Public Health

New CDC return-to-work guidance emphasizes symptoms over testing

Andis Robeznieks , Senior News Writer

Most health care personnel (HCP) with mild to moderate COVID-19 illness can discontinue isolation 10 days after the onset of symptoms, along with the resolution of fever—without the use of fever-reducing medications—for at least 24 hours, and with improvement of other symptoms such as cough or shortness of breath, according to updated guidance from the Centers for Disease Control and Prevention (CDC).

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The guidance is intended to clarify when HCP can safely return to work and to explain a move away from a testing-based strategy to a “symptoms-based strategy.”

“Except for rare situations, a test-based strategy is no longer recommended to determine when to allow HCP to return to work,” the CDC’s summary of the guidance changes states.

The guidance on waiting 24 hours after fever resolution represents a reduction from the 72-hour wait previously recommended. The CDC also eliminated the word “respiratory” from its guidance to observe “improvement in respiratory symptoms,” and noted that this was done to “address the expanding list of symptoms associated with COVID-19.”

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Limiting “unnecessary” isolation, resource use

“Accumulating evidence supports ending isolation and precautions for persons with COVID-19 using a symptom-based strategy,” the CDC explained in a decision memo. “This update incorporates recent evidence to inform the duration of isolation and precautions recommended to prevent transmission of SARS-CoV-2 to others, while limiting unnecessary prolonged isolation and unnecessary use of laboratory testing resources.”

Other specific recommendations included:

  • For HCP who test positive for SARS-CoV-2 RNA but never develop symptoms, isolation and other precautions can be discontinued 10 days after the test, according to the guidance update.
  • For HCP with severe to critical COVID-19 illness or those who are severely immunocompromised, however, the recommended time for staying away from work or other transmission-based precautions was extended to 20 days.
  • For asymptomatic severely immunocompromised HCP who tested positive, should also stay away from work for 20 days following their initial positive SARS-CoV-2 diagnostic test, according to the CDC.

The updated recommendations are based on the best information available in mid-July 2020 and reflect the realities of an evolving pandemic, the CDC decision memo states.

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It adds that “CDC will continue to closely monitor the evolving science for information that would warrant reconsideration of these recommendations.”

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