What are the recommended work restrictions for individuals with Covid-19 (Coronavirus disease 2019)?

Work Restrictions for COVID-19 Individuals

Individuals with COVID-19 should not go to work if they are feeling sick, have a fever, or have respiratory symptoms such as cough or shortness of breath, and should isolate for at least 5 days from symptom onset or positive test if asymptomatic. 1, 2

General Work Restriction Guidelines

The International Journal of Occupational and Environmental Medicine provides clear guidelines for work restrictions related to COVID-19:

For Infected Individuals:

• Stay home if you have any COVID-19 symptoms (fever, cough, shortness of breath) 2
• Isolate for a minimum of 5 days from symptom onset or positive test if asymptomatic 1
• Earlier in the pandemic, a full 10-day isolation was recommended 1
• Return to work should be based on symptom resolution and testing status

Screening Protocols:

• Verbal screening and temperature checks should be conducted at the start of each shift 2
• Screening questions should include:
  • Presence of fever, chills, cough, or difficulty breathing
  • Contact with known COVID-19 cases in the past 14 days 2

Risk-Based Approach to Work Restrictions

Evidence shows that healthcare personnel (HCP) with high-risk occupational exposure have:

• Increased probability of developing COVID-19 (4.5% of high-risk exposures)
• Higher rates of hospitalization and absenteeism 3

Based on exposure risk, the following approach is recommended:

1. High-risk exposure: 7-day exclusion from work is justified 3
2. Moderate-risk exposure: Monitor for symptoms, may continue working with precautions
3. Low-risk exposure: Continue working with regular symptom monitoring

Workplace Prevention Measures

When returning to work, individuals should follow these guidelines:

• Maintain physical distancing of at least 2 meters from others 2, 4
• Wear a face mask to protect others 2
• Practice frequent hand hygiene with soap and water for at least 20 seconds 2
• Use alcohol-based hand sanitizer (>60% ethanol or >70% isopropanol) when handwashing isn't available 2
• Avoid large gatherings or meetings of 10 or more people 2
• Drive to worksites alone - no carpooling 2
• Disinfect shared equipment and surfaces regularly 2

Special Considerations for Healthcare Workers

Healthcare workers require additional precautions:

• Use appropriate PPE including N95/FFP2 respirators during aerosol-generating procedures 1
• Implement full airborne isolation precautions when managing patients with COVID-19 symptoms 1
• Change out of work clothing/uniforms at the worksite to prevent home contamination 2

Pitfalls and Caveats

1. Droplet vs. Airborne Transmission: Evidence suggests COVID-19 transmission cannot be neatly separated into droplet versus airborne routes. Studies show droplets can travel more than 2 meters (up to 8 meters in some cases), and SARS-CoV-2 can remain viable in aerosols for 3 hours 5.

2. Relying solely on symptom screening: Some infected individuals may be asymptomatic or pre-symptomatic but still capable of transmitting the virus.

3. Insufficient isolation periods: Returning to work too early may lead to workplace transmission.

4. Mental health considerations: Extended isolation and work restrictions may impact mental health. Home-based exercise and activities should be encouraged during isolation periods 6.

The CDC recommends a strategic approach to minimizing COVID-19 impact that relies on vaccination, therapeutics to prevent severe illness, multicomponent prevention measures, and particular emphasis on protecting high-risk individuals 7.