Risk Assessment for Non-Healthcare Workers

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One of the critical aspects of COVID-19 control is the timely and effective quarantine/isolation of individuals who may have been exposed to the virus.  CDC guidelines divide these recommendations into two sets, one for exposures in the general public and one for healthcare workers exposed in the course of patient care.  The information below is the recommendation for non-healthcare exposures. See risk assessment and care for healthcare workers hereTables modified from CDC.

Note: the criteria for testing for COVID-19 are state-specific.  As of now there is no centralized list of these criteria.  CDC criteria can be found here but may differ from your state’s recommendations.

Risk Assessment and Quarantine/Isolation for Covid-19 Exposures in the General Public (last updated on March 13, 2020)

  1. The first step in determining risk and need for quarantine/isolation is determining the level and mode of exposure to the virus (Table 1). For the most up-to-date country by country risk, see here. We will also update this document as things change.
  2. Once risk is determined, look at Table 2 for appropriate isolation/quarantine precautions. Information courtesy of CDC.
  3. Last step:
    1. Appropriate homecare for those infected or with suspected disease can be found summarized here and here, and found in full here.
    2. Appropriate home isolation measures and measures for household members and care givers and those exposed to COVID-19 can be found summarized here  and here, and found in full here.

Table 1. Risk Categories for Exposures Associated with International Travel or Identified during Contact Investigations of Laboratory-confirmed Cases

Table 1: Risk Categories for Exposures Associated with International Travel or Identified during Contact Investigations of Laboratory-confirmed Cases (modified 13 March 2020 based on new country categorizations)

Risk Level

Geographic (Travel-associated) Exposures*

Exposures Identified through Contact Investigation

High

Travel from China, Iran and  the European Union (information courtesy of the CDC). All countries are Level III travel restrictions.

Living in the same household as, being an intimate partner of, or providing care in a nonhealthcare setting (such as a home) for a person with symptomatic laboratory-confirmed COVID-19 infection without using recommended precautions summarized here  and here.

Medium

(assumes no exposures in the high-risk category)

Travel from a country with sustained community transmission including South Korea and Malaysia

  • Close contact with a person with symptomatic laboratory-confirmed COVID-19
  • On an aircraft, being seated within 6 feet (two meters) of a traveler with symptomatic laboratory-confirmed COVID-19 infection; this distance correlates approximately with 2 seats in each direction
  • Living in the same household as, an intimate partner of, or caring for a person in a nonhealthcare setting (such as a home) to a person with symptomatic laboratory-confirmed COVID-19 infection while consistently using recommended precautions summarized here and here.

Low

(assumes no exposures in the high-risk category)

Travel from any other country

Being in the same indoor environment (e.g., a classroom, a hospital waiting room) as a person with symptomatic laboratory-confirmed COVID-19 for a prolonged period of time but not meeting the definition of close contact

No identifiable risk

Not applicable

Interactions with a person with symptomatic laboratory-confirmed COVID-19 infection that do not meet any of the high-, medium- or low-risk conditions above, such as walking by the person or being briefly in the same room.

*In general, geographic exposure categories do not apply to travelers who only transit through an airport.

Once the risk of exposure has been determined in table 1, check table 2 to determine the appropriate type of isolation.


Table 2. Summary of CDC Recommendations for Management of Exposed Persons with by Risk Level and Presence of Symptoms

Table 2: Risk Level

Risk Level

Management if Asymptomatic

Management if Symptomatic1

High risk

  • Quarantine (voluntary or under public health orders) in a location to be determined by public health authorities.
  • No public activities.
  • Daily active monitoring, if possible based on local priorities
  • Controlled travel
  • Immediate isolation with consideration of public health orders
  • Public health assessment to determine the need for medical evaluation; if medical evaluation warranted, diagnostic testing should be guided by the most recent recommendations from your state’s Public Health Department.
  • If medical evaluation is needed, it should occur with pre-notification to the receiving health care facility (HCF) and emergency medical services (EMS), if EMS transport indicated, and with all recommended infection control precautions in place.
  • Controlled travel: Air travel only via air medical transport. Local travel is only allowed by medical transport (e.g., ambulance) or private vehicle while symptomatic person is wearing a face mask.

Medium risk

Close contacts in this category:

  • Recommendation to remain at home or in a comparable setting
  • Practice social distancing
  • Active monitoring as determined by local priorities
  • Recommendation to postpone long-distance travel on commercial conveyances
  • Self-isolation
  • Public health assessment to determine the need for medical evaluation; if medical evaluation warranted, diagnostic testing should be guided by if medical evaluation warranted, diagnostic testing should be guided by the most recent recommendations from your state’s Public Health Department.
  • If medical evaluation is needed, it should ideally occur with pre-notification to the receiving HCF and EMS, if EMS transport indicated, and with all recommended infection control precautions in place.
  • Controlled travel: Air travel only via air medical transport. Local travel is only allowed by medical transport (e.g., ambulance) or private vehicle while symptomatic person is wearing a face mask.

Travelers from mainland China, Iran of most of European Union, South Korea (information courtesy of CDC).

  • Recommendation to remain at home or in a comparable setting
  • Practice social distancing
  • Self-monitoring with public health supervision as determined by local priorities
  • Recommendation to postpone additional long-distance travel on commercial conveyances after they reach their final destination

Travelers from other country with widespread transmission

  • Recommendation to remain at home or in a comparable setting,
  • Practice social distancing
  • Self-monitoring
  • Recommendation to postpone additional long-distance travel on commercial conveyances after they reach their final destination

Travelers from country with sustained community transmission

  • Practice social distancing
  • Self-observation

Low risk

  • No restriction on movement
  • Self-observation
  • Self-isolation, social distancing
  • Person should seek health advice to determine if medical evaluation is needed.
  • If sought, medical evaluation and care should be guided by clinical presentation; if medical evaluation warranted, diagnostic testing should be guided by the most recent recommendations from your state’s Public Health Department.
  • Travel on commercial conveyances should be postponed until no longer symptomatic.

No identifiable risk

None

  • Self-isolation, social distancing
  • Person should seek health advice to determine if medical evaluation is needed.
  • If sought, medical evaluation and care should be guided by clinical presentation; if medical evaluation warranted, diagnostic testing should be guided by the most recent recommendations from your state’s Public Health Department.
  • Travel on commercial conveyances should be postponed until no longer symptomatic.

EMS = emergency medical services; HCF = healthcare facility; PUI = Person Under Investigation for COVID-191. For the purpose of this document: subjective or measured fever, cough, or difficulty breathing.

Note: The public health management recommendations made above are primarily intended for jurisdictions not experiencing sustained community transmission. In jurisdictions not experiencing sustained community transmission, CDC recommends that post-exposure public health management for asymptomatic exposed individuals continue until 14 days after the last potential exposure; however, these decisions should be made based on the local situation, available resources, and competing priorities. These factors should also guide decisions about managing symptomatic exposed individuals.

International travelers and other potentially exposed individuals in jurisdictions experiencing sustained community transmission should follow local guidance.

For country-level risk classifications, see Coronavirus Disease 2019 Information for Travel.

CDC has provided separate guidance for healthcare settings. McGraw-Hill summary can be found here. CDC full guidelines can be found here.     

 

 

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