03/21/2020

Executive Summary

The Michigan Department of Health and Human Services is currently reporting sustained

widespread community transmission of COVID-19 in multiple areas of the State. This guidance is

intended to help with the development of occupational health programs, policies, and priorities

for groups that are critical to the healthcare system in the State of Michigan and is applicable to

the following groups: hospitals, healthcare facilities, EMS, other organizations that employ

healthcare workers in the inpatient or outpatient setting, all providers and support staff involved

in patient care, and public health staffing actively involved in the COVID-19 response (local or

state).

03/21/2020

the following groups: hospitals, healthcare facilities, EMS, other organizations that employ

healthcare workers in the inpatient or outpatient setting, all providers and support staff involved

in patient care, and public health staffing actively involved in the COVID-19 response (local or

state).

This interim guidance should be considered alongside applicable state and federal regulations and

provided to all healthcare workers as appropriate.

If you are sick, please stay home.

If you have a new onset of fever (subjective or temperature of ≥100.0⁰F* or 37.8°C) OR symptoms

healthcare workers should check with their employer before returning to work.

If your symptoms are severe (e.g., difficulty breathing) enough that you feel that you need to see a

healthcare provider but it is not an emergency, contact the healthcare provider before you seek

care and alert them that you are a health care worker who may have been exposed to a person

with COVID-19. You should put on a mask and ideally take a private vehicle to travel to your

healthcare provider. When arriving at the healthcare facility, let the staff know that you are ill and

had a possible exposure to COVID-19. If it is an emergency and you call 911, alert the operator

that you may have been exposed to a person with COVID-19 and describe your symptoms.

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All healthcare workers:

In the context of sustained community transmission of COVID-19, ALL healthcare workers

should self- monitor for illness consistent with COVID-19 because all healthcare workers are

at risk for unrecognized exposures. The purpose of self-monitoring is to identify illness early

and self-isolate at home to reduce the potential of transmission to those you care for. As a

*Fever cutoffs are different in guidance for the healthcare workers. This is done to recognize

illness early.

Timing of these checks should be at least 8 hours apart with one check immediately before each

healthcare shift. If any of these signs/symptoms develop, then DO NOT come to work. If

symptoms develop at work, you should immediately leave the patient care area, self-isolate, and

notify your supervisor.

Healthcare worker with HIGH-Risk exposure to a confirmed or probable COVID-19 patient:

High-risk exposures include: 1) an unmasked provider having prolonged close contact (<6 feet for

more than a few minutes) with an unmasked confirmed COVID-19 patient; 2) a provider not

wearing eye protection while present for an aerosol generating procedure (e.g. cardiopulmonary

resuscitation, intubation, extubation, bronchoscopy, nebulizer therapy, sputum induction); 3) an

unmasked provider present for an aerosol generating procedure. MDHHS asks that you self-

monitor at least twice daily for symptoms listed above (subjective fever or measured temp

>100.0°F, or cough, or shortness of breath or sore throat) AND additional new onset lower acuity

symptoms that may be associated with early signs of infection with COVID-19 including muscle

aches, or malaise (feeling tired or run down), or runny nose, or stuffiness, or congestion.

03/21/2020

Additional precautions for asymptomatic healthcare workers exposed to a possible or

confirmed COVID-19 patient:

In the context of sustained community transmission of COVID-19, all healthcare workers are at

some risk for exposure at work and within the community. CDC has advised that healthcare

facilities consider allowing asymptomatic healthcare workers exposed to a confirmed COVID-19

risk exposures or are involved in care of vulnerable patients (e.g., age ≥50, chronic lung disease

(e.g., asthma, COPD), heart disease, diabetes immunocompromised).

Testing of asymptomatic healthcare workers:

In keeping with CDC guidance, MDHHS advises against testing of any asymptomatic individuals

with or without an exposure to COVID-19, including healthcare workers, especially given current

shortages in PPE, collection swabs, viral transport media and testing reagents. Healthcare workers

should not be tested as a precondition of returning to work since a negative test result does not

provide assurance that that healthcare workers within 14 days of a high-risk exposure will not go

on to develop symptoms of COVID-19 after they are tested. However, while it is not yet known

additional 7 days from symptom onset or until they have been afebrile for 72 hours off

antipyretics, whichever is longer, before they return to work.

Note: your employer may require you to report your temperature and symptoms daily (i.e.,

active monitoring) and may have additional guidance for specific employees caring for high-

risk populations such as the elderly or immune compromised.

03/21/2020

Support for healthcare workers experiencing anxiety

During the monitoring period, it is normal for you and family members to feel distressed, anxious

or afraid. Try to keep a hopeful outlook and strengthen your resilience by drawing on your skills

that helped you manage difficult situations in the past. Keep in touch with other relatives and

friends by phone, email or social media. If you feel overwhelmed and need support to cope with

lower temperatures (<100.0°F) or other symptoms (e.g., muscle aches, nausea, vomiting, diarrhea,

abdominal pain headache, runny nose, fatigue) based on assessment by public health authorities.

Additional Resources:

Interim U.S. Guidance for Risk Assessment and Public Health Management of Healthcare

Personnel with Potential Exposure in a Healthcare Setting to Patients with Coronavirus Disease

(COVID-19)

(Additional Considerations and Recommendations)

https://www.cdc.gov/coronavirus/2019-ncov/hcp/guidance-risk-assesment-hcp.html