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NEW YORK CITY DEPARTMENT OF
HEALTH AND MENTAL HYGIENE
Oxiris Barbot, MD
Commissioner
NYC DOHMH 2020 Alert # 7
Guidance for Healthcare Worker Self-Monitoring and Work Restriction
In the Presence of Sustained Community Transmission of Coronavirus Disease 2019 (COVID-19)
March 17, 2020
The NYC Health Department (DOHMH) is reporting sustained widespread community transmission of COVID-
19. This guidance should be used by hospitals, healthcare facilities, and other organizations that employ
healthcare workers, including all providers and support staff involved in patient care, when developing
occupational health programs and policies. This interim guidance should be considered alongside applicable
state and federal regulations and provided to all healthcare workers as appropriate. Healthcare workers
currently furloughed because of previous guidance may return to work if asymptomatic. Refer to
intstructions below for additional details.
If you are sick, please stay home
If you have a new onset of fever (subjective or temperature of ≥100.0
o
F* or 38.0
o
C) OR symptoms of possible
COVID-19 syndrome (cough OR shortness of breath OR sore throat), you MUST STAY HOME and immediately
notify your supervisor.
For mild illness consistent with COVID-19, healthcare workers must stay home 7 days following onset of illness
or 72 hours after being consistently afebrile without use of antipyretics and with resolving respiratory
symptoms, whichever is longer. NYC DOHMH does not require healthcare workers to undergo quarantine or
to have a negative test for COVID-19 to return to work. However, at the completion of isolation, 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 walk or 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 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.
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 healthcare worker you should self-monitor by taking your
temperature twice daily and evaluating yourself for COVID-19 like illness which include any of the following:
• measured temperature >100.0
o
F* (37.8
o
C) or subjective fever
• cough
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• shortness of breath
• sore throat
*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:
If you are a healthcare worker who has had a known high-risk exposure to a patient(s) with confirmed
COVID-19, you should take extra care to monitor your health but can keep working. There is no
requirement for 14 day quarantine of healthcare workers with high-risk exposures in the setting of
sustained community transmission as we have in New York City. 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, nubulizer therapy,
sputum induction); 3) an unmasked provider present for an aerosol generating procedure. DOHMH asks that
you self-monitor at least twice daily for symptoms listed above (subjective fever or measured temp >100.0
o
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.
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 you MAY NOT come to work. If symptoms develop at work,
you MUST immediately leave the patient care area, isolate yourself and notify your supervisor.
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 healtcare facilities consider
allowing asymptomatic heathcare workers exposed to a confirmed COVID patient to work while wearing a
surgical mask (https://www.cdc.gov/coronavirus/2019-ncov/downloads/community-mitigation-strategy.pdf).
DOHMH again stresses that ALL providers should be self-monitoring and if sick, stay home. Given the limited
availability of personal protecitive equipment, use of surgical masks by asymptomatic exposed providers at
work should be limited to those who have had known high-risk exposures or are involved in care of vulnerable
paitents (e.g., age ≥50, chronic lung disease (e.g., asthma, COPD), heart disease, diabetes
immunocompromised).
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.
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 the situation, contact NYC Well at 888-NYC-WELL
(888-692- 9355) or text “WELL” to 65173. NYC Well is a confidential help line that is staffed 24/7 by trained
counselors who can provide brief supportive therapy, crisis counseling, and connections to behavioral health
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treatment in more than 200 languages. If you are thinking about harming yourself or someone else, call 911
immediately. Be sure to tell the operator and ambulance crew that you have had contact with someone with
COVID-19.
Follow these guidelines for the duration of ongoing community transmission of COVID-19. Alternative
monitoring approaches may be employed after community transmission has resolved.
More information is available at the websites of the NYC Health Department
(www.nyc.gov/health/coronavirus) and the CDC (www.cdc.gov/coronavirus).
Sincerely,
Demetre Daskalakis, MD, MPH
Deputy Commissioner
