Is it safe for a patient who has been sick for 2 days to return to work today without being seen in the office?

Work Note for Patient Returning After 2-Day Illness

The patient may return to work today if they have been fever-free for at least 24 hours without fever-reducing medications and their symptoms have improved. 1, 2

Return-to-Work Criteria

The decision to clear this patient for work depends on the specific illness and symptom resolution:

For Influenza-Like Illness

• Minimum requirement: 24 hours fever-free without antipyretics (acetaminophen, ibuprofen) AND improvement in respiratory symptoms 2
• After only 2 days of illness, the patient is likely still within the infectious period (typically 5-7 days from symptom onset) 2
• Most patients with influenza should NOT return after only 2 days, as they remain contagious for approximately 5 days after symptom onset 2

For COVID-19

• Standard isolation period: 10 days from symptom onset, PLUS 24 hours fever-free without antipyretics, PLUS improvement in other symptoms 1
• After only 2 days, this patient does not meet criteria for return to work if COVID-19 is suspected or confirmed 1

For Non-Specific Viral Illness

• If symptoms are mild and non-respiratory (e.g., gastrointestinal symptoms that have resolved), return after 24 hours symptom-free may be appropriate 2
• The patient must be completely fever-free for 24 hours without medications 1, 2

Critical Assessment Points

Before clearing for return to work, verify:

• Current temperature (must be <100.4°F without antipyretics for 24+ hours) 1, 2
• Absence of cough, shortness of breath, or other respiratory symptoms 1
• No recent COVID-19 exposure in past 14 days 3
• Improvement in all other symptoms 1, 2

Workplace Safety Measures Upon Return

If cleared to return, the patient should:

• Wear a face mask if any residual cough persists, especially within 6 feet of others 1, 3
• Practice rigorous hand hygiene (wash hands for 20 seconds or use >60% alcohol-based sanitizer) 3
• Maintain physical distance of at least 6 feet from coworkers 1, 3
• Avoid touching eyes, nose, or mouth with unwashed hands 3

Common Pitfalls to Avoid

Do not clear for return if:

• The patient has taken fever-reducing medications in the past 24 hours, even if currently afebrile 1, 2
• Respiratory symptoms (cough, shortness of breath) are still present or worsening 1
• The illness is confirmed or suspected COVID-19 and the patient has not completed 10 days of isolation 1
• The patient works in healthcare or with vulnerable populations and still has any symptoms 1

Key consideration: Returning to work too soon can lead to workplace outbreaks and puts coworkers at risk 1. When in doubt, extend the work restriction by 24-48 hours and reassess.

Documentation for Work Note

If clearing for return today, document:

• Patient has been fever-free for 24+ hours without antipyretics 1, 2
• Symptoms have improved or resolved 1, 2
• Patient counseled on mask use if residual cough, hand hygiene, and physical distancing 1, 3

If NOT clearing for return, document:

• Specific symptoms still present 1, 2
• Expected duration of continued work restriction (typically until day 5-7 for influenza, day 10+ for COVID-19) 1, 2
• Instructions for follow-up if symptoms worsen 1