lack of availability, testing positive for weeks even though no longer infectious, and slow turnaround for results.  Communication is key and making sure that your team knows that you are consistent and conservative in following return to work recommendations of the CDC, local health department and your clinical advisors (us) is helpful. 

An employee received a 10 day exclusion for symptoms. It’s day 5 and they’ve been symptom free for 3 days. Can they return to work sooner? 

Nope! Not an option. Many people who have COVID have very mild symptoms that resolve after just a few days, but they may still be infectious until Day 10. COVID also has a nasty habit where people start to feel better and then get much worse in the second week. We don’t want to risk it. Even if you test negative, and even if your symptoms improve, we won’t return folks who met the criteria for a 10 day exclusion before their time is up. 

Best Read:

This NYT article on herd immunity holds out some hope that we may get there sooner than we thought.

What if ‘Herd Immunity’ Is Closer Than Scientists Thought?

Best Laugh: