COVID-positive employees returning to work: 2 CEOs share their protocols

Hospital CEOs are relying on employees more than ever as the COVID-19 omicron variant continues to spread across the U.S. and staffing shortages persist. During the pandemic, they have worked to establish return-to-work protocols for employees who test positive for COVID-19 while ensuring that their workforce needs are addressed and workers are safe. 

Here, Cliff Deveny, MD, president and CEO of Akron, Ohio-based Summa Health, and Patty Maysent, CEO of UC San Diego Health, discuss their approaches for bringing employees back to work and how their workforces have responded. 

2 return-to-work approaches

Based on the revised CDC guidance, Summa Health updated its employee COVID-19 protocol to allow employees who test positive to return to work if they have no or mild symptoms.

The health system, which has about 8,150 employees, made the decision based on science and CDC recommendations, in consultation with a committee of infectious disease specialists, human resources professionals and others.

Committee members "are the ones who have been publishing the standards in how we do employee health and if you're symptomatic/asymptomatic. That's the consistent way we've always done it," Dr. Deveny said.   

The CDC's isolation protocol, updated Dec. 27, 2021, shortened the recommended isolation time from 10 days to five for asymptomatic Americans or those whose symptoms are resolving and have been fever-free for 24 hours without the use of medications. Isolation for those individuals may end after those five days, followed by five days of masking up around others, according to the guidance.

Before making changes to guidance for the general public, the CDC also reduced the recommended isolation period for asymptomatic healthcare workers Dec. 23, from 10 to seven days — with a negative test. In the event of staff shortages, that isolation time can be cut further, the CDC said, adding that healthcare workers who have received a complete vaccination series plus a booster shot don't need to quarantine at home following high-risk exposures to the virus.

At Summa Health, asymptomatic or mildly symptomatic employees are allowed to continue to work, under certain conditions, spokesperson Mike Bernstein said.

"Employees with a fever are not permitted to work," he said. "Making these updates allows us to enhance the care of our patients by ensuring we are well staffed at a time when having available staff is critical. The number of employees who are out varies on a daily basis."

Under the updated protocol, unvaccinated employees (those with either a medical exemption or religious accommodation) who have tested positive and have no or mild symptoms can return to work after isolating for five days, if they have not had a fever for at least 24 hours without using medications and their symptoms do not become more severe, according to the Akron Beacon Journal, which cites a memo to staff released Dec. 30. 

Fully vaccinated employees who have tested positive and have no or mild symptoms may continue to work, according to the newspaper. However, fully vaccinated employees with mild symptoms but who have a fever should isolate for five days or until they have not had a fever for at least 24 hours without using medications and their symptoms have not become more severe.

UC San Diego Health has invested in an extensive testing infrastructure and used various testing mechanisms from the very beginning of the pandemic, when they received the region's first patients with COVID-19 in the region. 

Currently, the health system requires unvaccinated workers to test twice a week. Asymptomatic, vaccinated workers must test once a week. By doing that, several hundred positive cases were identified, according to Ms. Maysent. People who tested positive were removed from the workforce until cleared to return to work. 

"The good news is that the positivity rate is dropping. It was 5 to 6 percent at the beginning, and now it's 2 to 3 percent," Ms. Maysent said. "That number is coming down, which means fewer people are being infected and coming into work infected." 

UC San Diego Health, which has more than 10,000 employees, requires workers who test positive to isolate for five days and then do an antigen test on the fifth day. If the antigen test is negative, the employee may return to work. If the antigen test is positive, the worker must continue to isolate until Day 10, and then can return to work on Day 11 without testing.

"Fundamentally, we want to keep the health system as safe as possible for our healthcare workers, for our patients," Ms. Maysent said. "So, as long as we weren't in crisis, we wanted to be able to follow this five-day window, plus antigen test strategy, so we weren't putting staff back into the workforce too early when they were still positive, when they were still shedding virus."

Earlier in January, California temporarily revised its guidelines to allow healthcare workers who test positive and are asymptomatic to return to work immediately without isolation or testing. The revised guidelines, which have been condemned by the California Nurses Association/National Nurses United, are effective through Feb. 1 because of "critical staffing shortages currently being experienced across the healthcare continuum because of the rise in the omicron variant," according to the state health department.  

While Ms. Maysent said she appreciates state officials trying to help overwhelmed hospitals deal with staffing challenges, her organization "felt better opting for a more aggressive strategy with overlapping prevention measures to maintain a safe environment" for healthcare workers and patients.

Pushback from employees

Both Ms. Maysent and Dr. Deveny reported little to no pushback from employees regarding their approaches.

"In fact, in most cases this was well received by our overall employee base because there were many people who wanted to work, and they were frustrated with the long quarantine period, and they felt they could be productive," Dr. Deveny said. "And then when they're seeing their colleagues struggling and trying to keep up with everything [while colleagues are away from work], I'd say the overall feeling was positive."

Overall, Summa Health wanted to ensure it wasn't putting patients, employees or visitors in harm's way, and experts who scrutinized the updated protocol gave their assurances that safety standards would not be compromised, he said. 

"This way we felt like we were getting people back to work who wanted to work," Dr. Deveny said. 

Ms. Maysent said UC San Diego Health employees are grateful that they have access to on-site COVID-19 PCR testing, even if they're vaccinated and asymptomatic.

"I think they're appreciative of us being more conservative relative to how we bring people back so we're keeping people as safe as possible," she said. 

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