From AHS’ COVID-19 Scientific Advisory Group (SAG): is there risk associated with shortening the quarantine period for healthcare workers?

AHS’ COVID-19 Scientific Advisory Group (SAG) recently investigated the latest evidence from around the world pertaining to a key question: is there risk associated with shortening the quarantine period for healthcare workers (HCW)?

Managing infection exposure includes testing, quarantine and monitoring symptoms. Currently in Alberta, HCW are required to quarantine for 14 days following a significant exposure. However, recommendations on length of quarantine vary around the world. The degree of risk exposure, whether usual or high, ought to be taken into consideration when determining quarantine duration.

Recommendations:

• Usual risk scenario: HCW should quarantine for 10 days (from last exposure) before consideration of return to work if:
  1. Tested negative at day eight following the last exposure;
  2. Exposure was deemed to be usual risk*;
  3. Remained asymptomatic throughout the 10-day quarantine;
  4. Confirmed no household nor community contact with a known COVID-19 positive case in the preceding 14 days; and
  5. Follows health recommendations upon return to the workplace for continuous masking, appropriate PPE, hand hygiene and continued self-monitoring of symptoms.

*Usual risk does not meet criteria for high risk, as defined below:

• High-risk scenario: HCW should quarantine for 14 days from last exposure before consideration of a return to work.

High-risk is operationally defined by contact or exposure event risks.

Contact assessment—high-risk includes:

1. Contact with a source case who was unmasked and had respiratory symptoms
2. Close contact with respiratory droplet contamination
3. Prolonged exposure (> 15 minutes) to an AGMP without proper PPE
4. Interacting in a confined case with source case
5. Multiple exposures to source case in short duration (> 15 minutes)

OR

Exposure event—high-risk includes:

Significant exposure in a high-risk exposure event (e.g., an outbreak with the possibility of a high attack rate based on the evolving scenario, or exposure to a source case with demonstrated spread to others with similar exposure parameters during the likely infectious time period).

• Positive COVID-19 HCW must isolate for 10 days after symptom onset before consideration of a return to work. Although most immunocompromised HCW may be eligible for 10-day isolation before considering a return to work, Workplace Health & Safety (WHS) assessment regarding duration of isolation is needed as severely immunocompromised individuals may have prolonged viral shedding and guidance may evolve.

Please review the recommendations within the school reopening report.