Return to Work for HCWs with Confirmed or Suspected COVID-19 and Management of HCWs Exposures to COVID-19

Updated on: June 29, 2022

The Ministry of Health has updated the Interim Guidance on Return to Work for Health-Care Workers with Confirmed or Suspected COVID-19. The updated guidance includes information on management of health-care workers (HCWs) following a close contact exposure and replaces the Recommendations for Risk Assessment and Management of Health-Care Worker Exposures to COVID-19 guidance as well as the previous exposure risk assessment tool. ​

This guidance is intended for health-care employees, workplace health and safety (WHS), public health staff and medical health officers (MHOs) to support decision-making on return to work for health-care workers (HCW) with confirmed or suspected COVID-19 illness, including:

• HCWs with a positive COVID-19 test, for example, rapid antigen test (RAT) or polymerase chain reaction (PCR);
• HCWs with symptoms compatible with COVID-19 who tested negative or who were not tested;
• HCWs who travelled outside of Canada; and
• HCWs who had close contact with a confirmed COVID-19 case.
  
   

This guidance applies to all health-care facilities, programs and services, including acute care, long-term care and seniors' assisted living, community physician and primary care provider offices, outpatient clinics, and settings where health-care services are provided.

Here's what is new or different:

Criteria for return to work based on COVID-19 immunization status

• There are now two tables of criteria – one for fully immunized and one for partially immunized or unimmunized HCWs – that HCWs need to meet before they can return to work, subject to the status of their COVID-19 test or risk factors (pgs. 2- 6).
• For HCWs who are fully immunized and tested positive for COVID-19, the following changes have been made:
  
  • In alignment with the latest public health management advice, they may return to work if their symptoms have improved, and fever has resolved for 24 hours without the use of fever reducing medication (timeframe added) (pg. 2); and
  • They must self-isolate for at least five days from the onset of their symptoms before they can return to work, in addition to taking other return to work precautions as required (pg. 2).

• In alignment with the latest public health management advice, HCWs who test positive for COVID-19 and are partially or unimmunized, need to self-isolate until at least 10 days have passed since the onset of their symptoms (pg. 7).
• With respect to HCWs who are not tested, but have symptoms that meet testing criteria, the self-isolation periods for returning to work have been added:
  
  • Those who are fully immunized need to self-isolate until at least five days have passed since the onset of symptoms (pg. 3); and
  • Those who are partially or unimmunized need to self-isolate until at least 10 days have passed since onset of symptoms (pg. 5).
• Examples of persistent, mild respiratory symptoms and other protective measures including wearing a mask at all times have been added to both tables of criteria (pgs. 2, 3, 5)

 NEW - Management of HCWs with Close Contact Exposures:

• On page 8, the Recommendations for Risk Assessment and Management of Health-Care Worker Exposures to COVID-19 Patients guidance and exposure risk assessment tool have been condensed into this new section for management of all HCWs following a close contact exposure regardless of vaccination status.
  
  • The update was made to reflect the latest public health management information and to avoid repetition. Additional information such as links to other resources have been included in this updated guidance.

Return to Work Precautions:

• A clarification has been added that in general, returning to work while symptomatic should be considered the exception and not the rule, and should be avoided in settings with patients who are at risk of developing more severe disease or outcomes from COVID-19 (pg. 8).
• The list of return-to-work precautions has been updated for those returning to work earlier than recommended, between day five to 10 from the onset of symptoms or after a close contact exposure. o HCWs who have symptoms should avoid contact with severely immunocompromised patients and others who are at risk of developing severe illness until at least 10 days (previously 14 days) have passed since symptom onset or until their symptoms have resolved (pg. 9).
  
   

Other changes:

• The reference to quarantine period has been condensed with a hyperlink to the Government of Canada’s Quarantine Order which provides more information.
• The incubation period and period of communicability for SARS-CoV-2, which was in the Recommendations for Risk Assessment and Management of Health-Care Worker Exposures to COVID-19 Patients guidance, have been condensed with a hyperlink to the BCCDC’s interim guidance on public health management of cases and contacts​ associated with novel coronavirus (COVID-19) which provides more information and to avoid duplication.​

Reminders:

• All HCWs and staff must follow immunization-related requirements in accordance with orders and policies from the provincial health officer (PHO), their local medical health officer (MHO), their regulatory college and their employer. This requires HCWs and staff specified in the PHO's Hospital and Community (Health Care and Other Services) COVID-19 Vaccination Status Information and Preventive Measures order to be fully vaccinated for COVID-19 to work unless medically exempt.
• The decision to extend self-isolation for HCWs beyond the timelines in this document should be made in consultation with an individual's most responsible medical provider. The decision to discontinue self-isolation earlier than recommended should be made in consultation with MHOs, public health and WHS based on the potential risk of transmission to others (pg. 1)
• All HCWs who have a risk factor(s) associated with COVID-19 need to self-monitor for symptoms regardless of their vaccination/recent infection status (pgs. 4, 6, 8).