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, especially if they are not fully vaccinated against COVID-19. Exposures encountered by 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 who are not fully vaccinated or have not recently recovered from COVID-19 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 of more infectious variants, established infection control principles, and the availability of effective COVID-19 vaccines.
In addition to following these HCP guidelines, HCF are required to follow State and Local Health Officer Orders including health care worker vaccination requirements:
They are also expected to follow CDC and Cal/OSHA COVID-19 infection prevention guidance and requirements 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.
Employers and facilities can have policies that are stricter than those required by State and County Health Officer Orders and Cal/OSHA or recommended by the CDC.
Currently licensed and authorized vaccines in the United States are highly effective at protecting vaccinated people from severe disease and death from COVID-19. Fully vaccinated people are less likely to become infected and, if infected, to develop symptoms of COVID-19. Per the CDC, there is preliminary evidence that suggests that fully vaccinated people who do become infected can be infectious and can spread the virus to others. For this reason, infection prevention measures continue to be necessary for all staff even if fully vaccinated.
Health Care Worker Vaccine Requirement
All persons who work in healthcare facilities must be vaccinated against COVID-19 as required by the California and the LA County Public Health Officers. Workers must receive the final dose of a COVID-19 vaccine series by September 30, 2021. Workers may be exempt from the vaccination requirements based on either a) Religious Beliefs or b) a Qualifying Medical Reason. (See the CDC’s Interim Clinical Considerations for Use of COVID-19 Vaccines for clinical guidance.)
High-risk occupational exposure
In the healthcare setting, the following exposures to a confirmed infectious COVID-19 case* are considered high-risk:
In the community, a close contact is any of the following persons who were exposed to a laboratory-confirmed COVID-19 case while they were infectious:
**This is regardless of use of face masks of the case or contact.
*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.
Symptomatic persons Regardless of vaccination status, HCP with any signs or symptoms of COVID-19 should be prioritized for SARS-CoV-2 viral testing (and other respiratory viral testing, such as influenza, as indicated), even if the symptoms are mild. Positive viral tests (NAAT 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.
Post-exposure Testing is recommended for asymptomatic HCP after a high-risk occupational or after a community close-contact exposure to SARS-CoV-2, regardless of vaccination status. Testing also should be performed in response to a cluster of cases meeting the outbreak investigation threshold for hospitals in AFL 20-75.
Screening HCFs are required to routinely test unvaccinated employees that have been granted a vaccine exemption and those who are incompletely vaccinated against COVID-19, pursuant to the State and LA County Orders. CDPH-licensed health facilities must also follow instructions in relevant AFLS. Note that HCP cannot opt to regularly test instead of getting vaccinated.
HCP that are unvaccinated or incompletely vaccinated are required to be tested at least once a week.
Note: unvaccinated workers who previously tested positive with a viral COVID-19 test are exempted from this testing only for 90 days from their initial positive test. After 90 days have passed, they must restart testing
Fully Vaccinated HCP
*Fully vaccinated HCP at acute care hospitals, SNFs, and intermediate care facilities must be included in screening testing if vaccination rates at their facility are below 70% for staff at GACH or below 70% for both staff AND residents (SNFs and intermediate care facilities)
Return to work Testing for return to work clearance of confirmed cases is not recommended, see Return to Work Protocol for HCP with Confirmed COVID-19 below.
Recently recovered from COVID-19 Recently infected persons are known to shed non-infectious viral particles for at least 90 days after recovery and reinfection is unlikely to occur during this period. HCP who previously tested positive and are asymptomatic should not be retested for 90 days since the date of symptom onset or date of collection of the first positive viral test. For HCP that develop new symptoms consistent with COVID-19 within 90 days from their prior infection, if an alternative etiology cannot be identified, it is recommended that retesting be done in consultation with infectious disease or infection control experts.
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. 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 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 HCP in quarantine to return to work using the following shortened 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 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 CDPH Guidance on Isolation and Quarantine for COVID-19 Contact Tracing 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 email@example.com or call at 213-240-7941.