COVID-19: Extended Home Isolation Period, Updates to Specimen Collection & Handling

Posted May 7, 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, including a link to Spokane-specific data which are updated daily.

CDC Updated Guidance For Healthcare Worker Return to Work

  • Updated guidelines to extend the duration of exclusion from work to at least 10 days since symptoms first appeared for symptomatic healthcare workers. This update was made based on evidence suggesting a longer duration of viral shedding and will be revised as additional evidence becomes available. Asymptomatic healthcare workers should be excluded for ten days from specimen collection date.
  • Based on this extension of the symptom-based and time-based strategies, language about the test-based strategy being preferred was removed.
  • The guidance removed specifying use of nasopharyngeal swab collection for the test-based strategy and linked to the Interim Guidelines for Collecting, Handling, and Testing Clinical Specimens for 2019 Novel Coronavirus (2019-nCoV), so that the most current specimen collection strategies are recommended.
  • Full guidelines can be found here: https://www.cdc.gov/coronavirus/2019-ncov/hcp/return-to-work.html. DOH has aligned its return to work guidance with CDC. Summary guidance is below.

CDC Updated Guidance For Non-Healthcare Worker Return to Work

Revisions to Guidelines for Collecting, Handling and Testing Clinical Specimens

Several updates have occurred to the CDC’s Interim Guidelines for Collecting, Handling and Testing Clinical Specimens from Persons for COVID-19:

  • Added guidance on properly handling bulk-packaged sterile swabs for specimen collection.
  • Updated guidance on viral transport medium (VTM) - some point-of-care tests advise against its use.
  • Removed preference for nasopharyngeal (NP) swabs.
  • Updated guidance for the use of personal protective equipment.

Full guidelines can be found here: https://www.cdc.gov/coronavirus/2019-ncov/lab/guidelines-clinical-specimens.html

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.

  • 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.
  • If a HCW or FR with COVID-19 cannot avoid direct contact with persons at higher risk of complications (age ≥ 65, those with comorbid conditions such as cardiovascular disease, diabetes, and/or immunocompromised), they should be excluded from work for a full 14 days after symptom onset (if symptomatic) or specimen collection date (if asymptomatic).
  • 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 ten days (updated) have passed since symptoms first appeared.
    • 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.
        • Adherence to respiratory hygiene, hand hygiene, and cough etiquette should be maintained.
  • If asymptomatic (and tested positive for COVID-19):
    • HCW and FR should not return to work until:
      • At least ten days (updated) from the collection date of their positive test specimen.
      • The HCW should self-monitor for symptoms and seek re-evaluation from occupational health immediately if fever, respiratory, or other symptoms consistent with COVID-19 illness 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.
        • Adherence to respiratory hygiene, hand hygiene, and cough etiquette should be maintained.

Additional Resources

DOH COVID-19 Healthcare Provider Resources and Recommendations: https://www.doh.wa.gov/Emergen...

CDC COVID-19 Information for Healthcare Professionals: https://www.cdc.gov/coronaviru...

SRHD Case Information and Provider Alerts: https://srhd.org/covid19hcp