Return to work guidelines for the COVID-19 pandemic.

Details

• Personal Author:
  de la Hoz RE ; del Campo MT ; Delclos GL ; Fernandez-Montero A ; Kales SN ; Reinoso-Barbero L ; Rueda-Garrido JC ; Vicente-Herrero MT
• Description:
  The novel coronavirus 2019 or SARS-CoV-2 has spread worldwide since first being detected in China in December 2019. It has been declared a global health emergency by the World Health Organization, and public health measures have been applied, including social distancing, work restrictions and home-working promotion. As many countries have flattened the epidemic curve, they are now examining strategies to reopen their economies, requiring evidence-based strategies to return workers to their jobs in the safest way possible. Occupational physicians can play key roles in monitoring workers' health and developing effective return to work guidelines. Along with clinical presentation, laboratory tests provide added value to confirm the diagnosis and the stage of COVID-19. Rapid tests based on viral antigen or antibody detection are often scarce. The use of reverse transcriptasepolymerase chain reaction (RT-PCR), based on viral-RNA detection, may be limited to high-risk patients, healthcare and first-responder personnel. The Spanish Society of Infectious Diseases and Clinical Microbiology and other societies have established that RT-PCR can remain positive for up to 1 month in patients who are no longer contagious. RT-PCR is a useful diagnostic test in COVID-19, but used alone qualitatively (positive or negative), it may be inadequate to determine the end of a COVID-19-affected worker's isolation. The combined use of SARS-CoV-2 viral-RNA detection and serological antibody determination could improve the management of COVID-19 patients, but timing is important. Doing tests too early may result in test repetition and waste of resources, whereas delaying tests may delay return to work. The best strategy, preventing any contagious worker from entering/re-entering the workplace based on large-scale screening, is usually not available. Therefore, best practice for safe return to work after COVID-19 requires accurately identifying the final phases of the disease, where the worker is clinically recovered and no longer contagious. As laboratory tests are limited, we propose the combined use of: Clinical parameters based on clinical evolution and days since exposure. The isolated use of clinical criteria without laboratory support for return to work decisions would only be justified in circumstances where laboratory tests are unavailable. ... In conclusion, return to work guidelines in any pandemic will depend on the state of the local epidemic, the nature and conditions of each job and on the availability of testing. Guidelines need to be reviewed and updated over time as local epidemic status and supplies may change. In the current situation with a high rate of transmission and limited testing resources, it is important to differentiate between high- and low-risk workers. While low-risk workers' guidelines may rely on clinical criteria, more specific testing-based strategies should be used for high-risk workers. [Description provided by NIOSH]
• Subjects:
  Communicable Diseases Laboratories Occupational Health Public Health Safety
• Keywords:
  Return to work; Guidelines; COVID-19; SARS-CoV-2; Infection control; Coronavirus; Public health; Work operations; Laboratory testing; Safety practices; Disease transmission
• ISSN:
  0962-7480
• Document Type:
  Text
• Funding:
  Grant
• Genre:
  Journal Article
• Place as Subject:
  Massachusetts ; New York ; OSHA Region 1 ; OSHA Region 2 ; OSHA Region 6 ; Texas
• CIO:
  National Institute for Occupational Safety and Health (NIOSH)
• Topic:
  Workplace Safety & Health
• Location:
  North America
• Pages in Document:
  300-305
• Volume:
  70
• Issue:
  5
• NIOSHTIC Number:
  nn:20065352
• Citation:
  Occup Med 2020 Jul; 70(5):300-305
• Contact Point Address:
  Alejandro Fernandez-Montero, Asociación Española de Especialistas en Medicina del Trabajo, Madrid, Spain and Department of Occupational Medicine, Universidad de Navarra, Navarra, Spain
• Email:
  afmontero@unav.es
• Federal Fiscal Year:
  2020
• Performing Organization:
  University of Texas Health Science Center, Houston
• Peer Reviewed:
  False
• Start Date:
  20050701
• Source Full Name:
  Occupational Medicine
• End Date:
  20250630
• Collection(s):
  National Institute for Occupational Safety and Health
• Main Document Checksum:
  urn:sha-512:2a200d7eb8f8fa7ec28f6fa9ea990da57bbd5de91535d8195231d955b36dcd1d03aa83b6408cd148b0e71bccc868e13c6e180c263df2331b5d112de3e8aa923f
• Download URL:
  https://stacks.cdc.gov/view/cdc/249412/cdc_249412_DS1.pdf
• File Type:
  [PDF - 2.12 MB ]