Recommendations for Industry

Q. I saw that CDC released new guidance on Criteria release from isolation for people diagnosed with COVID-19. Do we need to change anything to be sure we are following their guidance?

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A. No, there is nothing you need to change! The CDC is moving away from using testing as a means of allowing people to be released from isolation following COVID infection. This change results from a few changes: individuals may test positive but not be infectious; access to testing is limited in some areas; and turnaround times for test results are as long as 7-10 days in some areas of the US. However, businesses can certainly continue to use a test-based return-to-work strategy if they prefer to do so.

CDC also notes that if a seriously ill, critically ill or immune-compromised individual has been diagnosed with COVID-19, such individuals should stay out for 20 days rather than ten days.  In TAG’s experience, anyone in this category is likely to be out for several weeks, anyway.  If there is any question about whether an employee is immune-compromised, we recommend that the employee discuss the situation with their health care provider.

Another change to CDC recommendations is the reduction of the symptom-free timeframe from 72 hours down to 24 hours (#1 below) for release from isolation. TAG agrees with this change as we see no compelling medical reason to stay with a 72-hour timeframe if other symptoms have improved, and it has been at least 10 days since symptom onset.  However, CDC does recommend that a test-based strategy be considered for those who are severely immunocompromised (#2), because of the reduced ability of their immune systems to fight viruses.

CDC also reiterates its recommendations (and TAG agrees) that serologic (antibody) testing not be used to determine the presence or absence of an active COVID-19 infection or reinfection.

The following are the specific CDC Recommendations:

1. Duration of isolation and precautions

   • For most persons with COVID-19 illness, isolation and precautions can generally be discontinued 10 days after symptom onset and resolution of fever for at least 24 hours, without the use of fever-reducing medications, and with improvement of other symptoms.

     • A limited number of persons with severe illness may produce replication-competent (infectious) virus beyond 10 days that may warrant extending duration of isolation and precautions for up to 20 days after symptom onset; consider consultation with infection control experts.

   • For persons who never develop symptoms, isolation and other precautions can be discontinued 10 days after the date of their first positive RT-PCR test for SARS-CoV-2 RNA.

2. Role of PCR testing to discontinue isolation or precautions

   • For persons who are severely immunocompromised, a test-based strategy could be considered in consultation with infectious disease experts.

   • For all others, a test-based strategy is no longer recommended except to discontinue isolation or precautions earlier than would occur under the strategy outlined in Part 1, above.

3. Role of PCR testing after discontinuation of isolation or precautions

   • For persons previously diagnosed with symptomatic COVID-19 who remain asymptomatic after recovery, retesting is not recommended within 3 months after the date of symptom onset for the initial COVID-19 infection. In addition, quarantine is not recommended in the event of close contact with an infected person.

   • For persons who develop new symptoms consistent with COVID-19 during the 3 months after the date of initial symptom onset, if an alternative etiology cannot be identified by a provider, then the person may warrant retesting; consultation with infectious disease or infection control experts is recommended. Isolation may be considered during this evaluation based on consultation with an infection control expert, especially in the event symptoms develop within 14 days after close contact with an infected person.

   • For persons who never developed symptoms, the date of first positive RT-PCR test for SARS-CoV-2 RNA should be used in place of the date of symptom onset.

4. Role of serologic testing

   • Serologic testing should not be used to establish the presence or absence of SARS-CoV-2 infection or reinfection.

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TAG Risk Matrix Update (July 22, 2020)

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As depicted in the TAG exclusive COVID-19 Risk Matrix (below) updated each week, TAG’s analysis of national COVID-19 data shows that 12 states currently have a weekly test positive rate greater than 10%:

• Arizona: 23%

• Nevada, Idaho, Florida: 19%

• Alabama: 18%

• South Carolina: 16%

• Mississippi, Texas, Georgia: 15%

• Kansas: 11%

• Louisiana, Arkansas: 10%

The social index has decreased from 32 to 29 this week indicating that people are more mobile compared to last week.

• Because of increases in COVID-19 cases in the U.S., nine (9) states have reversed re-opening guidance (California, Nevada, Arizona, New Mexico, Colorado, Texas, Louisiana, Florida, and Michigan). States that are reversing re-opening guidance have a * next to their names.

• Thirteen (13) stares are partially reopening (Washington, Oregon, Idaho, Wyoming, Illinois, Arkansas, Mississippi, Alabama, South Carolina, North Carolina, Delaware, New Jersey, and Connecticut). This is indicated by a † in the charts.

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TAG continues to provide this analysis on a weekly basis to assist clients in their business planning. By tracking past and current trends, we are able to deliver predictive analytics to help businesses determine where their states appear to be headed; where governors may be implementing travel bans/quarantines; whether the business should be reopening or may have to close back down; etc. For further clarification and specifications on the states in which your facilities are located or employees need to travel, and other impacts on your situation, give TAG a call today. We are here to help your business.