Operating Safely GUIDE

How restaurants and foodservice operations can adopt safe practices while operating efficiently

What To Do When an Employee Gets Sick with COVID-19 or Other Contagious Illnesses

The data and recommendations below are from The Acheson Group for US Foods^®

Below we outline 7 general scenarios covering symptomatic and asymptomatic employees based on travel and close-contact exposure risks for COVID-19. Each specific scenario will consist of its own fact set. Complete information may not be available about employee travel or exposure histories.

Quick Links to Sections:

Information to Collect and Immediate Actions I  | Confirmed Employee Case | I Employee has COVID-19 Symptoms I Asymptomatic | Exposed Employee | Asymptomatic with No Exposure | Ill Employee with No Positive Test | COVID Positive Employee in Isolation  | Asymptomatic COVID Positive Employee

Information that should be collected from Symptomatic Employees Immediately:

Regardless of the risk scenario described below, the following information should be obtained from a symptomatic employee:

• What is the employee’s work location?
• What are the employee’s work hours?
• What are the employee’s general and specific work duties?
• Does the employee work in one location or do they travel throughout the building or to multiple sites?
• What was the last day the employee was at work?
• Did the employee start to feel sick while they were at work?
  • If so, what date and what time?
• Has the employee been tested for COVID-19 or have they considered getting a test?
  • If so, when do they expect test results?
• Has employee been in contact with a known or suspected COVID-19 case?
• Who did the employee have close contact with (physical contact or within 6 feet for more than 10-15 minutes) 48 hours before the employee became ill or during their last day at work? (Collect this information as it will determine other employees that may need to self-quarantine if the employee were to test positive in the future.)
• Has the employee had close contact with a known or suspected COVID-19 case in their household?
• Does the employee live with any other employees?
• Does employee carpool with any employees to work?
• Who does the employee take breaks or have meals with?
• Does employee share an office with others?
  • If so, who?
• Does the employee regularly work within 6 feet of others?
  • If so, who?

Scenario 1 – Confirmed COVID-19 Case in an Employee

You are likely to learn about a confirmed case because:

• You are contacted by a relevant health department to inform you one of your employees is a confirmed case; or
• The employee is diagnosed and calls you as the employer; or
• In rare instances, the employee shows up at work to communicate this. (In this case, IMMEDIATELY send the employee home and self-isolate – staying 6 feet away from everyone until fully recovered).

See recommended actions under scenario 2.

Scenario 2 - Employee has COVID-19 symptoms 

Symptoms may include (fever or chills, cough, shortness of breath or difficulty breathing, fatigue, muscle or body aches, headache, new anosmia, sore throat, congestion or runny nose, nausea or vomiting, and diarrhea, or oxygen levels <90%) or becomes sick with these symptoms at work.

Recommended actions for high risk and symptomatic (Scenario 1 or Scenario 2):

1. Because many regions of the world are or will be experiencing widespread community transmission, TAG recommends that close contact exposure to anyone with “clinically compatible illness” should be considered a possible COVID-19 exposure that warrants self-quarantine unless guidance from local health agencies indicates otherwise.

2. For Scenario 2, if employee is experiencing:

a. Any primary symptoms, they should be immediately sent home and should self-isolate.

b. Two or more secondary symptoms, employee should be sent home and instructed to call a health-care provider and return to work based on healthcare advice.

3. Verify that the employee has sought medical diagnosis and treatment as needed. If the employee has not sought medical diagnosis and treatment, encourage them to do so.

4. Send a communication to potentially affected staff that includes recommendations from the relevant health department.

5. Clean and disinfect the immediate work area of the employee and common areas in the facility.

6. Identify potential close contacts of the case (those that would have been within 6 feet of the case for more than 10-15 minutes 48 hours before the employee became symptomatic) in the facility. These close contacts should self-quarantine at home and contact their respective healthcare providers by phone.

Scenario 3 - Asymptomatic employees exposed to someone with symptomatic COVID-19.

Employee is a household member or intimate partner or has had close contact (<6 feet [2 meters] for more than 10-15 minutes) with a person with symptomatic COVID-19 during an exposure period:

• From 48 hours before symptoms onset until the COVID-19 case meets the criteria for discontinuing home isolation. This is the timeframe when the COVID-19 case may be infectious.

• The COVID-19 case can be a laboratory-confirmed case or a case with clinically compatible illness in a state or territory with widespread community transmission.

Recommended actions for high risk and asymptomatic, Scenario 3:

1. Employee should stay home (self-quarantine) from work until 14 days after their last exposure to a COVID-19 case and maintain a social distance of 6 feet (2 meters) from others at all times.

2. They should self-monitor for symptoms and check their temperature twice a day and watch for fever or chills, cough, shortness of breath or difficulty breathing, fatigue, muscle or body aches, headache, new anosmia, sore throat, congestion or runny nose, nausea or vomiting, and diarrhea or oxygen levels <90% . They should also avoid contact with people at higher risk for severe illness (unless they live in the same home and have had the same exposure).

3. If telework is an option for an asymptomatic employee, this can be used so long as the employee does not come to the workplace or directly interacts with other employees.

Scenario 4 – Asymptomatic employees with no known exposure risks

Recommendations for Scenario 4:

1. Healthy employees should continue heightened handwashing and hygiene practices, including social distancing and not touching the face.

2. They should also be alert for symptoms of COVID-19 including: fever or chills, cough, shortness of breath or difficulty breathing, fatigue, muscle or body aches, headache, new anosmia, sore throat, congestion or runny nose, nausea or vomiting, and diarrhea, or oxygen levels <90%. They should take their temperature if fever develops and stay home from work if they have any of these symptoms.

Scenario 5 - An employee that has been out ill with symptoms consistent with COVID-19 but has not been tested or has tested negative.

Recommendations for Scenario 5:

1. The employee should remain at home under isolation until:

a. At least 1 day (24 hours) has passed since resolution of fever without the use of fever-reducing medications, AND

b. Improvement in symptoms (e.g., cough, shortness of breath, anosmia10); AND

c. At least 10 days have passed since symptoms first appeared

For employees with severe to critical illness, or who are severely immunocompromised, the recommended duration for work exclusion is extended to 20 days after symptom onset (or, for asymptomatic severely immunocompromised employees, 20 days after their initial positive SARS-CoV-2 diagnostic test).

2. For example, if an employee has had a fever and was coughing for 4 days, they need to stay home 6 more days with no fever for a total of 10 days. Or, if they have a fever and were coughing for 5 days, they need to stay home for 5 more days with no fever for a total of 10 days.

3. There is emerging evidence that individuals may retest positive for COVID-19 after symptom resolution. As such, a test-based strategy is no longer the recommended method to determine when to allow employees to return to work. Depending on testing availability, you may elect to continue using a test-based strategy to allow employees to return to work. If so, employees in Scenario 5 should be tested, and receive a negative test, prior to returning to work. To ensure business continuity, you should seek to facilitate testing arrangements for your employees for the return-to-work process. It is unlikely that someone who has fully recovered from their COVID-19 infection and is no longer symptomatic will infect others.

4. If an employee has been evaluated by a healthcare provider for COVID-19 and tests negative or receives an alternative diagnosis, they may return to work 24 hours after symptoms have improved. In this case, the time out with symptoms may be less than 10 days since the infection is determined to be non-COVID related.

Scenario 6 – An employee has been in isolation and tested positive for COVID-19

Recommendations for Scenario 6:

1. Because COVID-19 testing resources are limited, it is unlikely that someone with a COVID-19 laboratory diagnosis will be retested to be released from isolation. In consultation with the employee’s healthcare provider, the employee may be able to return to work after all the following requirements are met:

a. At least 1 day (24 hours) has passed since resolution of fever without the use of fever-reducing medications, AND

b. Improvement of symptoms (e.g. cough, shortness of breath, anosmia10); AND

c. At least 10 days have passed since symptoms first appeared.

For employees with severe to critical illness, or who are severely immunocompromised, the recommended duration for work exclusion is extended to 20 days after symptom onset (or, for asymptomatic severely immunocompromised employees, 20 days after their initial positive SARS-CoV-2 diagnostic test).

d. They should also be in contact with their healthcare provider to assist in making a return-to-work determination.

2. If testing is available and in conjunction with their healthcare provider, employee may return to work if all the following requirements are met:

a. The patient is free from fever without the use of fever-reducing medications.

b. The patient is no longer showing symptoms, including cough.

c. The patient has tested negative on at least two consecutive respiratory specimens collected at least 24 hours apart.

3. There is emerging evidence that individuals may retest positive for COVID-19 after symptom resolution. As such, a test-based strategy is no longer the recommended method to determine when to allow employees to return to work. Depending on testing availability, you may elect to continue using a test-based strategy to allow employees to return to work. If so, employees in Scenario 6 should be tested and receive two negative tests prior to returning to work. To ensure business continuity, you should seek to facilitate testing arrangements for your employees for the return-to-work process. It is unlikely that someone who has fully recovered from their COVID-19 infection and is no longer symptomatic will infect others.

Scenario 7 – An employee has tested positive for COVID-19 but has never experienced any symptoms (was always asymptomatic)

Recommendations for Scenario 7:

1. Persons with laboratory-confirmed COVID-19 who have not had any symptoms and were directed to care for themselves at home may discontinue isolation under the following conditions:

a. At least 10 days have passed since the date of their first positive COVID-19 diagnostic test, assuming they have not subsequently developed symptoms since their positive test.

b. If they develop symptoms, then the symptom-based or test-based strategy should be used.

c. NOTE: As symptoms cannot be used to gauge where these individuals are in the course of their illness, it is possible that the duration of viral shedding could be longer or shorter than 10 days after an individual’s first positive test.

2. Persons with laboratory-confirmed COVID-19 who have not had any symptoms and were directed to care for themselves at home may discontinue isolation under the following conditions:

a. Discontinue isolation and other precautions 10 days after the date of their first positive RT-PCR test for SARS-CoV-2 RNA.

Immediate Actions You Should Take if an Employee Tests Positive:

There are several ways you may learn that an employee has tested positive for COVID-19, including being directly informed by the employee, their family, or the health department. TAG recommends the following immediate steps:

1. Collect information about the employee and their close contacts:

• What is the employee’s work location?
• What are the employee’s work hours?
• What are the employee’s general and specific work duties?
• Does the employee work in one location or do they travel throughout the building or to multiple sites?
• Did the employee start to feel sick while they were at work?
• If so, what date and what time?
• What was the last day the employee was at work?
• Has the employee been tested for COVID-19 or have they considered getting a test?
• If so, when do they expect test results?
• Has employee been in contact with a known or suspected COVID-19 case?
• Who did the employee have close contact with (physical contact or within 6 feet for more than 10-15 minutes) 48 hours before the employee became ill or during their last day at work? (Collect this information as it will determine other employees that may need to self-quarantine if the employee were to test positive in the future.)
• Has the employee had close contact with a known or suspected COVID-19 case in their household?
• Does the employee live with any other employees?
• Does employee carpool with any employees to work?
• Who does the employee take breaks or have meals with?
• Does employee share an office with others?
• If so, who?
• Does the employee regularly work within 6 feet of others?
• If so, who?

2. Clean and disinfect the employee’s immediate work area and all common areas:

• Ideally the employee’s personal work area and common areas were cleaned when/if the employee went home when they began feeling sick.
• If not, immediately clean and disinfect the immediate work area (office, cubicle, workstation, workbench, etc.) using processes described in the “Enhanced Sanitization and Disinfection of Facilities” section of the Toolkit.

3. Prepare necessary internal and external communications:

• Determine the necessary extent of internal and external communications. Consider if communication needs to be company-wide or targeted at the work location of the positive employee.
• If the employee has contact with the public or offsite customers, consider communication messaging with these audiences and in consultation with the local health department.