DOH Issues Updated Guidance Regarding Revised Protocols for Personnel in Healthcare and Other Direct Care Settings to Return to Work Following COVID-19 Exposure or Infection

DOH has issued revised guidance for all health care providers, except Nursing Homes.

This updated return to work guidance includes language related to out of state travel.

DOH notes that in accordance with the State’s aggressive containment strategy to Test-Trace-Isolate/Quarantine, return to work protocols should only be considered in cases where furloughing healthcare personnel (HCP) would result in staff shortages that would adversely impact operation of the healthcare entity, and all other staffing options have been exhausted. This is in addition to all other criteria contained in the guidance. You can find the updated DOH Guidance here.

This guidance supersedes DOH’s April 1, 2020 guidance entitled “Updated Protocols for Personnel in Healthcare and Other Direct Care Settings to Return to Work Following COVID-19 Exposure or Infection”. This guidance does not apply to nursing homes, which must follow the return to work guidance released by DOH on April 29, 2020, which requires 14 days of quarantine or isolation.
A. Entities may allow HCP who have been exposed to a confirmed case of COVID-19, or who have traveled internationally in the past 14 days, whether healthcare providers or other facility staff, to work if all of the following conditions are met:
1. Furloughing such HCP would result in staff shortages that would adversely impact the operation of the healthcare entity and all other staffing options have been exhausted.
2. HCP who have been contacts to confirmed or suspected cases are asymptomatic.
3. HCP who are asymptomatic contacts of confirmed or suspected cases should self-monitor twice a day (i.e. temperature, symptoms), and undergo temperature monitoring and symptom checks at the beginning of each shift, and at least every 12 hours during a shift.
4. HCP who are asymptomatic contacts of confirmed or suspected cases should wear a facemask while working, until 14 days after the last high-risk exposure.
5. To the greatest extent possible, HCP working under these conditions should preferentially be assigned to patients at lower-risk for severe complications, as opposed to higher-risk patients (e.g. severely immunocompromised, elderly).
6. HCP allowed to return to work under these conditions should maintain self-quarantine when not at work, for a full 14 days.
7. At any time, if the HCP who are asymptomatic contacts to a positive case and working under these conditions develop symptoms consistent with COVID-19, they should immediately stop work and isolate at home. All staff with symptoms consistent with COVID-19 should be immediately referred for diagnostic testing for SARS-CoV-2.
B. Entities may allow healthcare personnel (HCP) who have traveled in the past 14 days to a state with a significant degree of community spread of COVID-19 (see guidance at https://coronavirus.health.ny.gov/system/files/documents/2020/06/interimguidance_traveladvisory.pdf), whether healthcare providers or other facility staff, to work if all of the following conditions are met:
1. Furloughing such HCP would result in staff shortages that would adversely impact operation of the healthcare entity, and all other staffing options have been exhausted.
2. HCP are asymptomatic.
3. HCP received diagnostic testing for COVID-19 within 24 hours of arrival in New York.
4. HCP self-monitor twice a day (i.e. temperature, symptoms), and receive temperature monitoring and symptom checks at the beginning of each shift, and at least every 12 hours during a shift.
5. HCP wear a facemask while working.
6. To the extent possible, HCP working under these conditions should preferentially be assigned to patients at lower risk for severe complications, as opposed to higher-risk patients (e.g. severely immunocompromised, elderly).
7. HCP allowed to return to work under these conditions should maintain self-quarantine when not at work.
8. At any time, if the HCP working under these conditions develop symptoms consistent with COVID-19, they should immediately stop work and isolate at home. All staff with symptoms consistent with COVID-19 should be immediately referred for diagnostic testing for SARS-CoV-2.
C. Entities may allow HCP with confirmed or suspected COVID-19, whether healthcare providers or other facility staff, to continue to work if all of the following conditions are met:
1. To be eligible to return to work, HCP with confirmed or suspected COVID-19 must have maintained isolation for at least 10 days after illness onset, must have been fever-free for at least 72 hours without the use of fever reducing medications, and must have other symptoms improving.
2. HCP who are severely immunocompromised as a result of medical conditions or medications should consult with a healthcare provider before returning to work. Entities should consider seeking consultation from an infectious disease expert for these cases.
3. If HCP is asymptomatic but tested and found to be positive, they must maintain isolation for at least 10 days after the date of the positive test and, if they develop symptoms during that time, they must maintain isolation for at least 10 days after illness onset and must have been at least 72 hours fever-free without fever reducing medications and with other symptoms improving.
4. Staff who are recovering from COVID-19 and return to work after 10 days should wear a facemask while working until symptoms have completely resolved, so long as mild symptoms are improving, if they persist.
5. In the rare instance when an HCP with unique or irreplaceable skills critical to patient care has a positive COVID-19 diagnostic test, but remains asymptomatic, the healthcare entity may contact NYS DOH to discuss alternative measures to allow such HCP to safely return to work before 10 days from such positive diagnostic test have elapsed.
HCP who are furloughed due to close contact with a known positive case, or because they do not meet the above conditions for returning to work, may qualify for paid sick leave benefits, and their employers can provide them with a letter confirming this, which can be used to demonstrate eligibility for the benefit.

General questions or comments about this advisory can be sent to icp@health.ny.gov, covidhospitaldtcinfo@health.ny.gov, or covidadultcareinfo@health.ny.gov.

Revised Interim Guidance: Protocol for COVID-19 Testing Applicable to All Health Care Providers and Local Health Departments

This updates the guidance issued on May 31, 2020.

Testing Authorization:
Governor Cuomo has announced that diagnostic and/or serologic testing for COVID-19 may now be authorized by a health care provider for any New Yorker who resides or works within the state given the dramatic increase in testing capacity. Health care providers should use clinical judgment to determine the appropriate COVID-19 test(s) (i.e. diagnostic or serologic) that should be obtained based on individual clinical factors.

Testing Prioritization:
On April 17, 2020, Executive Order 202.19, as extended, was issued requiring the establishment of a single, statewide coordinated testing prioritization process that shall require all laboratories in the state, both public and private, that conduct COVID-19 diagnostic testing, to complete such COVID-19 diagnostic testing only in accordance with such process.

To support the statewide coordinated testing prioritization, health care providers can authorize any New Yorker for testing, but may consider the following prioritization when ordering a COVID-19 test:
  1. Symptomatic individuals, particularly if the individual is part of a high-risk population, including persons who are hospitalized; persons residing in nursing homes, long-term care facilities, or other congregate care settings; persons who have a compromised immune system; persons who have an underlying health condition; and persons who are 70 years of age or older.
  2. Individuals less than 21 years of age who have symptoms consistent with Multisystem Inflammatory Syndrome in Children (MIS-C), which is also known as Pediatric Multi-System Inflammatory Syndrome.
  3. Individuals requiring a COVID-19 test for medical care, including being tested prior to an elective surgery or procedure, or individuals who are pregnant and their designated support person.
  4. Individuals who have had close (i.e. within six feet) or proximate contact with a person known to be positive with COVID-19.
  5. Individuals who are subject to a precautionary or mandatory quarantine.
  6. Individuals who are employed as health care workers, first responders, or in any position within a nursing home, long-term care facility, or other congregate care setting, including but not limited to: Correction/Parole/Probation Officers, Counselors (e.g. Mental Health, Addiction, Youth, Vocational, Crisis, etc.), Direct Care Providers, Dentists and Dental Hygienists, Firefighters, Health Care Practitioners, Professionals, Aides, and Support Staff (e.g. Physicians, Nurses, Public Health Personnel), Medical Specialists, National Guard and Military Service Members Aiding in COVID-19 Response, Nutritionists and Dietitians, Occupational/Physical/Recreational/Speech Therapists, Optometrists, Opticians, and Supporting Staff, Paramedics/Emergency Medical Technicians (EMTs), Police Officers, Psychologists/Psychiatrists, and Residential Care Program Managers.
  7. Individuals who are employed as essential employees who directly interact with the public while working.
  8. Individuals who are employed by an essential business (e.g. food production, medical supply manufacturing) or any business that has been designated to “reopen” in certain regions of the state (e.g. Phase 1, Phase 2, Phase 3, or Phase 4 of the State’s New York Forward plan).
  9. Individuals who participated in recent protest activities that occurred in localities around New York State.
  10. Individuals who present with a case where the facts and circumstances – as determined by the treating clinician in consultation with state or local department of health officials – warrant testing, or other criteria set forth by NYS DOH (e.g. place of residence, occupation).

Diagnostic Testing Access:
Individuals who do not currently have access to testing can call the New York State COVID-19 Hotline at 1-888-364-3065 or visit the NYS DOH website https://covid19screening.health.ny.gov/ to have an appointment set up at one of the State’s Testing Sites.

Serologic Testing Access:
Individuals seeking serologic (antibody) testing should speak with their health care provider.

Additional Resources: