The Centers for Disease Control and Prevention just changed its guidance for discontinuing transmission-based precautions and disposition of patients with COVID-19 for both healthcare and non-healthcare settings. Generally, the updated guidance reflects a better understanding of transmission and those most at risk for severe illness.

Specifically, the CDC reports findings that people with mild to moderate COVID-19 remain infectious no longer than 10 days after their symptoms began, and those with more severe illness or those who are severely immunocompromised remain infectious no longer than 20 days after their symptoms began. Many employers and employees will view these changes as good news as the CDC gathers new information to help combat the spread of COVID-19. What do you need to know about this development for your own workplace?

Test-Based Strategy

The CDC had previously recommended that employees who tested positive for COVID-19 could stop isolating and return to work if they could provide two negative COVID-19 tests that were collected more than 24 hours apart. Under new guidance, however, the CDC determined that COVID-19 patients are rarely contagious 10 days after symptom onset. The CDC also found that testing can return positive results without any contagious viral material for extended periods after a patient is no longer contagious, making them overinclusive.

For these reasons, the CDC no longer recommends a test-based strategy to determine when to discontinue Transmission-Based Precautions except in rare circumstances. This change addresses situations where a seemingly healthy person continues to test positive while posing no threat of transmission and reserves testing supplies primarily to diagnose new cases. 

The CDC encourages testing for persons who are severely immunocompromised, in consultation with infectious disease experts. For all others, the CDC no longer recommends a test-based strategy except to discontinue isolation or other precautions earlier than would typically occur under the symptom-based strategy outlined below.

For employers, this means that if an employee wants to return to work without completing a quarantine, they may do so if testing supplies are available. The CDC still recommends testing for those exhibiting COVID-19 symptoms or those who have been directly exposed to the virus.

Symptom-Based Strategy

In addition to using negative tests to end isolation and return to work, the CDC also recommended a symptom-based strategy, which tracked when a person became sick and recovered to determine if they could cease isolating. That strategy required people to achieve various milestones: (1) 72 hours passing since experiencing fever without the aid of fever-reducing medication; (2) respiratory symptoms improving; and (3) 10 days passing since symptoms began.

The CDC’s updated symptom-based strategy allows isolated or quarantined persons to end such protocols – and return to work faster – under certain circumstances. But in other circumstances, the updated guidance may require more extended quarantines. For both healthcare and non-healthcare settings, the CDC changed the symptom-based criteria from:

• “at least 72 hours” to “at least 24 hours” have passed since last fever without the use of fever-reducing medications; and
• “improvement in respiratory symptoms” to “improvement in symptoms” to address expanding list of symptoms associated with COVID-19.

Generally, these changes should make isolation, quarantine, and time away from work shorter for most people. 

Non-Healthcare Settings

In non-healthcare settings, persons who never develop symptoms can discontinue isolation and other precautions 10 days after the date of their first positive test, which should also speed a return into the workforce. But patients with severe illness may now require 20 days of isolation after symptom onset, depending upon advice from infectious disease experts. Such guidance follows the principle that anyone who still has symptoms should remain isolated.

Healthcare Settings

In healthcare settings, patients with severe illness or who are severely immunocompromised may isolate for up to 20 days after symptom onset. The CDC again advises that people consider consulting with infection control experts in those situations.  Applying this to severely immunocompromised patients only in healthcare settings suggests that these patients would likely be under healthcare protocols regardless of COVID-19. The CDC did not change its guidance for asymptomatic persons in healthcare.

Conclusion

Although the CDC’s updates only serve as non-binding guidance, many state and local governments have followed the CDC’s lead in passing laws, mandates, ordinances, and guidance of their own. The CDC has served as an authority for information throughout the COVID-19 pandemic, and its recommendations are likely best practices for workplaces. We urge employers to review the changes carefully and monitor state and local laws for similar changes. Employers also may want to consider revising their return to work policies to adhere to the latest guidance.