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A small start-up company decides to have their employees resume work in the office following several months of teleworking.
The number of COVID-19 cases and deaths in their state and city have been decreasing slowly over the last month.
One Thursday morning, the CEO receives a phone call from an employee who has been working in the office over the last two weeks; the employee says that they developed a cough and fever the night before. The CEO advises the employee to stay home and contact their medical provider, but then begins to wonder if the employee has COVID-19 and if other employees might have been exposed.
Determining exposures to a communicable disease is a key function of public health agencies, both local and state.
Some communicable diseases, including COVID-19, are mandated to be reported to public health agencies by healthcare providers and laboratories.
The public health agency investigates reported cases to:
The public health investigation of a case of COVID-19 does not typically begin until the positive test is reported. Additionally, due to the historical lack of resources put into pandemic planning and the sheer number of cases of COVID-19, public health agencies are still scrambling to scale up their ability to investigate and perform contact tracing.
However, there are steps businesses, organizations, and communities can take to prevent COVID-19 transmission between the time an employee reports COVID-19-like illness or a positive test, and the time public health begins an investigation.
Given the current obstacles to contact tracing by public health agencies, it is imperative that businesses fill the gap to prevent COVID-19 transmission within their organization.
Businesses should have clear plans to identify and manage possible COVID-19 illness and exposures.
These plans should allow businesses and organizations to put into place prevention measures while working with over-stretched public health partners.
Businesses and organizations should be familiar with local and state COVID-19 data (found on local and state health department websites), develop relationships with their local public health agency, and be knowledgeable about pandemic planning related to the Americans with Disabilities Act and the U.S. Equal Employment Opportunity Commission, including what information can be obtained and the need to keep such information confidential.
Given the current obstacles to contact tracing by public health agencies, it is imperative that businesses fill the gap to prevent COVID-19 transmission within their organization.
For most businesses, I recommend virtual or in-person daily screening, to include current symptoms and exposures to COVID-19 within the last 14 days, prior to persons entering the business.
An employee or visitor that indicates symptoms consistent with COVID-19 should be separated from others and sent home safely.
If healthcare is urgently needed, call 911.
Disinfect the areas commonly used by the ill person according to guidance from the Centers for Disease Control and Prevention (CDC).
When an employee reports a positive test for COVID-19 (excluding an antibody test, which indicates past and not current infection), additional steps should be taken to assess possible exposures in the workplace.
Establish the date that was two days prior to when their symptoms began.
The employee should be asked if they were within 6 feet of other persons in the workplace for at least 15 minutes at any time since that date.
This is a good approximation of exposure, although it is worth noting that it might not capture all exposures (such as coughing or sneezing in someone’s face); exposure classification might change over time as we learn more about the virus, and it is good to check for any updates to the CDC guidance for management of exposures.
A more aggressive approach would include implementing detection of workplace exposures not only for employees with a positive COVID-19 test, but also for employees that report illness consistent with COVID-19 and have had an exposure themselves (close contact [within 6 feet] for at least 15 minutes with someone with COVID-19 in the 14 days before they became ill).
Persons with COVID-19-like illness and a known exposure might be considered to have probable COVID-19, and this allows for early intervention.
If the employee was within 6 feet of other persons for at least 15 minutes (considered to be an exposure), identify the names of persons that were potentially exposed.
Inform employees of the possible exposure to COVID-19; be sure to maintain confidentiality as per the Americans with Disabilities Act.
Advise exposed employees to stay home until 14 days after the exposure, to maintain physical distance (at least 6 feet) from others, and to self-monitor for symptoms and contact their healthcare provider if symptoms develop.
When possible, make alternative arrangements for them to work at home.
Photo by Lisa Fotios from Pexels
Work with your local public health agency whenever possible during this process. They are an excellent resource and can help with more complicated situations.
They also might reach out to your business or organization as part of their investigation.
The ultimate objective is to implement prevention measures as quickly as possible to prevent transmission of COVID-19 within the workplace, protecting employees, visitors, and other individuals associated with your business or organization.
Current barriers to full and rapid contact tracing by public health should not be a barrier to prevention of COVID-19 transmission within the workplace.
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© Medical Epidemiology Consulting. All rights reserved | Privacy Policy
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