New IDPH Guidance: Health Workers Can Keep Working After COVID-19 Exposure, If They're Asymptomatic

Mar 23, 2020

The Iowa Department of Public Health is directing essential employees to keep working, even if they have been exposed to someone who has COVID-19. The recommendations come as the number of confirmed cases in the state continues to increase and as officials scramble to secure adequate supplies of personal protective equipment or PPE.

The new IDPH guidance dated March 22 recommends that essential employees can continue working after a potential COVID-19 exposure so long as they remain asymptomatic.

Employees considered essential include healthcare providers, law enforcement officers, firefighters and EMS workers, employees at long-term care facilities and other public health and emergency management personnel.

“Essential services personnel are allowed to go to work as long as they remain asymptomatic and monitor their temperature at the beginning and end of their shift,” the guidance reads in part. “If essential services personnel become symptomatic at any point during their shift, they should be sent home immediately and self-isolate.”

Public health officials are urging all residents to drastically limit physical contact with others by practicing social distancing and to limit trips outside the home as much as possible.

The IDPH guidance explains that essential personnel can be considered exposed to COVID-19 if they’ve traveled outside of Iowa in the last 14 days; taken a cruise in the last 14 days; live with someone who has symptoms of the disease or has tested positive; provided care for a patient with symptoms of the disease or has tested positive without using proper PPE; or had close contact (within six feet for more than two minutes) with a person who is visibly sick with respiratory symptoms or says they are sick with those symptoms.

The change follows updated guidance from the Centers for Disease Control and Prevention.

At earlier stages in the nation’s coronavirus response, scores of healthcare workers in other states were quarantined for two weeks after being exposed to COVID-19, sidelining sorely-needed providers during a health crisis the scale of which the country hasn’t seen in a century.

It is true there's asymptomatic spread, and there is potential that that may happen. But I think [UnityPoint and Mercy Cedar Rapids] have taken steps to minimize, should that occur. -Dustin Arnold, Chief Medical Officer, UnityPoint Cedar Rapids

“With a mask and other precautions, those individuals can come back safely to work,” said Sean Williams, president and CEO of Mercy Hospital in Iowa City, which is following the recommendations. “It’s a changing target that CDC is putting out for recommendations and IDPH as well so we follow those exclusively. When they say, ‘a person is safe under certain circumstances’ that’s what we follow.”

For essential personnel who do become symptomatic, the IDPH guidelines direct them to go home immediately and self-isolate until: they’ve had no fever for at least 72 hours (without the aid of fever reducers); and other symptoms have improved; and at least seven days have passed since symptoms first appeared.

While the recommendations stem from recent guidance by the CDC, they stand in apparent contrast to other research indicating that it is possible for people to transmit the novel coronavirus before they become symptomatic, though the scale of this kind of covert transmission isn’t clear.

Researchers say that some individuals who become infected will never experience symptoms, or have symptoms so mild that they don’t recognize them.

Dustin Arnold, Chief Medical Officer at UnityPoint Cedar Rapids, says that through the use of PPE, employee health screenings during shifts, and strict limits of visitations, hospitals are limiting the potential that healthcare providers themselves could spread the disease.

“It is true there’s asymptomatic spread, and there is potential that that may happen. But I think [UnityPoint and Mercy Cedar Rapids] have taken steps to minimize, should that occur,” he said.

University of Iowa Hospitals and Clinics CEO Suresh Gunasekaran alerted staff over the weekend that hospital would also be adopting these changes to allow employees to keep working as long as they don’t show symptoms.

“With COVID-19 now in our community, you can expect to know someone who has the disease. As we continue to respond, it is important to take care of yourself by practicing good hand hygiene and social distancing whenever possible. It’s also important to be transparent about any potential exposures,” he wrote in a message to staff.

The changes come as clinicians in the hard-hit city of Bergamo in the Lombardy region of Italy are warning the rest of world what could be in store if they don’t establish a system to adequately care for patients during the pandemic. A group of physicians at the epicenter of the COVID-19 outbreak penned an article in the journal NEJM Catalyst Innovations in Care Delivery.

“[W]e are learning that hospitals might be the main Covid-19 carriers, as they are rapidly populated by infected patients, facilitating transmission to uninfected patients,” the article reads in part. “Health workers are asymptomatic carriers or sick without surveillance; some might die, including young people, which increases the stress of those on the front line.”