COVID-19 UPDATE #215
December 27, 2021
CDC UPDATES RETURN TO WORK CRITERIA FOR HEALTH CARE PROVIDERS
On Thursday, December 23, 2021, the Centers for Disease Prevention and Control (CDC) announced updates to their guidance on Managing Health Care Personnel with COVID-19 Infection or Exposure. An AHCA/NCAL summary of the new return to work criteria can be found here. A New York Times article can be found here.
 
The new guidance:
  • Updates recommendations regarding when HCP with COVID-19 infection can return to work.
  • Added options that would allow asymptomatic HCP with a higher-risk exposure who have not received all COVID-19 vaccine doses, including booster dose, as recommended by CDC, to return to work prior to the previously recommended 14-day post-exposure period of work restriction, assuming they do not develop symptoms or test positive for SARS-CoV-2.
  • Updates the definition of higher-risk exposure to include use of a facemask (instead of a respirator) by HCP if the infected patient is not also wearing a facemask or cloth mask.

Return to Work After COVID-19 Infection:
  • Asymptomatic HCP not moderately to severely immunocompromised:
  • Return to work after 7 days with a negative antigen or PCR test within 48 hours prior to returning to work.
  • Or 10 days if testing is not performed or a positive test at day 5-7 since the date of their first positive viral test.
  • HCP with mild to moderate illness who are not moderately to severely immunocompromised:
  • Return to work after 7 days with a negative antigen or PCR test within 48 hours prior to returning to work.
  • Or 10 days if testing is not performed or if a positive test at day 5-7 since symptoms first appeared; and
  • At least 24 hours have passed since last fever without the use of fever-reducing medications; and
  • Symptoms (e.g., cough, shortness of breath) have improved. ​ 
  • HCP with severe to critical illness who are not moderately to severely immunocompromised:
  • In general, when 20 days have passed since symptoms first appeared; and
  • At least 24 hours have passed since last fever without the use of fever-reducing medications; and
  • Symptoms (e.g., cough, shortness of breath) have improved.
  • HCP who are moderately to severely immunocompromised, may shed virus beyond 20 days after symptom onset or, for those who were asymptomatic throughout their infection, the date of their first positive viral test.
  • Use of a test-based strategy (2 negative tests 24 hours apart after symptom resolution) and consultation with an infectious disease specialist or other expert such as occupational health specialist is recommended to determine when these HCPs may return to work.
For contingency and crises staffing situations shorter time frames can be used (see CDC site for contingency and crisis staffing).

Return to Work After Higher-Risk Exposure:
  • HCP who have received all COVID-19 vaccine doses, including booster dose, as recommended by CDC, do not require work restriction unless they develop symptoms and test positive:
  • They must test as soon as possible after 24 hours from exposure and 5-7 days after exposure.
  • Continue to use source control masks and PPE as recommended by CDC (no change).
  • HCP who are either fully vaccinated but without a booster or are unvaccinated, should exclude from work for 7 days following the higher-risk exposure:
  • With a negative test 48 hours before returning to work; and
  • HCP did not develop symptoms.

Return to Work After a Low-Risk Exposure:
  • No work restrictions regardless of vaccination status.
  • Must continue to use source control masks and PPE per CDC recommendations (no change).
CMS CLARIFIES NURSING HOME VISITATION POLICY AMID INCREASING OMICRON CASELOADS
On Thursday, December 23, 2021, the Centers for Medicare and Medicaid Services (CMS) issued a new set of Frequently Asked Questions (FAQs) on the revised nursing home visitation guidelines outlined in QSO-20-39-NH Revised. A helpful summary of the FAQs from AHCA/NCAL is available here. FAQ highlights include:
  • Visitations must be allowed, but state or local health department can restrict visitations during an infectious disease outbreak;
  • Facilities can limit large gatherings and develop a schedule for visitation IF social distancing cannot be maintained;
  • You must require visitors to follow infection control practices, such as the use of source control masks, while in the building and communal areas;
  • Visits among residents who have roommates should ideally occur in a separate space or when the roommate(s) are out of the room.

While many of these expectations outlined by the CMS FAQs are applicable right now in Washington State, we have been advised by DSHS and the Governor’s office to continue following the Safe Start plans in effect (found here for SNF and here for ALF). Of note, DSHS has indicated via a recent email notice that visitors may not eat with residents. WHCA continues to meet with DSHS, DOH, and the Governor’s office to advocate for members specific to COVID response and visitation, and will notify members as updates are made to the Safe Start plan and other state-issued guidance.
SKILLED NURSING AND ASSISTED LIVING INCENTIVES EXTENDED FOR ACUTE CARE HOSPITAL DISCHARGES
In Dear Administrator Letters amended December 23, 2021, DSHS Aging and Long-Term Support Administration announces extension of incentives to skilled nursing facilities and assisted living communities who accept new resident admissions from acute hospitals through January 31, 2022.
DOH PROVIDES TEMPLATES AND CONTINUES WEEKLY LTC Q&A CALLS INTO 2022
As a follow up to the December 16, 2021, weekly call, DOH has provided an Epi Curve Template and DOH linelist for your reference and use.

The DOH weekly LTC Q&A calls are scheduled to continue through June 30, 2022. Dates and registration link can be found here.
ADDITIONAL RESOURCES
WHCA continues to post resources and information as it becomes available on our website. If you have questions or need additional information, please call the WHCA office at (800) 562-6170.