April 21, 2020By Robert H. Shmerling, MD, Senior Faculty Editor, Harvard Health Publishing; Editorial Advisory Board Member, Harvard Health Publishing
Along with widespread illness and death, the COVID-19 pandemic is also causing massive economic disruption. Stay-at-home measures and business shutdowns have prevented millions of people from working. In just four weeks, between mid-March and mid-April, 22 million Americans filed for unemployment benefits. These numbers are bound to spiral higher.
Given all the hardships — and new predictions that cases of COVID-19 will begin falling in most states in the coming weeks — when might people be able to return to work? Thus far, the answers are quite uncertain.
Although the Centers for Disease Control and Prevention (CDC) has issued some federal guidelines, you may need to follow stricter state or local regulations and employer policies. Some experts have suggested serologic (antibody) tests to determine who has had the virus and to guide decisions about returning to work. And the experiences of countries that have successfully slowed cases of COVID-19 and loosened restrictions on work will come into play, too. Below I’ve explained a bit about each approach.
Return-to-work recommendations from the CDC
The recommendations vary depending on where you work – in healthcare or critical infrastructure, for example – whether you had symptoms of COVID-19, and whether a test confirmed that you had COVID-19. (Tests are not widely available in some areas of the country.)
- Workers in critical infrastructure (such as emergency services, the nuclear reactor industry, or defense) who have no symptoms, but were exposed to someone with confirmed or suspected COVID-19 Recent guidelines permit continuing to work if the worker has no symptoms, no fever, wears a mask for 14 days from last exposure, maintains six-foot physical distancing from others (“as work duties permit”), and disinfects and cleans work spaces well. This relaxes previous requirements that urged such workers to remain in quarantine for 14 days before returning to work.
- Workers in healthcare settings (such as hospitals, medical practices, or nursing homes) with suspected or confirmed COVID-19 The guidelines allow discontinuation of isolation and returning to work once fever has resolved, symptoms have improved, and swab tests for the virus are negative twice at least 24 hours apart. However, there are additional points to consider:
- If follow-up testing is not performed Those who had COVID-19 should wait until they’ve had three or more days of improved symptoms without fever and ten days have passed since symptoms began.
- If no symptoms were ever present but a test was positive A person can discontinue isolation if a lack of symptoms continues and it’s been 10 days since the first positive test or if two follow-up tests for the virus are negative at least 24 hours apart.
- If testing was never performed for a person with suspected COVID-19 A person can discontinue isolation once they have had three or more days of improved symptoms without fever and ten days have passed since symptoms began.
- If isolation was recommended following exposure to someone who had COVID-19 A person can discontinue isolation if swab testing is negative; a second test may be recommended when suspicion remains high.
- Workers outside of these settings Currently the guidelines for people who work in healthcare settings apply here, too.
Because local regulations or employer policies may be more stringent than these recommendations, it’s important to check with your employer and primary care physician before going back to work. Return to work guidelines cannot entirely prevent the spread of COVID-19. They may change in coming months as public health officials respond to rising or falling levels of the virus.
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