Should workers with COVID-19 exposure keep working? When should a quarantined worker come back?

Protecting healthcare workers during the COVID-19 pandemic is a top priority for practice leaders — both as a business initiative to ensure proper staffing and a human concern to limit the further spread of the illness.

Losing providers and other staff to quarantine can have a major destabilizing effect on an organization’s ability to continue serving patients. It also poses a question for practice leaders in determining when those workers might be able to return to work.

One member recently asked the MGMA Ask an Advisor program:

One question that has come up for us is what to do with a not sick positive test. … Would we let an asymptomatic carrier work with restrictions such as mask, hand hygiene, etc.?

When it comes to guidance from the Centers for Disease Control & Prevention (CDC), there are few distinctions made between healthcare workers with confirmed COVID-19 cases and workers who have suspected cases but have not been tested:

• Employers should actively encourage sick employees to stay home.
• Sick employees should follow recommended steps and not return to work until they meet the criteria to discontinue home isolation.

If someone has been tested and it comes back positive, it is very likely that they can still spread the virus or that they may eventually develop symptoms and are likely contagious as some point throughout the infection, even if they are asymptomatic at the time of the test results.

When can someone come back to work?

If a healthcare worker takes leave due to a confirmed or suspected COVID-19 case, the CDC recommends two approaches for when that worker may return to work:

1. A negative COVID-19 test result, in addition to recovery (defined as resolution of fever without the use of fever-reducing medications and improvement of any respiratory symptoms, e.g. cough or shortness of breath).
2. Passage of three days (72 hours) since recovery (as defined above) and having at least seven days passed since symptoms first appeared.

This guidance often is adapted for use in specific states and counties, so be sure to check with local public health authorities. For example, the Iowa Department of Public Health recently said essential workers can keep working after they’ve been exposed to COVID-19 if they remain asymptomatic.

Numerous studies have been conducted and are ongoing regarding the risks posed by asymptomatic carriers of the coronavirus. The CDC has clinical presentation and clinical course information as part of its interim guidance on caring for patients with COVID-19.

Legislative changes

Practice leaders also should understand how the Families First Coronavirus Response Act, signed into law on March 18, might affect their organizations. The law requires employers to provide employees with paid FMLA and sick time under certain circumstances.

Both new Sick and FMLA rules:

• Are effective within 15 days.
• Apply to employers with fewer than 500 employees.
• Include exceptions to their respective requirements for:
  • An employer of an employee who is a healthcare provider or an emergency responder may elect to exclude those employees, and
  • Two additional exceptions designated in forthcoming regulations under the Department of Labor.

Paid FMLA Leave for “Public Health Emergency”

• Creates a new category of FMLA-covered leave for up to 12 weeks of job-protected leave for employees unable to work (or telework) due to the need to care for his or her child (under 18 years) if their school or daycare has been closed due to a public health emergency. Leave under this category makes employees eligible.
• Payment during new category of leave:
  • The first 10 days of leave is not paid and the employee is allowed to substitute any accrued vacation, personal or medical/sick leave for unpaid leave.
  • After the first ten days, the employer must provide the employee no less than two-thirds of the employee’s usual pay, capped at $200/day ($10,000 aggregate).

Tax credit for employers: Provides a refundable tax credit equal to 100% of qualified family leave wages paid by an employer for each calendar quarter, capped at $200/day and $10,000 for all calendar quarters.

Emergency Paid Sick Leave

• Covered employers must make up to 80 hours of paid sick leave available for certain Coronavirus-related absences, in addition to any current paid time off provided by the employer.
• Reasons for sick leave:

1. Employee is subject to federal, state or local quarantine or isolation order
2. Employee has be advised by healthcare provider to self-quarantine
3. Employee is experiencing COVID-19 symptoms and seeking medical diagnosis
4. Employee is caring for individual who is subject to order described in #1 above
5. Employee is caring for his or her child if school or place of care is closed due to COVID-19 precautions
6. Employee is experiencing nay other substantially similar condition specified by Secretary of Labor

• Payment during sick leave:
  • For sick leave under reasons 1-3 (e.g., employee is sick), leave is paid at the employee’s regular rate of pay, capped at $511 per day ($5,110 aggregate).
  • For sick leave under reasons 4-6 (e.g., employee is caring for someone else), leave is capped at $200/day ($2,00 aggregate).

Tax credit for employers: Provides a refundable tax credit equal to 100% of qualified paid sick leave wages paid by an employer for each calendar quarter.

Additional resources

• U.S. Department of Labor COVID-19 FMLA Q&A
• Critical Infrastructure Essential Worker Letter Template

Handling staff shortages in your medical practice amid COVID-19