Summary of Recent Changes
Significant changes to this guidance include the following:
HCP may be exposed to COVID-19 in the community or at home and increase the risk of transmission to patients or other HCP. Exposures encountered by non-fully-vaccinated HCP at work are unlike those that might occur in the community because HCF follow infection control prevention and control procedures and HCP use personal protective equipment (PPE) per strict standards. Due to their often extensive and close contact with vulnerable individuals, HCP with symptoms of possible COVID-19 illness and those with community or high-risk occupational exposures should be managed more conservatively.
These guidelines have evolved as a result of greater experience with COVID-19, the availability of published data on COVID-19, continued evidence of community transmission of COVID-19 including asymptomatic and pre-symptomatic transmission, established infection control principles, and the availability of effective COVID-19 vaccines.
In addition to following these HCP monitoring guidelines, HCF are expected to protect their HCP and patients by following CDC and Cal/OSHA COVID-19 infection prevention guidance including universal use of PPE for patient care, use of N95 respirators for the care of suspect or confirmed COVID-19 cases, and routine respirator fit testing. For more information see:
In the healthcare setting, the following exposures to a confirmed infectious COVID-19 case* are considered high-risk:
*COVID-19 cases are considered to be infectious beginning 2 days prior to symptom onset (or initial positive viral test if case is asymptomatic) until the time they meet criteria for discontinuing isolation.
Regardless of vaccination status, HCP with any signs or symptoms of COVID-19 should be prioritized for SARS-CoV-2 diagnostic testing (and other respiratory viral testing, such as influenza as indicated), even if the symptoms are mild. Positive viral tests (molecular or antigen tests) in vaccinated HCP should not be attributed to the COVID-19 vaccine as vaccination does not affect the results of these tests.
CDPH published a recommendation for weekly testing of HCP in acute care hospitals (AFL 20-88). While all acute care hospitals are required to submit a plan to CDPH to address testing of their HCP, hospitals should weigh the benefits of routine testing against the need to preserve scarce institutional resources when they develop and submit their plan.
Currently, the CDC does not generally recommend testing asymptomatic HCP who had occupational exposures. See CDC Interim Guidance on Testing Healthcare Personnel for SARS-CoV-2. The CDC does recommend testing exposed non-fully vaccinated HCP if quarantine is to be discontinued early, see Facilities Experiencing Staffing Shortages below. Testing for return to work clearance of confirmed cases is not recommended, see Return to Work Protocol for HCP with Confirmed COVID-19 below.
HCF should have a plan to evaluate HCP with symptoms of possible COVID-19 illness. It is recommended that symptomatic HCP be evaluated by a clinician. SARS-CoV-2 diagnostic viral testing is recommended for HCP with even mild symptoms of possible COVID-19 infection. Symptomatic HCP with compatible symptoms and no clear alternate diagnosis should be told to isolate at home pending clinical evaluation and testing.
For HCP who had symptoms of possible COVID-19 and had it ruled out, either with negative PCR test(s) and/or with a clinical assessment that COVID-19 is not suspected (e.g. clear alternate diagnosis), then return to work decisions should be based on their other suspected or confirmed diagnoses.
See CDC Return to Work: https://www.cdc.gov/coronavirus/2019-ncov/hcp/return-to-work.html
HCP with mild to moderate illness who are not severely immunocompromised can return to work:
Asymptomatic HCP who are not severely immunocompromised should be excluded from work until 10 days have passed since the date of their first positive COVID-19 diagnostic test, assuming they have not subsequently developed symptoms. If they develop symptoms, follow above guidance.
Symptomatic HCP with severe or critical illness or who are severely immunocompromised can return to work:
Note: Asymptomatic HCP who are severely immunocompromised, should wait to return to work until at least 20 days since first positive viral diagnostic test.
For current definitions of COVID-19 illness severity and severely immunocompromised see CDC Return to Work for Healthcare Personnel with SARS-CoV-2 Infection
Return to Work Practices and Work Restrictions
HCP with confirmed COVID-19 do not need medical or LAC DPH clearance to return to work.
Testing of laboratory-confirmed cases is not recommended for return to work due to the prolonged detection of SARS-CoV-2 RNA without direct correlation to viral culture. Refer to the CDC Return to Work for Healthcare Personnel with SARS-CoV-2 Infection for more information on the limitations of using a test-based strategy.
Employers must be prepared for staffing shortages and have plans and processes in place to mitigate them. Every effort should be made to limit exposure to both patients and facility HCP. Refer to the CDC Strategies to Mitigate Healthcare Personnel Staffing Shortages for protocols on contingency and crisis strategies for mitigating staffing shortages.
Healthcare facilities experiencing critical staffing shortages may allow the following unvaccinated/partially vaccinated HCP to continue to work during their quarantine period as long as they remain asymptomatic:
These HCP must observe strict infection control procedures including source control at all times (facemask or respirator required) while working. They must adhere to full home quarantine when not doing their essential work. They must continue regular daily symptom monitoring and if symptoms occur within 14 days of the exposure, they must be immediately excluded from work and told to isolate at home pending clinical evaluation and testing.
Non-fully vaccinated HCP who are close contacts to a household confirmed case (i.e., the HCP lives with the infected person) are at highest risk for infection. For this reason, stricter return to work rules apply. The following are recommendations for unvaccinated/partially vaccinatedHCPs who are close contacts to a household confirmed case when healthcare facilities are experiencing critical staffing shortages:
These HCP must observe strict infection control procedures including source control at all times (facemask or respirator required) while working. They must continue regular daily symptom monitoring and if symptoms occur within 14 days of the exposure, they must be immediately excluded from work and told to isolate at home pending clinical evaluation and testing.
See CDC Options to Reduce Quarantine for Contacts of Persons with SARS-CoV-2 Infection Using Symptom Monitoring and Diagnostic Testing and Vaccinated healthcare personnel, patients, and residents in healthcare settings for more information.
HCP who are infected with SARS-CoV-2 should be excluded from work until they meet all return to work criteria (as outlined above). If extreme shortages continue despite all other mitigation strategies, facilities may consider following CDC crisis capacity strategies to mitigate severe staffing shortages. See CDC Strategies to Mitigate Healthcare Personnel Staffing Shortages
If you have questions, email LAC DPH at firstname.lastname@example.org or call at 213-240-7941.