On Friday, July 17, 2020, the Center for Disease Control and Prevention (“CDC”) modified its guidance for people with COVID-19 to leave quarantine by removing its Transmission-Based Precautions in exclusive favor of a Symptom-Based strategy.
Given the continually changing legal landscape, we strongly encourage employers to reach out to Raimondo & Associates with questions regarding specific situations. We are closely monitoring these developments. Because of these frequent developments, and the need to adapt the general guidance below to specific circumstances, employers should consult counsel regarding specific circumstances.
At a general level, the legal rules and guidance we summarize below should not be applied in a manner that would prevent employers from taking reasonable, common-sense steps to protect the health and safety of employees, customers, vendors and their communities. There are many nuances and fact-specific elements that make individualized legal counsel on these questions of critical importance.
Q: Why does the CDC no longer recommend using a test-based strategy to help determine when a COVID-19 patient may leave isolation?
The CDC has decided to recommend against a test-based strategy because, in the majority of cases, it resulted in prolonged isolation of patients that continued to shed detectable amounts of SARS-CoV-2 RNA but were actually no longer infectious.
Q: What are the CDC’s new guidelines?
The CDC recommends a symptom-based strategy for discontinuing transmission-based precautions in two large categories: (1) patients with mild to moderate illness who are not severely immunocompromised and (2) patients with severe to critical illness or who are severely immunocompromised.
Category 1: Mild to Moderate Illness & Not Severely Immunocompromised
- At least 10 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, etc.) have improved
For patients that are not severely immunocompromised and were asymptomatic throughout their infection, transmission-based precautions may be discontinued when at least 10 days have passed since the date of the first positive viral diagnostic test.
Category 2: Severe to Critical illness or Severely Immunocompromised
- At least 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, etc.) have improved
For severely immunocompromised patients who were asymptomatic throughout their infection, transmission-based precautions may be discontinued when at least 20 days have passed since the date of their first positive viral diagnostic test.
The degree of immunocompromise for the patient is determined by the treating provider, and preventative actions are tailored to each individual and situation.
Q: How Do I Know The Severity Of The Illness?
Mild Illness: Individuals who have any of the various signs and symptoms of COVID-19 (e.g., fever, cough, sore throat, malaise, headache, muscle pain) without shortness of breath, dyspnea, or abnormal chest imaging.
Moderate Illness: Individuals who have evidence of lower respiratory disease by clinical assessment or imaging, and a saturation of oxygen (SpO2) ≥94% on room air at sea level.
Severe Illness: Individuals who have respiratory frequency >30 breaths per minute, SpO2 <94% on room air at sea level (or, for patients with chronic hypoxemia, a decrease from baseline of >3%), ratio of arterial partial pressure of oxygen to fraction of inspired oxygen (PaO2/FiO2) <300 mmHg, or lung infiltrates >50%.
Critical Illness: Individuals who have respiratory failure, septic shock, and/or multiple organ dysfunction.