The Coronavirus pandemic has created new, urgent challenges for employers. Below, we’ve documented some of the current leave of absence practices that our clients are using to help manage during this pandemic, as well as an FAQ based on our work with our clients.

NEW: ACOEM® COVID-19 Guidance for Employers and Businesses

Business Considerations

The actions an employer can take to mitigate the risk of COVID-19 infection center primarily on the virus’s potential respiratory and contact spread. There are multiple domains for an employer’s actions. Please see the following sections on:

  1. Employee issues (e.g., education and medical surveillance)
  2. Travel issues
  3. Social distancing methods
  4. Disinfection practices and contact spread measures
  5. Personal protective equipment (e.g., masks, gloves, and face shields)
  6. Ventilation issues
  7. Policies and procedures
  8. Industry-specific recommendations

The education of workers in each of these areas is advised as appropriate.

A business with broad geographic interests may also wish to incorporate geographic-specific risks. McKinsey suggested risks for a given jurisdiction should be related to four metrics assessing the strength of test, trace, and quarantine efforts (adapted from [97]):

  1. Test positivity rate, a measure of testing systems’ abilities to capture all cases. The World Health Organization recommends a target of <10% positivity.
  2. Tests per million population, a measure of the depth of testing.
  3. Average number of contacts identified per case, a measure of how effective contact-tracing systems are at identifying and isolation the likely next generation of cases. The figured are expected to trend lower in the lockdown settings than when people are moving and interacting freely.
  4. Fraction of cases arising from contact lists, a measure of the portion of cases arising from known sources versus undetected community transmission.

(Note: Always check current guidance from the Centers for Disease Control and Prevention.)

Employee Issues

COVID-19 surveillance

Employers are recommended to implement a surveillance system that at minimum includes education of workers and screening to avoid having workers with potential COVID symptoms enter the workplace premises. Options for larger employers and/or jobs with greater risks (e.g., mission-critical jobs; a workforce where one ill worker could infect an essential group of workers, which would shut down the workplace) include either daily/periodic electronic questionnaires and/or temperature measurements. Diagnostic testing should be performed on those with symptoms, most commonly through the local healthcare or public health systems. Diagnostic testing may also be performed to ascertain asymptomatic spread, especially among essential workers. Considerations also include providing communications and expectations to subcontractors, suppliers, and others who may have significant interactions with the employer (e.g., assurance of policies to address symptomatic employees, surveillance).

Employees with possible COVID symptoms 

Sick employees (including those with minimal symptoms) should stay home from work, as it is important to eliminate all contact between the healthy workers in the workplace and anyone with potentially infectious symptoms [58]. If there is believed to be COVID-19’s SARS-CoV-2 virus transmission in the area (currently true of essentially all US urban and many rural areas), then anyone with even mild symptoms of a respiratory tract infection (e.g., cough, fever, fatigue) should stay home to be sure they do not progress to a clear, readily transmissible, and potentially severe COVID-19 infection [45], as well as to prevent transmission to others. Sick employees should also be encouraged to undergo testing if available. They should be instructed to call a provider or healthcare organization in advance, discuss the symptoms, seek testing if available (especially at outdoor tents), and put on a mask prior to entering any clinic or hospital.

Any questions about potential COVID-19 infections should be directed to the local health department, which has the expertise and personnel to investigate outbreaks and perform contact tracings (provided they are not overwhelmed by the current epidemic). It is important to recognize that return-to-work recommendations for essential workers, especially healthcare workers, may need to be modified during the course of the epidemic for practical reasons in response to acute workforce shortages in key jobs and sectors.

CDC recommendations for healthcare workers have been revised to address the removal exposed workers who had relatively low risks for conversion during potential incubation periods, as it affected the capacity for patient care [100]. Current guidance includes the following [100]:

  • A symptom-based strategy for symptomatic workers, who are recommended to be excluded from work until there has been at least 3 days since recovery, improvement in respiratory symptoms, and at least 10 days since the symptoms first appeared.
  • A test-based strategy for symptomatic workers, who are recommended to be excluded from work until there is resolution of fever, improvement in respiratory symptoms, and negative COVID-19 results for at least 2 consecutive tests. (There is a risk of ongoing positive test results in a minority of workers of uncertain significance).
  • A time-based strategy for confirmed but asymptomatic employees, who are recommended to be excluded from work for 10 days since the positive test result.
  • A test0based strategy for confirmed but asymptomatic employees, who are recommended to be excluded from work until at least two consecutive tests are negative 24+ hours apart. (There is risk of ongoing positive test results in a minority of workers of uncertain significance).

Although the above recommendations are official CDC guidance, it is also advisable for a healthcare employer to consider factors including staffing needs, manpower infection rates, and individualized assessment of the degree of that person’s contact with susceptible patients (especially those with comorbidities). Furthermore, it is advisable that the other CDC guidance to be followed [100]. Depending on those factors, more conservative or more liberal return-to-work time frames may be advisable to balance the risks of infecting patients with the ability to staff and care for patients.

What to do if an employee tests positive for COVID-19 

The sick employee should follow current CDC guidelines, quarantining at home (if able). A symptom-based approach recommends recording temperatures twice daily until 72 hours (three days) have passed without fever or treatment with any fever-reducing medications. In order to leave quarantine, it is advised that a minimum of seven days must have passed since the onset of symptoms, with then three subsequent days of no fever and improvement in symptoms. A testing-based approach requires two negative PCR viral tests obtained at least 24 hours apart. The area where the sick employee worked, including conference rooms and common areas, should undergo deep cleaning and decontamination to prevent spread to other employees.

Employees in contact with an infected coworker

Employees in contact with an infected coworker should continue to undergo medical screening. Close contacts are defined as any individual who was within 6 feet of an infected person for at least 15 minutes starting from two days before illness onset (or, for asymptomatic patients, two days prior to positive specimen collection) until the time that the patient is isolated [101].

Risk assessment should include the duration of contact with the sick employee, whether they were using any personal protective equipment, and the type of personal protective equipment used (e.g., cloth face covering vs. respirator) [102]. Attempt to maintain confidentiality regarding an ill employee’s identity. Employers may wish to apply more or less restrictive policies depending on their individual business requirements, organizational characteristics (e.g., closeness and numbers of other workers), and risk tolerances. For higher risk exposures with greater business considerations, the most conservative approach is to have employees who could be in the incubation stage work from home for at least two weeks after the possible exposure.

Yet, in certain manpower shortage situations, medical centers and critical service workers are being allowed to work while asymptomatic with twice-daily temperature checks, self-surveillance for symptoms, social distancing, disinfection of work spaces, and consistent mask-wearing instead of being quarantined for 14 days [103]. This option is controversial and not without considerable risks as pre-symptomatic spread is believed to be a primary source of epidemic spread. This option should be carefully weighed between the industry sector, criticality of the job, job requirements, and risks of an infectious individual in that particular workplace. This option is likely unduly risky if the workforce or work group is mission critical.

High-Risk Employee Issues

For the purposes of these recommendations, high-risk individuals have any of the following conditions [98, 104]:

  • Age 65 years and older
  • Chronic lung disease, including moderate to severe asthma
  • Serious heart condition (e.g., history of heart attack or heart failure)
  • Immunocompromised (e.g., having had bone marrow or organ transplantation, immune deficiencies, poorly controlled HIV or AIDS; using corticosteroids or other immune modulating medications, undergoing cancer treatment)
  • Smoking, current or former
  • Obesity, especially severe
  • Diabetes mellitus
  • Chronic kidney disease, especially those undergoing dialysis
  • Liver disease
  • Hypertension
  • Current cancer
  • Neurological diseases, including stroke and dementia

Generally, the risks associated with the above conditions are greater as the severity of the conditions increase. The presence of multiple conditions likely further increases risks [105].

Employers should attempt to reduce exposures to higher-risk situations for workers who self-identify as high-risk, while being cognizant of the implications of the Americans with Disabilities Act and amendments. A full- or part-time medical director and medical department may help to interface between the worker and management to effect these risk assessments and potential risk reductions. Examples of reductions in exposure (beyond electronic questionnaires with or without temperature checks) include the following:

  • Emphasize distance-based work methods, including telecommuting where feasible
  • Place high-risk individuals behind barriers
  • Reduce public-facing work
  • Use personal protective equipment (PPE) to protect from exposure
  • Use masks (evidence form randomized controlled trials has suggested a surgical mask is equally effective as an N95 respirator for prevention of influenza) [106].
  • Consider placing high-risk individuals closer to ventilation that provides fresh air
  • Regular disinfection of surfaces

Travel Issues

Travel risks include those associated with travel to and from a site, as well as business conducted at that sites [107]. Risks differ considerably by mode of transportation, geographic locations, and current state of the epidemic in any given locale. Businesses need to weigh the value of the travel against the risks associated with that travel. Such valuations should include costs associated with any potential illness and the post-trip quarantine period. Caution is especially advised for all non-essential travel to any locales with outbreaks or community spread in progress [107], which currently includes most urban and many rural US areas (see map to help with other risk considerations: https://www.arcgis.com/apps/opsdashboard/index.html#/bda7594740fd40299423467b48e9ec f6) [108]. International trips are currently similarly affected, with somewhat increased risk estimates due to the length of the transit. Any trips that can be canceled or postponed should be. As risks are reduced, travel to lower-risk locales may increasingly be acceptable (e.g., New Zealand).

Employees returning from, or having traveled through, area known to have COVID-19 infections 

For employees returning from personal or work-related travel, the safest course of action is to self-quarantine and work from home for a minimum of two weeks4 and avoid direct contact with other workers [45], especially for travel to higher-risk areas compared with travel by personal automobile to an unaffected rural area. If that worker becomes ill, he or she should promptly call a healthcare provider before appearing in a clinic or hospital (i.e., to arrange which entrance to use, to be given an appropriate type of mask before entering the building). The person should also avoid all contact with other people. Wearing a surgical-type mask when ill, such as in transit to a healthcare facility, may help to reduce the spread of the virus from the wearer’s sneezes or coughs.

Social Distancing Methods

The following are some social distancing options to consider:

  • Work from home when feasible to help improve social distancing.
  • Consider rotating workers between home and work settings to reduce workplace population densities while facilitating functions that are best to be performed at work to continue.
  • Improve social distancing at work (e.g., increase distances between workers, install temporary barriers, mark 6-foot distances on the floor between co-workers).
  • Consider either social spacing in cafeterias, closing cafeterias and offering individual prepackaged meals, and/or having workers eat their own food at their workstations.
  • Consider one-way walkways where there are two options for walking through a workplace.
  • Where there are two options for walking through a workplace, consider one-way walkways.
  • Reorganize shifts to spatially- and temporarily-spread workers.
  • Route shifts of workers to enter through one entrance that is a different entrance than that being used to exit the premises.
  • Provide protection for those who interact with the general public (e.g., install temporary barriers to prevent respiratory transmission, install barriers to physically require social distancing of 6+ feet).
  • Consider discouraging carpooling and mass transit, or encouraging the use of masks if using either of those options.
  • Minimize reasons for external individuals and the public to enter a workplace (e.g., curbside deliveries, web-based meetings). If there are multiple options for meetings onsite, attempt to limit which rooms are used and have them cleaned after every use.

Personal Protective Equipment

PPE measures (masks, gloves, and face shields) are lower on the list of controls, but still may help to slow the spread of the COVID virus and include the following:

  • Have healthy individuals wear a face covering or mask, as there is evidence of COVID-19’s SARS-CoV-2 virus spreading by asymptomatic and presymptomatic individuals [109, 110].
  • Use face shields, especially where there is potential for human-related splashes or droplet exposures.
  • Follow OSHA guidance regarding requirements for fit testing of PPE and to assure proper use, donning and doffing [111, 112].
  • Appropriate PPE for cleaning a workspace contaminated by the virus is thought to normally be a face mask and gloves. If there are concerns about aerosols (e.g., an infected worker was in the room, especially with coughing, sneezing, and/or for an extended time), an option may be to leave the room overnight before cleaning it; otherwise, an N95 mask would ideally be recommended (P100 is not an appropriate mask for these purposes).

Ventilation Issues

Ventilation issues (general and local) have been underutilized as potential COVID controls. Local ventilation can provide a relatively safe zone for workers:

  • Use local ventilation to supply clean air to a worker’s workspace
  • Utilize increased air exchanges in the HVAC system to dilute the general ambient air (including HEPA filters in the HVAC system).
  • Where possible, use portable air purification systems for small work areas.

Disinfection Practices and Contact Spread Measures

The following disinfection practices may help to slow spread by contact:

  • Train staff on how to disinfect workplaces
  • Clean commonly touched worksite surfaces frequently (e.g., hourly or between shifts), including machine controls, door handles, bathroom doors, bathroom fixtures, faucet handles, lunch tabletops, breakrooms, etc.
  • Consider propping open bathroom and other doors to reduce handling or touching.
  • Avoid shared equipment when possible (e.g., keyboards), and clean common surfaces between shifts or between worker usage.
  • Clean surfaces with an EPA-approved virucidal agent and follow manufacturer’s instructions for use. Reports include agents containing 62-71% ethanol, 0.5% hydrogen peroxide, 0.1% sodium hypochlorite for at least 1 minute [38], although some agents will require longer contact times. It is important to allow sufficient time for sanitizing agents to work, and directions should be carefully followed. The EPA has a list of products active against human coronavirus, with recommendations for the duration of contact time [113].
  • Encourage frequent hand hygiene (hand washing or use of alcohol-based hand disinfectants) with appropriate techniques [114].
  • Provide ample hand sanitizer and hand-sanitizer stations.

Policies and Procedures 

The following are potential policies and procedures to consider:

  • Inform and seek authorization for the plan from the organization’s leadership.
  • Develop a plan in conjunction with occupational health and safety professionals, government regulations, and public health authorities (including CDC).
  • Educate and place posters throughout workplace to remind employees to avoid touching their eyes, nose, and/or mouth with unwashed hands (e.g., CDC poster).
  • Teach workers to use tissues to catch a cough or sneeze, then throw that tissue away and wash their hands.
  • Avoid scheduled aggregate meetings and encourage physical distancing within group settings, ideally a distance of at least 6 feet. Encourage use of teleconferences and/or other virtual meeting formats.
  • Encourage early reporting of any symptoms consistent with COVID-19 to the medical department, designated employer representative, and/or supervisor, following the company’s established policies. It is preferable to preclude all symptomatic workers, including those who are mildly symptomatic, from physically entering all workplaces; electronic questionnaires may be useful to facilitate this. Place posters prominently to help remind workers of procedures (e.g., CDC posters).
  • Have employees who develop symptoms stay away from the workplace until clinically evaluated and/or until the symptoms are resolved and any quarantining period has expired.
  • Consider having employees who could be in the incubation stage work from home for at least two weeks after the possible exposure.
  • In certain manpower shortage situations, medical centers and critical service workers are being allowed to work while asymptomatic with twice-daily temperature checks, self-surveillance for symptoms, and consistent mask-wearing instead of being quarantined for 14 days. However, this has some residual risks of transmission and may not be compatible with mission-critical operations (e.g., dispatch center; air traffic control tower).
  • If there is a confirmed case in your workplace, have the worker identify his or her most common contacts in collaboration with public health officials while attempting to maintain confidentiality. Using business risk tolerance procedures, identify whether any further actions are required other than increased monitoring (see above) and increased cleaning and disinfection of commonly used areas.
  • Antibody testing is becoming available, but the sensitivity and specificity vary greatly between kits (see Diagnostic Testing). Their usefulness is limited in areas where the prevalence of disease is around 1 to 3%, and, in this setting and even with 95% specificity, the majority of positive tests will be false positives. With further validation, antibody testing may likely become useful in assessing possible susceptibility to infection versus protective response to prior infection. Currently, however, antibody testing is not able to provide that information and cannot be reliably used for that purpose. In the future, COVID-19 serology can determine infection risk in critical and susceptible populations (under medical direction to ensure proper implementation, interpretation, and management). Examples of these critical populations include employees in health care settings, on oil drilling platforms, commercial maritime, food preparation, cruise lines, airlines, and assembly lines with workforces working closely together.
  • Provide proactive assistance to support mental health for the workforce.
  • Identify and train workplace coordinators who will be responsible for implementing and monitoring the plan.

Industry-Specific Recommendations

Below are select industry guidelines, which are in addition to the general guidance above. Further guidance is available from the CDC [115].

Restaurants

  • Provide social distancing between tables. Be alert to local ventilation issues that may cause downwind exposures beyond 6 feet.
  • Barriers between tables allow for seating closer than 6 feet.
  • Outdoor seating may allow distancing that is closer than 6 feet.
  • Menus should be either disposable or laminated and sanitized after each customer contact.
  • Clean and disinfect chairs and tables after each customer use (see Disinfection).
  • Assign high-risk employees with multiple co-morbidities or concerns to low-exposure areas, such as working in non-customer-facing areas as much as possible.
  • Wear protective masks while in the restaurant and kitchen.
  • When possible, designate non-high-risk employees to bus tables.
  • Housekeeping in public areas should ideally be performed by lower-risk employees.
  • Encourage drive-through and carryout options to promote social distancing.

Retail

  • When possible, preferentially assign low-risk employees to cashiering and other customer-facing work.
  • Stocking by high-risk individuals should ideally be done when customers are not present.
  • Returns that cannot be disinfected should best be handled by low-risk employees.
  • Clothing from dressing rooms should ideally be restocked by low-risk employees.
  • Housekeeping in public areas should ideally be assigned to lower-risk employees.
  • Limit total number of customers within enclosed dwellings or structures at one time to allow for social distancing.
  • Encourage customers to use personal respiratory protection and provide PPE to customers where feasible.

Hospitality

  • Eliminate handling of luggage and other customer items. Otherwise, use gloves.
  • Valet services should be provided by lower-risk employees if possible. Gloves should be used. • Room keys should be disinfected between employee and customer usage.
  • Housekeeping in public areas should ideally be assigned to lower-risk employees.

Personal Services (hair, tattoo, nail salons)

  • Use physical barriers where possible.
  • Employees should use aprons, gloves, eye, and face protection in addition to protective masks.

Home Repair

  • Where clothing may be potentially contaminated from SARS-Cov-2, protective coverings (e.g., Tyvek or disposable smocks) should be worn to protect clothing from surface exposure.

Gyms

  • Locker room and gym housekeeping should ideally be performed by low-risk employees.
  • Employees should avoid using a public water fountain. Employees should be provided with bottled water.
  • Towel service and other laundry should ideally be handled by low-risk employees.
  • Housekeeping in public areas should be assigned to lower-risk employees.
  • Saunas and steam rooms should be limited in use and ideally cleaned only by low-risk employees.

Construction

  • Assure cleanliness and frequent cleaning of portable restrooms.
  • Face coverings should be used when performing maneuvers that require close contact with co-workers or within confined spaces.
  • Avoid sharing tools or disinfect between users.
  • Reduce unnecessary shared rides; disinfect heavy equipment cabs between operators.
  • Designate a COVID-19 coordinator for large job sites, with the responsibility to coordinate prevention efforts for all contractors, subcontractors, and crafts on site.
  • Provide hand washing or issue hand sanitizer to be used for donning/doffing respiratory PPE.

Manufacturing

  • Install physical barriers when physical distancing is not possible.
  • When possible, consider wearing gloves while assembling parts.

Food Production Facilities

These have been hot spots of virus infection due to structural and socioeconomic challenges in meat and poultry processing facilities. Difficulties to overcome include workers speaking many different primary languages, an incentive to work while ill as a result of limited medical leave and disability policies, and attendance bonuses that could encourage working while sick. At home, many workers live in crowded, multigenerational settings and may share transportation to and from work, increasing risk for transmission of disease [116]. Recommended potential changes in facility practice include the following:

  • Adjust start and stop times of breaks and shifts, add outdoor break rooms. Avoid en masse movements of workers.
  • Install physical barriers between workers.
  • Screen all workers and visitors, isolate workers who become ill at work.
  • Require universal face coverings and provide training on donning and doffing PPE.
  • Assign additional staff to sanitize high-touch areas.
  • Add hand-sanitizer dispensers and hand washing stations.
  • Develop culturally informed messaging.
  • Include messaging about behaviors to limit spread of virus at home.
  • Add additional vehicles to shuttle routes.

Disability and Return-to-Work Considerations

Disability will be better defined with studies over time. Extrapolation using recovery from other conditions, such as ARDS, may provide some preliminary estimates.

Return-to-work evaluations should consider the worker’s current status as compared with the physical requirements of the job, mental demands of the job, safety-critical work functions, current treatments, use of impairing medication, residual effects of the virus, requirements for personal protective equipment, potential risk to others if returned too early, and protection of other employees if additional risk is identified. Many of these complex cases will need to be addressed by occupational and environmental medicine physicians.

Currently, for patients without hospitalization, there are no quality data on returning to work, short-term disability, or long-term disability. Regarding short-term disability and return to work, recovery from post-infection fatigue is estimated to take approximately 2–3 weeks and appears to correlate with clinical duration and severity. For patients with mild to moderate pneumonia treated with oxygen supplementation, recovery is estimated to require 4–8 weeks after hospitalization or clinical recovery. Severe pneumonia and ARDS have worse prognoses.

The overall trajectory of recovery from COVID-19 remains unclear. Prior experience with diseases that have similar manifestations, such as ARDS, suggest there is significant risk of delayed return to work and long-term disability, as approximately 50% of individuals surviving ARDS have not returned to work after 1 year [117, 118]. ARDS is also associated with approximately 20% reductions in spirometry and lung volume, which resolve at about 6 months based on prior H7N9 influenza data [119]. Lung diffusion abnormalities can take up to 5 years to resolve in ARDS cases [119, 120]. Cognitive impairments and psychiatric abnormalities related to ARDS may be to occur in 30–55% and 40–60% of patients, respectively; the duration of these impairments is unclear, but other causes of ARDS raise considerable concerns about long-term disability [118-124]. Generalized skeletal muscle deconditioning is expected in patients who are intubated for any extended duration; these patients require exercise programs and possibly rehabilitation, which often results in residual incapacity [118, 121, 125, 126]. Cardiac problems are common with COVID-19, with cardiomyopathy, arrhythmia, and direct cardiac muscle injury affecting approximately 30%, 20%, and 10% of patients, respectively [127].

In general, for patients who are intubated and survive, recovery of the cardiorespiratory systems and endurance are estimated to take at least several months. It currently appears likely that some hospitalized and severely affected individuals will incur long-term disability with permanent impairments of the cardiac, respiratory, neurological, and/or musculoskeletal systems. [118-122]. The potential for a minority of patients to be permanently totally impaired cannot be excluded [122].

Cardiac, respiratory, and neurological disability measures include:

  • Metabolic stress ECHO
  • Full pulmonary function testing with impedance booth or washout testing
  • Functional capacity testing
  • Neuropsychological testing

Ratings for impairment can be found in the AMA Guides 5th Edition [82] and 6th Edition [83].

See all references here: https://info.mdguidelines.com/wp-content/uploads/2020/06/ACOEM-COVID-June-17-2020-public.pdf

Quarantined or Virus Exposed Employee FAQs

The sick employee should follow current CDC guidelines, quarantining at home (if able). A symptom-based approach recommends recording temperatures twice daily until 72 hours (three days) have passed without fever or treatment with any fever-reducing medications. In order to leave quarantine, it is advised that a minimum of seven days must have passed since the onset of symptoms, with then three subsequent days of no fever and improvement in symptoms. A testing-based approach requires two negative PCR viral tests obtained at least 24 hours apart. The area where the sick employee worked, including conference rooms and common areas, should undergo deep cleaning and decontamination to prevent spread to other employees.

We have not seen any company policy additions. However, we are seeing clients leverage existing plans and policies in different ways (e.g. allowing unpaid leave and personal leaves.)

We recommend foregoing paperwork or certification documents and more flexibility regarding eligibility requirements for the client’s paid leave programs. This decision at each employer’s discretion.

If they are on the CDC watch list, they are under mandatory quarantine.

A physician’s clearance may be required for an employee to return to work; however, it will depend on the type of leave that they utilized. This will vary, depending on what your company authorized.

Per CDC guidelines, the quarantine period is 14 days, which would be an appropriate period of time to cover the employee if the client chooses to do so.

Per the CDC guidelines, if the family member lives in the same home, your employee cannot enter the workplace. They can, however, be permitted to work from home if that’s appropriate for their job function.

We have been deferring to our clients regarding the amount of flexibility they would like to extend to quarantined employees.

For employees returning from personal or work-related travel, the safest course of action is to self-quarantine and work from home for a minimum of two weeks4 and avoid direct contact with other workers [45], especially for travel to higher-risk areas compared with travel by personal automobile to an unaffected rural area. If that worker becomes ill, he or she should promptly call a healthcare provider before appearing in a clinic or hospital (i.e., to arrange which entrance to use, to be given an appropriate type of mask before entering the building). The person should also avoid all contact with other people. Wearing a surgical-type mask when ill, such as in transit to a healthcare facility, may help to reduce the spread of the virus from the wearer’s sneezes or coughs.

This person should be treated as if he or she was infected, with a quarantine period of at least 2 weeks. Be sure that the local health department is involved. If the employee develops typical symptoms of COVID-19 infection, they should contact their primary physician or health department for testing.

Follow the same protocol as if the person was returning from an overseas country or area with a high risk of infection.

Sick employees (including those with minimal symptoms) should stay home from work, as it is important to eliminate all contact between the healthy workers in the workplace and anyone with potentially infectious symptoms [58]. If there is believed to be COVID-19’s SARS-CoV-2 virus transmission in the area (currently true of essentially all US urban and many rural areas), then anyone with even mild symptoms of a respiratory tract infection (e.g., cough, fever, fatigue) should stay home to be sure they do not progress to a clear, readily transmissible, and potentially severe COVID-19 infection [45], as well as to prevent transmission to others. Sick employees should also be encouraged to undergo testing if available. They should be instructed to call a provider or healthcare organization in advance, discuss the symptoms, seek testing if available (especially at outdoor tents), and put on a mask prior to entering any clinic or hospital.

Any questions about potential COVID-19 infections should be directed to the local health department, which has the expertise and personnel to investigate outbreaks and perform contact tracings (provided they are not overwhelmed by the current epidemic). It is important to recognize that return-to-work recommendations for essential workers, especially healthcare workers, may need to be modified during the course of the epidemic for practical reasons in response to acute workforce shortages in key jobs and sectors.

CDC recommendations for healthcare workers have been revised to address the removal exposed workers who had relatively low risks for conversion during potential incubation periods, as it affected the capacity for patient care [100]. Current guidance includes the following [100]:

  • A symptom-based strategy for symptomatic workers, who are recommended to be excluded from work until there has been at least 3 days since recovery, improvement in respiratory symptoms, and at least 10 days since the symptoms first appeared.
  • A test-based strategy for symptomatic workers, who are recommended to be excluded from work until there is resolution of fever, improvement in respiratory symptoms, and negative COVID-19 results for at least 2 consecutive tests. (There is a risk of ongoing positive test results in a minority of workers of uncertain significance).
  • A time-based strategy for confirmed but asymptomatic employees, who are recommended to be excluded from work for 10 days since the positive test result.
  • A test-based strategy for confirmed but asymptomatic employees, who are recommended to be excluded from work until at least two consecutive tests are negative 24+ hours apart. (There is risk of ongoing positive test results in a minority of workers of uncertain significance).

Employees in contact with an infected coworker should continue to undergo medical screening. Close contacts are defined as any individual who was within 6 feet of an infected person for at least 15 minutes starting from two days before illness onset (or, for asymptomatic patients, two days prior to positive specimen collection) until the time that the patient is isolated [101].

Risk assessment should include the duration of contact with the sick employee, whether they were using any personal protective equipment, and the type of personal protective equipment used (e.g., cloth face covering vs. respirator) [102]. Attempt to maintain confidentiality regarding an ill employee’s identity. Employers may wish to apply more or less restrictive policies depending on their individual business requirements, organizational characteristics (e.g., closeness and numbers of other workers), and risk tolerances. For higher risk exposures with greater business considerations, the most conservative approach is to have employees who could be in the incubation stage work from home for at least two weeks after the possible exposure.

Yet, in certain manpower shortage situations, medical centers and critical service workers are being allowed to work while asymptomatic with twice-daily temperature checks, self-surveillance for symptoms, social distancing, disinfection of work spaces, and consistent mask-wearing instead of being quarantined for 14 days [103]. This option is controversial and not without considerable risks as pre-symptomatic spread is believed to be a primary source of epidemic spread. This option should be carefully weighed between the industry sector, criticality of the job, job requirements, and risks of an infectious individual in that particular workplace. This option is likely unduly risky if the workforce or work group is mission critical.

Commonly Asked Questions by Employees

If the family member is not ill, the employee may not be entitled to any statutory or company leave programs.  However, your company could offer personal leave time to cover the quarantine period.  If the family member is subsequently diagnosed with the virus, your employee may be entitled to either a statutory or company
leave program.

Unless the employee is ill, they are likely not entitled to any statutory or company leave programs. However, your company may choose to offer personal leave time.

Unless the employee is ill, they are likely not entitled to any statutory leave, but they might be eligible for other company leave programs.

Follow your normal leave process.  If the absence is supported medicallythen it may qualify as a serious health condition.  If it’s not a serious health condition, the option would be an alternate leave plan (company sponsored or statutory leave).

Since the leave time is unrelated to the child’s illness, your employee may not be entitled to statutory or company leave program.  However, your company may offer personal leave time to cover the time period of the child’s school closing.  Some of our clients are offering employees personal leaves in the event of school closures.

Policy & Regulation Impacts

Yes, several states have provided update guidance or enhanced leave policies. On the right-hand side of this page, you’ll find a running list…we are adding new links frequently as we learn of new legislation.

We are following the progress of the relevant Federal legislation closely, and will provide guidance via this FAQ once a law passes.

Coronavirus Leave of Absence Statutory Guidelines

Click the image to view and download the latest Statutory Updates

Additional Coronavirus Leave of Absence Questions

In terms of leave eligibility, we’ve advised ReedGroup clients to manage claims as they normally would under their plans.  For example, if an employee does not meet the requirements for FMLA or STD, even if quarantined, they would not be entitled to leave under these programs.  However, the employer may consider providing that employee with PTO for the quarantined period or allow them to work from home if possible.  We are deferring to our clients’ directives as to how they would like these claims managed; large employers can have very different operational needs.

We are seeing various applied methods including paid leave for a certain period of time, the use of personal leave, and utilization of paid time off. One example: authorizing a paid, “excused” absence for 14 days.

Our primary recommendation: allow the employee to work from home where able.  In instances where the employee is unable to perform the functions of their job in a work from home environment, we recommend employers look to existing leave policies and procedures up to and including  leave as an accommodation. 

If an employee is asked not to report to work, and is unable to substantiate that they have a serious health condition, the employee should follow the normal expected path for leave of absence requests  in order to determine what, if any, applicable leave types they may be eligible for based on their situation. 

To date, we have not seen any increase in mental health claims related to Coronavirus.

We’ll update this page with additional information and resources as they become available.

State and Federal Guidelines and Resources Related to Work & Coronavirus

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