COMMENTARY

How Long Should Docs and Nurses With COVID Stay Home?

Alok S. Patel, MD

Disclosures

November 13, 2020

Find the latest COVID-19 news and guidance in Medscape's Coronavirus Resource Center.

This transcript has been edited for clarity.

Let's say you're exposed to the coronavirus. Maybe you test positive and have mild symptoms, or none at all. And let's say you're working in a short-staffed hospital. Do you stay home? It's actually complicated.

But when it comes to what others should do, it's not complicated. We tell people exactly what the guidelines are.

Think back to when members in the White House were exposed to coronavirus. Doctors blasted social media with CDC recommendations. Many public health experts and doctors called for President Trump to isolate after he tested positive. The Infectious Diseases Society of America recommended that Mike Pence quarantine for 14 days because of his exposure even though he tested negative. Now, they're not essential workers, per se; they are not on the front lines in a hospital or clinic, and this is a politically charged example.

But if we just push that tribal mentality aside, I still want to know if healthcare professionals stand by the same CDC guidelines when it comes to their own exposures or if they're around a close contact.

According to the CDC, a close contact is defined as being within 6 feet of someone who's tested positive for at least 15 minutes, starting 2 days prior to their illness onset. That has happened to so many of us, both in the hospital and out.

Let's say you have been exposed and you're scheduled to work shifts in the hospital. There don't seem to be clear guidelines on what you're supposed to do if you're exposed and you test negative. It kind of depends on who you ask. I've heard of people saying that in this exact situation, they were told to quarantine for 10 days. Others said 72 hours. Others were told that they could go right back to work as long as they didn't have any symptoms. But what if you test positive?

According to the CDC, if you test positive and you're asymptomatic, you can come back to work if it's been 10 days since your test.

If you test positive and you have symptoms, you can come back to work if it's been 10 days since your symptoms first appeared, 24 hours since your last fever, and if your symptoms have improved.

These recommendations kind of concern me because, based on how strained our healthcare system is, I don't know how closely they are adhered to.

I read one story about a nurse who tested positive, was coughing and had GI symptoms, but because she was fever free, she was told to come back to work within 2 days. This sends a terrible message and it adds to the reality of "presenteeism," where people go to work when they are sick, and they shouldn't be there because they can't fully, safely do their jobs.

Now, I don't think healthcare professionals are inherently irresponsible, but for many reasons, many of us do show up to work when we're sick, and there are surveys that demonstrate this. People in healthcare cite a lot of different reasons why they feel pressured to do this. They're afraid of letting down their patients or colleagues, they’re afraid of being criticized, or they're afraid they're going to lose continuity of care.

Also, not every hospital service has backup call or a jeopardy system. Some people have seen pay cuts or lost their PTO, or they feel pressured by administration or their colleagues to go back to work faster than they should. In the end, I really hope our colleagues feel supported enough to say, "Hey, you know what? I've been exposed. I may need to quarantine."

This is a loaded topic. I know. We're still in this pandemic and we're heading into cold and flu season. I want to hear from all of you. What do you think we healthcare professionals should actually be doing if we're exposed or if we test positive and still have mild or no symptoms? Also, what changes need to be made to ensure that our colleagues who are sick actually stay home? Comment below.

Alok S. Patel, MD, is a pediatric hospitalist, television producer, media contributor, and digital health enthusiast. He splits his time between New York City and San Francisco as he is on faculty at both Columbia University/Morgan Stanley Children's Hospital and the University of California San Francisco Benioff Children's Hospital. Alok hosts The Hospitalist Retort video blog on Medscape.

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