July 17, 2020
Dear Members of the Baylor College of Medicine Community,
As the COVID-19 pandemic evolves in Houston, we are receiving many questions related to when to leave work and when it is safe to come back to work. Part of the confusion around the return to work (RTW) issue relates to the fact that the CDC, and therefore BCM OHP, has two options for a RTW decision: a test-based and a symptom/time-based strategy. Employees who develop COVID-19-related symptoms, even if mild, should not report to work and will be tested by OHP. Regarding a decision as to when to return to work, BCM OHP currently uses a symptom-based strategy following a positive diagnosis.
A symptom/time-based strategy and a test-based strategy are equally appropriate in CDC guidance. The symptom-based RTW approach is believed to be safe and appropriate as transmission of SARS-CoV-2 from individuals whose symptoms have resolved has not been documented (unlike asymptomatic and pre-symptomatic spread which has been documented). Bottom line, if your symptoms have resolved, you are almost certainly not contagious.
Furthermore, even the data on asymptomatic and pre-symptomatic transmission are from the era before physical control measures were widely implemented. Transmission of the virus is greatly reduced by physical distancing, hand hygiene and universal masking of employees in the work place. BCM mandates that physical distancing and masking be practiced at work. We also have a contact tracing program in place to identify and interrupt work place transmission should it occur. Face shields confer yet another layer of protection and should be used in patient-facing encounters since Houston is currently experiencing moderate-to-high transmission in our community.
Another question we frequently receive relates to people who have prolonged positive PCR tests, sometimes persisting for 3-4 weeks. This “persistent positive” scenario is well documented. The CDC discusses this issue of persistent positives. People with persistently positive PCR tests weeks and months after their initial infection have not been documented to spread infection. Live virus has not been isolated in those who have shown sustained improvement in symptoms. This is one reason OHP usually uses a symptom-based RTW decision.
The most important take away from this message is: follow social distancing and masking rules strictly; monitor your symptoms; report your symptoms; do not work if you are sick; and contact OHP if you develop any symptoms for evaluation.
James McDeavitt, M.D.
Incident Command Center