March 28, 2020in Doctor Resource

Returning to Work and Normal Life after COVID-19

Regaining our normal lives is on everyone’s mind, and wondering when you’ll be safe to go back to work is a common question. As we suppress the first wave of the coronavirus outbreak, this Returning to Work and Normal Life post helps you decide when to resume work and regular activities. Note that recommendations do vary among countries. We still must be quick to isolate and treat new COVID-19 cases that pop up in our communities, and we should self-quarantine for 2 weeks any visitors or returnees coming into the state until the pandemic ends. Together we stay strong and keep fighting the good fight.

Start by seeing which of these two paragraphs describes your own situation, and then look at the criteria for resuming normal activities and going back to work:

Person who never had symptoms - and was Confirmed COVID-19 (positive test) or Exposed to COVID-19

Return to regular activities, upon the latter of

  • 14 days past the exposure, or
  • 14 days past the first positive COVID-19 virus test (not antibody test)

Person who had symptoms - and was Confirmed COVID-19 or Suspected COVID-19

Return to regular activities upon meeting BOTH criteria #1 and #2:

1. At least 3 days (72 hours) have passed since recovery, which is defined as

  • No fever, while not using fever-reducing medications, and
  • Improved and resolving respiratory symptoms such as cough or shortness of breath

2. Meets time-based or test-based criterion

  • At least 14 days have passed since symptoms first appeared, or
  • Negative results on COVID-19 virus tests (not antibody tests)

-- From at least two consecutive nasopharyngeal swabs, and

-- Collected at least 24 hours apart and at least 7 days after symptoms first appeared

A video consultation with a doctor on HealthTap can provide documentation in the Patient’s Visit Summary that the patient meets the criteria for returning to regular activities, but HealthTap does not print out a formal back-to-work note or permission-to-travel note. Doctors in clinics everywhere are caring for pandemic patients all day, so are too busy to see people just for work or travel notes.

There is no way to certify any person with 100% certainty that he or she does not have the COVID-19 virus, because all types of tests have occasional false-negative or false-positive results. The Centers for Disease Control (CDC) advises: “Employers should not require a positive COVID-19 test result or a healthcare provider’s note for employees who are sick to validate their illness, qualify for sick leave, or to return to work.” (3/22/2020)

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Recommendations in more detail, divided by patient subgroups (based mainly on CDC recommendations, and less conservative than the overall recommendation above):

Confirmed or Suspected COVID-19. Recommendations for all persons, including healthcare personnel, excluding immunocompromised persons

  • Test-based strategy. End home isolation, and may return to work if
    • At least 1 day (24 hours) have passed since recovery defined as
      • Afebrile while not using fever-reducing medications, and
      • Improved respiratory symptoms such as cough or shortness of breath, and
    • Negative results on COVID-19 molecular tests from at least two consecutive nasopharyngeal swabs collected at least 24 hours apart
  • Time-based strategy (Non-test-based). End home isolation, and may return to work if
    • At least 3 days (72 hours) have passed since recovery defined as
      • Afebrile while not using fever-reducing medications, and
      • Improved respiratory symptoms such as cough or shortness of breath, and
    • At least 7 days have passed since symptoms first appeared
  • Confirmed COVID-19 (positive test) but always without symptoms: end home isolation if at least 7 days have passed since the first positive COVID-19 test
  • Suspected COVID-19 but had an alternate diagnosis (eg: positive test for influenza) and never tested for COVID-19 : return to work criteria should be based on the alternate diagnosis.

Exposed to COVID-19 but always without symptoms: end self-quarantine if at least 14 days have passed since exposure

Upon returning to work, precautions in the workplace vary depending on various factors.

For example, healthcare personnel returning to work should:

  • Wear a face mask at all times while in the healthcare facility until the latter of
    • 14 days after COVID-19 illness onset, or
    • All symptoms are completely resolved
  • Avoid contact with severely immunocompromised patients (eg: transplant or cancer patients) until the latter of
    • 14 days after COVID-19 illness onset, or
    • All symptoms are completely resolved
  • Adhere to good hand hygiene, respiratory hygiene, and cough etiquette
  • Self-monitor for symptoms, and seek re-evaluation if respiratory symptoms recur or worsen

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Read more about returning to work at: https://www.cdc.gov/coronavirus/2019-ncov/healthcare-facilities/hcp-return-work.html

Read more about COVID-19 symptoms, testing, and care at: https://www.uptodate.com/contents/coronavirus-disease-2019-covid-19?source=history_widget

Read more about ending home isolation at: https://www.cdc.gov/coronavirus/2019-ncov/hcp/disposition-in-home-patients.html

Read more about hospital discharge and ending home isolation at: https://www.ecdc.europa.eu/sites/default/files/documents/COVID-19-Discharge-criteria.pdf

Robert Kwok

Robert Kwok

Robert Kwok, MD, Director of Health Informatics at HealthTap, is a board-certified physician who practiced medicine for 27 years. He earned his MD and pediatrics credentials at Baylor College of Medicine. Before HealthTap, he practiced clinical pediatrics in Northern California, most recently with Stanford Medicine.