COVID-19: Update to Healthcare Worker Management & Masks

Posted April 8, 2020. Past health advisories and alerts are archived for historical purposes and are not maintained or updated.

Community transmission of COVID-19 continues to occur in Washington, including Spokane County. Washington State Department of Health (DOH) is maintaining current case counts by county. Spokane Regional Health District (SRHD) is maintaining a COVID-19 website specifically for healthcare providers, which includes a link to Spokane-specific data which are updated daily.

 Summary of Updates In This Alert
  • DOH updated guidance on management of healthcare workers and first responders who test positive for COVID-19.
    • Updates include management of asymptomatic persons who test positive.
    • The recommendations are summarized below.
  • DOH also provided more detailed and expanded guidance on management of healthcare workers or first responders with high or medium risk exposures.
  • As a reminder, return to work guidance is predicated on:
    • Symptom monitoring, AND
    • The facility exhausting all other options for alternative coverage of the healthcare worker’s duties, AND
    • The individual’s ability to wear a face mask while at work, practice good hand hygiene and respiratory etiquette, AND
    • The facility’s ability to provide face masks for the healthcare worker’s use.
    • It is further recommended that healthcare workers who are confirmed cases or have medium/high risk exposures do not work with anyone who is severely immune compromised or at risk for infection, e.g., patients ≥ 60 years of age, comorbidities to include cardiopulmonary disease
  • Some of your patients may be asking about wearing cloth face masks in public when social distancing may be difficult. DOH issued guidance on cloth face masks for the general public.
    • CDC has also published tutorials for making homemade cloth face masks.
Isolation & Return to Work – Healthcare Workers (HCW) and First Responders (FR) Who Test Positive for COVID-19

HCWs and FRs with confirmed COVID-19 should not return to work until they can meet the criteria listed BELOW and can adhere to respiratory hygiene, hand hygiene and cough etiquette recommendations. Additionally, HCW and FR with confirmed COVID-19 should not work with anyone who is severely immunocompromised for at least 14 days after the onset of symptoms.

  • If symptomatic (and tested positive for COVID-19):
    • HCW and FR should not return to work until:
      • At least three days (72 hours) have passed since recovery defined as resolution of fever without the use of fever-reducing medications and improvement in respiratory symptoms (e.g., cough, shortness of breath); AND,
      • At least seven days have passed since symptoms first appeared.
    • When returning to work:
      • Until all symptoms have completely resolved or until 14 days after illness onset, whichever is longer:
        • A facemask should be worn at all times while in the healthcare facility, if there is a sufficient supply of facemasks.
        • Adherence to respiratory hygiene, hand hygiene, and cough etiquette should be maintained.
        • The HCW or FR should not work with anyone who is severely immune compromised or otherwise at risk for complications from infection, to include anyone over the age of 60 and/or with comorbidities to include cardiopulmonary disease.
  • If asymptomatic (and tested positive for COVID-19):
    • HCWs and FRs should not return to work until:
      • At least seven days from the date on which their positive test was collected.
      • The HCW should self-monitor for symptoms and seek re-evaluation from occupational health immediately if respiratory symptoms begin.
    • When returning to work:
      • After all symptoms have completely resolved or until 14 days after illness onset, whichever is longer:
        • A facemask should be worn at all times while in the healthcare facility, if there is a sufficient supply of facemasks.
        • Adherence to respiratory hygiene, hand hygiene, and cough etiquette should be maintained.
        • The HCW or FR should not work with anyone who is severely immune compromised

 Guidance document for healthcare workers and first responders: doh.wa.gov/Portals/1/Documents/1600/coronavirus/HealthCareworkerReturn2Work.pdf  

Quarantine – HCWs and FRs with High or Medium Risk Exposures* to a Known Case of COVID-19:

Ideally, HCWs and FRs with high or medium risk exposures* should be excluded from work for 14 days from their last exposure. After other staffing options have been exhausted and in consultation with their occupational health program, facilities can consider allowing asymptomatic HCW who have had high or medium risk exposure to continue working, with these provisions, for 14 days after their last exposure:

  • HCWs and FRs should actively monitor for symptoms consistent with COVID-19 infection; AND
  • Adhere to cough etiquette and hand hygiene; AND
  • Wear a facemask at all times while in the healthcare facility or while in the field, if there is a sufficient supply of facemasks.

If symptoms develop during the monitoring period and if fever and/or respiratory symptoms consistent with COVID-19 infection develop, the HCW or FR must:

  • Cease patient care activities, immediately self-isolate (separate themselves from others), don a facemask (if not already wearing), and notify their supervisor or occupational health services promptly, so they can coordinate consultation and referral to a healthcare provider for further evaluation.
  • Testing for COVID-19 should be performed, if available. If testing is not available, follow guidance above for infected HCWs.
    • If positive, refer to guidance above.
    • If negative, they can return to work under the following conditions:
      • Symptoms have resolved.
      • It has been at least 24 hours since the fever has resolved without the use of fever-reducing medications.
      • They should wear a facemask at all times while in the facility or in the field, if there is sufficient supply of facemasks, until 14 days after the last exposure.
      • If new symptoms develop, retesting is indicated.

* See CDC Interim Guidance for Risk Assessment and Public Health Management of Healthcare Personnel with Potential Exposure in a Healthcare Setting to Patients with COVID-19  

Guidance document: doh.wa.gov/Portals/1/Documents/1600/coronavirus/HealthCareworkerReturn2Work.pdf

Cloth Mask Recommendations

Many of you may have patients who ask about the utility of wearing cloth masks in situations where social distancing cannot be maintained. Recent studies have found that a significant portion of individuals with COVID-19 are asymptomatic and that even those who eventually develop symptoms can transmit the virus to others before showing symptoms. In light of this new evidence, CDC, DOH and SRHD recommend wearing cloth face coverings in public settings where other social distancing measures are difficult to maintain (such as indoor public settings like grocery stores or pharmacies).  

Please emphasize to your patients that maintaining six feet social distancing remains important to slow the spread of the virus. We recommend the use of a simple cloth face covering to slow the spread of the virus and help people who may have the virus and not know it from transmitting it to others. Cloth face coverings will not provide protection to the person wearing the mask. Additionally, these are not surgical masks or N-95 respirators, which are critical supplies that should continue to be reserved for healthcare workers and first responders.  

Additional Resources

Washington State Department of Health and CDC have compiled additional guidance for healthcare providers, which is available on their website (this is a rapidly evolving situation and you should continue to check for updates to these documents): https://www.doh.wa.gov/Emergencies/NovelCoronavirusOutbreak2020/HealthcareProviders