Employers Advised to Weigh Their Own Risk Tolerance in Face of CDC Guidelines

Sarasota, FL (WorkersCompensation.com) – Calling them “confusing” and “counterproductive,” the American Medical Association has condemned the Centers for Disease Control and Prevention’s latest COVID-19 guidelines. The agency recently shortened the recommended isolation period from 10 to five days for those who test positive but are asymptomatic or have only mild symptoms. The AMA’s formal statement comes as many employers and others have also questioned the new guidelines in the face of spiking cases, largely due to the highly transmissible Omicron variant.

While the change may be “concerning,” the guidelines are not enforceable, says one expert. Each company should decide its own best course of action based on its industry and worker population.”

The Change

“Given what we currently know about COVID-19 and the Omicron variant, CDC is shortening the recommended time for isolation for the public,” the CDC’s statement reads. “The change is motivated by science demonstrating that the majority of SARS-CoV-2 transmission occurs early in the course of illness, generally in the 1-2 days prior to onset of symptoms and the 2-3 days after.”

Specifically, the CDC says those who test positive should quarantine for five days if either they are asymptomatic or their symptoms “are resolving (without fever for 24 hours),” then wear a mask for the next five days.

The guidelines do not suggest people test negative for the virus before ending their isolation. In an updated statement this week, the CDC said tests for the virus “are best used early in the course of illness to diagnose COVID-19 and are not authorized by the U.S. Food and Drug Administration to evaluate duration of infectiousness.” There are some patients who will remain positive long after the expected infectiousness period. “The significance of a positive or negative antigen test late in the course of illness is less clear; while a positive antigen test likely means a person has residual transmissible virus and can potentially infect others, a negative antigen test does not necessarily indicate the absence of transmissible virus.”

The head of the CDC defended the new guidelines, saying they were based on what the agency believes people would be able to tolerate. If they feel well enough to be at work they would not necessarily tolerate staying home, she said.

“The recommendations reflect the societal impact (e.g., critical infrastructure and staffing shortages) and the latest science on disease severity and when and for how long a person is maximally infectious,” the CDC said. “CDC will continue to evaluate these recommendations as more data become available.”

Criticism

The AMA this week said the new guidelines “are not only confusing but are risking further spread of the virus.” The statement from Gerald E. Harmon, MD, president of the AMA said not getting a negative test before ending isolation risks further transmission of the virus.  

“Physicians are concerned that these recommendations put our patients at risk and could further overwhelm our health care system,” the AMA statement continued. “Test availability remains a challenge in many parts of the country, including in hospitals, and we urge the administration to pull all available levers to ramp up production and distribution of tests. But a dearth of tests at the moment does not justify omitting a testing requirement to exit a now shortened isolation.”

Advice for Employers

The change from 10 to five days of isolation increases the risk of lingering infection by about 10 percent, according to the CDC. While that can be concerning for some organizations, it’s important to weigh the risks and benefits.

“Every company should actually be the custodian of their own risk tolerance,” said Scott Cherry, DO, chief Medical Officer for Axiom Medical. “Is 10% too much for them, because it can potentially lead to outbreaks they can no longer control or maintain a certain operating ability.”

The CDC is an advisory agency and, technically, does not have enforcement power for its guidelines, Cherry said. Therefore, each organization should evaluate its own risk tolerance when establishing policies and procedures for returning employees who test positive for the virus.

For example, are employees working in close proximity to one another, or can they be socially distanced? Are they interacting with the public? Are they older and/or do they have underlying health conditions? Is the workplace well ventilated?

Some states may dictate employers’ policies regarding returning positive employees. California-OSHA, for example, has issued a requirement for 10 days of isolation following a positive test. Others have, or may follow suit.

“We wondered if the CDC would pull back their guidance, but it doesn’t look like it,” Cherry said. “I’m not sure if other states will go along with the old guidance or have even more nuanced guidance.”

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