Clinical Questions about COVID-19: Questions and Answers
Written by COVID-19 NEWS on February 21, 2021
1. If HCP have recovered from SARS-CoV-2 infection but have a high-risk exposure within 3 months of their initial infection to a patient with SARS-CoV-2 infection, should they be restricted from work for 14 days after the exposure?
CDC has posted interim guidance for risk assessment and work restrictions for HCP with potential exposure to SARS-CoV-2. Because of their often extensive and close contact with people who are at high risk for severe illness, this guidance recommends a conservative approach to HCP monitoring and applying work restrictions to prevent transmission from potentially contagious HCP to patients, other HCP, and visitors. Review of currently available evidence suggests that most people do not become re-infected in the 3 months after SARS-CoV-2 infection. Testing of asymptomatic people during this 3-month period is complicated by the fact that some people have detectable virus from their prior infection during this period; a positive test during this period may more likely result from a prior infection rather than a new infection that poses risk for transmission.
In light of this, exposed HCP who are within 3 months of their initial infection, could continue to work, while monitoring for symptoms consistent with COVID-19 and following all recommended infection prevention and control practices (e.g., universal use of well-fitting source control). If symptoms develop, exposed HCP should be assessed and potentially tested for SARS-CoV-2, if an alternate etiology is not identified. Some facilities might still choose to institute work restrictions for asymptomatic HCP following a higher risk exposure, particularly if there is uncertainty about a prior infection or the durability of the person’s immune response. Examples could include:
- HCP with underlying immunocompromising conditions (e.g., after organ transplantation) or who become immune compromised (e.g., receive chemotherapy) in the 3 months following SARS-Cov-2 infection who might be at increased risk for reinfection. However, data on which specific conditions may lead to higher risk and the magnitude of risk are not available.
- HCP for whom there is concern that their initial diagnosis of SARS-CoV-2 infection might have been based on a false positive test result (e.g., individual was asymptomatic, antigen test positive, and a confirmatory nucleic acid amplification test (NAAT) was not performed).
- HCP for whom there is evidence that they were exposed to a novel SARS-CoV-2 variant for which the risk of reinfection might be higher (e.g., exposed to a person known to be infected with a novel variant).
CDC continues to actively investigate the frequency of reinfection and the circumstances surrounding these episodes, including the role that new variants might play in reinfection, and will adjust guidance as necessary as more information becomes available.
2. If HCP within 3 months of their initial infection develop symptoms consistent with COVID-19, should they be excluded from work and retested?
HCP within 3 months of a confirmed SARS-CoV-2 infection who develop symptoms consistent with COVID-19 should be evaluated to identify potential alternative etiologies for their symptoms. If an alternate etiology for the symptoms cannot be identified, they may need to be retested for SARS-CoV-2 infection with the understanding that a positive viral test could represent residual viral particles from the previous infection, rather than new infection. Decisions about the need for and duration of work exclusion should be based upon their suspected diagnosis (e.g., influenza, SARS-CoV-2 infection).
3. Do HCP within 3 months of their initial infection need to wear all recommended personal protective equipment (PPE) when caring for patients with suspected or confirmed SARS-CoV-2 infection? For example, if there are limited respirators, should respirators be prioritized for HCP who have not been previously infected?
Regardless of suspected or confirmed immunity, healthcare personnel should always wear all recommended PPE when caring for patients. In situations of PPE shortages, facilities should refer to CDC strategies for optimizing PPE supply. However, as with other infectious diseases (e.g., measles), allocation of available PPE should not be based on whether HCP have been previously infected or have evidence of immunity.
4. Should HCP within 3 months of their initial infection be preferentially assigned to care for patients with suspected or confirmed SARS-CoV-2 infection?
While individuals who have recovered from SARS-CoV-2 infection might develop some protective immunity, the duration and extent of such immunity are not known. Staffing decisions should be based on usual facility practices. Any HCP assigned to care for patients with suspected or confirmed SARS-CoV-2 infection, regardless of history of infection, should follow all recommended infection prevention and control practices when providing care. Guidance on mitigating staff shortages is also available.
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