COVID Answers

If you have symptoms or exposure or think you might please follow this process:

1) Call the hotline, the Duke COVID-19 Hotline at 919-385-0429, option 1, from 8 a.m. to 8 p.m. After hours 8 p.m. to 8 a.m. use the BBP Exposure Hotline:  919-684-8115

2) Communicate to the charge nurse what the determination is from the hotline. Call 919-470-8763 and clearly tell them if you are missing a shift for testing and when your test is if there is one. The earlier the better if you are missing time

3) Call/test/email Jason and Kelly with what is going on so we can ensure scheduling is correct and you have what you need. 

4) Stay Healthy 

Healthcare Worker Guidance for Quarantining – FAQs 

1. Why is quarantine important? a. Quarantine is used to keep someone with a possible exposure to COVID-19 away from others to decrease the risk of spread. A person can spread the disease before they feel sick or have symptoms. Since you have been in close contact with someone who has COVID-19, it is especially important for you to quarantine. b. Duke University also requires people who are returning from international travel to quarantine. Employee Occupational Health and Wellness (EOHW) will help you determine if you need to quarantine.

2. How do I quarantine? a. Stay home – do not go to work, school, or other public places such as a grocery store. b. You should leave your home ONLY if you need to seek medical care. c. Do not allow visitors into your home. d. SEPARATE YOURSELF from others in your home: i. Stay in a specific room away from other household members. ii. If possible, use a separate bathroom from other household members. iii. If you need to leave your quarantine room, practice social distancing and wear a mask/face covering in your home to protect other members. Other household members should also wear a mask. iv. Do not prepare or serve food for other household members. v. Promptly clean and disinfect common surfaces you touch– countertops, doorknobs, bathroom fixtures, etc. vi. Wash your hands often, especially after coughing, sneezing, or blowing your nose.

3. What is considered “close contact?” a. This is defined as being exposed to a COVID positive person while they were infectious. A COVID positive person is infectious from 48 hours prior to symptom onset through at least 10 days after symptom onset. Close contact is being within 6 feet for more than 15 minutes. Living in the same home as COVID positive person is especially high risk. Wearing a surgical mask or cloth face covering lowers exposure risk.

4. Do I need to quarantine while I’m awaiting COVID-19 test results? What if I’m asymptomatic?

a. If you are being tested because you have symptoms, then you should quarantine until you receive your negative test result and communication from EOHW that you may return to work. If the test is positive, you should continue isolating from all others and contact your doctor and EOHW for further instructions. b. EOHW does not typically recommend testing team members who are asymptomatic. However, if testing is recommended in certain circumstances, EOHW will give advice whether you should continue working or quarantine.

5. If I am instructed to quarantine by EOHW (due to personal COVID-19 confirmation or that of a close household contact), will I need to use my PTO while I’m out of the workplace? a. Team members who are unable to work because they have been instructed by EOHW to stay home due to COVID-19 exposure or illness will continue to be paid their base rate of pay without using PTO.

6. If I am confirmed to have COVID-19, how long do I need to stay out of work if I am symptomatic? What if I’m asymptomatic? a. Team members with mild to moderate illness who are not severely immunocompromised should not return to work until: i. At least 10 days have passed since symptoms first appeared and ii. At least 24 hours have passed since last fever without the use of fever-reducing medications and iii. Symptoms (for example, cough, shortness of breath, diarrhea) have improved b. Team members with severe to critical illness or who are severely immunocompromised should not return to work until: i. At least 20 days have passed since symptoms first appeared and ii. At least 24 hours have passed since last fever without the use of fever-reducing medications and iii. Symptoms (for example, cough, shortness of breath, diarrhea) have improved c. Team members who are asymptomatic and test positive should not return to work until: i. 10 days (or 20 days if severely immunocompromised) have passed since the date of their first positive COVID19 test assuming they have not subsequently developed symptoms. If they develop symptoms, then the criteria for symptomatic HCPs should be used.

Guidance for Healthcare Workers Living in Same Household with Someone Suspected of or Confirmed to have COVID-19 – FAQs 

1. Do I need to quarantine if I am living in the same household as someone getting tested for COVID-19? What if the person in my household has symptoms? a. Asymptomatic healthcare workers may continue to report to work while a household contact is awaiting results as long as the healthcare worker does not develop any symptoms.

2. I live in the same household as someone confirmed to have COVID-19. How long do I need to quarantine? a. You need to stay in quarantine for 14 days from the date you last had close contact with the COVID-19 positive person during their infectious period. Thus, separation of yourself from any infected household member is especially important because continued exposure to an infected household member will extend your time in quarantine.

3. What is the infectious window period for my household contact? a. If the household contact is asymptomatic: i. The start date of the infectious period is two days prior to taking the test that came back positive. ii. The end date of the infectious period is 10 days following the collection of the positive test. b. If the household contact is symptomatic: i. The start date of the infectious period is two days prior to the first day of experiencing symptoms. ii. The end date of the infectious period is 10 days following the contact’s symptom onset or longer if the contact has persistent fever or lack of improvement in other symptoms.

4. What is the expected duration of my quarantine if my household contact does not have any severe immunocompromising conditions and I cannot isolate from them? Does this change if the household contact is asymptomatic or experiencing symptoms? a. The expected duration of quarantine would be 24 days from onset of symptoms of household contact. 10 days for the contact to become non-infectious (presuming fever resolves and symptoms improve) and 14 days quarantine after that.

5. What is the expected duration of my quarantine if my household contact has severe immunocompromising conditions and I cannot isolate from them? Does this change if the household contact is asymptomatic or experiencing symptoms?

a. The expected duration of quarantine could be 34 days from onset of symptoms of household contact. 20 days for the contact to become non-infectious (presuming fever resolves and symptoms improve) and 14 days quarantine after that. Contact EOHW under these special circumstances.

6. What if my household contact is truly asymptomatic?  Do I still have to stay home even though asymptomatic people have lower rates of transmission? a. Yes, you must stay home and quarantine. See above for the description of how many days you must stay home depending on when your last close contact was with the person confirmed with COVID-19.

7. What symptoms should I monitor while in quarantine? a. Monitor twice a day for symptoms, including: fever (temperature >100.0), sore throat, runny nose, cough, shortness of breath, chest pain, loss of smell or taste, fatigue, headache, muscle aches, nausea/vomiting, or diarrhea. You should use the EOHW monitoring system to monitor symptoms.

If you develop symptoms while in quarantine, please contact the Duke Health COVID-19 Hotline: 919-385-0429, option 1 (8:00 am to 8:00 pm, seven days a week). For urgent concerns after hours, contact EOHW via the Blood and Body Fluid Exposure Emergency Hotline, 919-684-8115. 

Duke Employee Occupational Health Management Plan for Healthcare Providers 

Ability to Work Protocols 

The following applies to all faculty and staff who are employed by DUHS, including PDC, SOM, and SON. 

Asymptomatic Healthcare Providers (HCPs) 

ALL HCPs should self-monitor by taking their temperature twice daily and assessing for COVID-19 illness.  Signs and symptoms of COVID -19 include:  • Fever (for healthcare providers any temperature greater than 100.0 Fahrenheit)  • Shortness of breath or difficulty breathing • New onset cough (within the last 2 weeks)  • New onset nasal congestion or runny nose (within the last 2 weeks)  • Sore throat  • Muscle aches • Chills, including shaking chills • Headache • GI symptoms • New loss of taste or smell 

Symptomatic Healthcare Providers 

All HCPs who develop any of the above symptoms should follow these steps: • You may not work.   • If any signs or symptoms occur while working, the HCP should immediately mask, leave the patient care area, and inform their supervisor. • Call the Duke COVID Hotline for assessment and COVID-19 testing while continuing to wear a mask.  By contacting the hotline, you will register with Employee Health and must complete the Duke employee survey that will be sent to your email.  Employee Health will contact you promptly.  • Self-isolate until cleared by Employee Occupational Health & Wellness (EOHW) to return to work.  

Testing for HCPs for COVID-19 will be ordered through the Duke COVID Hotline (utilizing the EOHW testing triage plan for HCPs) or by EOHW if symptoms develop during the monitoring period supervised by EOHW.  Testing will be expedited, and HCPs will be cleared to return to work per the guidelines below. 

Duke COVID Hotline:  919-385-0429 option 1 for employees 8am – 8pm. For urgent afterhours concerns, call Blood and Body Fluid (BBF) hotline:  919-684-8115 

Symptomatic HCPs should:  • Rest and hydrate. Adequate sleep and staying hydrated are typically helpful in your recovery.  • Manage and treat your symptoms with fluids and medicines for fevers (acetaminophen), cough, and other cold symptoms.  

Last updated: 7/24/20  

• Call your doctor if you start to feel worse (increased shortness of breath, chest congestion, coughing, or fevers).  • Seek emergency medical treatment if you have severe difficulty breathing.  

Follow guidelines for hand washing and germ management: • Clean your hands often. Wash your hands with soap and water for at least 20 seconds. If soap and water are not available, clean your hands with an alcohol-based hand sanitizer that contains at least 60% alcohol, covering all surfaces of your hands and rubbing them together until they feel dry. Soap and water should be used preferentially if hands are visibly dirty.  • Avoid touching your eyes, nose, and mouth with unwashed hands, and wash your hands after touching your face.  • Cover your mouth and nose with a tissue when you cough or sneeze. Throw used tissues into a lined trash can. Immediately wash your hands with soap and water or hand sanitizer.  

Personal Assistance Service (PAS) is available to offer emotional support during this stressful period.  Telephonic or video counseling is available, and you can access this service using most smartphones, tablets and computers with a camera. You may contact PAS by calling 919-416-1727. The following link will help you get ready:  https://pas.duke.edu/about/counseling-services/onlinecounseling-services  

Return to Work Criteria for HCP with Confirmed or Suspected COVID-19 

HCP with mild to moderate illness who are not severely immunocompromised: 

• At least 10 days have passed since symptoms first appeared and • At least 24 hours have passed since last fever without the use of fever-reducing medications and • Symptoms (e.g., cough, shortness of breath) have improved 

HCP with severe to critical illness or who are severely immunocompromised1: 

• At least 20 days have passed since symptoms first appeared  • At least 24 hours have passed since last fever without the use of fever-reducing medications and 

• Symptoms (e.g., cough, shortness of breath) have improved 

Note:  HCP who are severely immunocompromised but who were asymptomatic throughout their infection may return to work when at least 20 days have passed since the date of their first positive viral diagnostic test. 

Severe Immunocompromising Conditions Include: • Primary immunodeficiency  • Cancer diagnosis on active chemotherapy  • Hematopoietic stem cell transplant recipient  • Solid organ transplant recipient  

Last updated: 7/24/20  

• Poorly controlled HIV (CD4 < 200)  • Steroids >20mg per day for >2 week  • Autoimmune disease on biologic agents (like Remicade, Enbrel) and/or multi-drug immunosuppression  

HCP with laboratory-confirmed COVID-19 who have not had any symptoms: 

•  Time-based strategy. Exclude from work until:  

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. If they develop symptoms, then the criteria above for symptomatic HCPs should be used.   

If HCP was never tested for COVID-19 but has an alternate diagnosis (e.g., tested positive for influenza), criteria for return to work should be based on that diagnosis.  Influenza:  Must be fever-free for 24 hours off fever-reducing medications and feeling well enough to work. GI illness only: Must be free of vomiting and diarrhea for at least 24 hours. 

Return to work requires clearance by Duke Employee Occupational Health & Wellness (EOHW). 

A Health Recommendation Form will be emailed to the HCP and their supervisor. 

Asymptomatic HCP Scenarios  

Asymptomatic HCPs who have had exposure to a confirmed COVID case (except for when the case is a close household contact) may work as long as asymptomatic.  HCPs will be enrolled in the EOHW symptom monitoring program and must wear a surgical mask throughout the workday. 

Asymptomatic HCP who is a close household contact of a confirmed COVID case will be quarantined for 14 days from date of last contact with the case during their infectious period. The quarantine duration is determined by EOHW and can be 14 days IF the employee can separate from their household member within the house.  If unable to separate then duration can be length of infectious period + incubation period, often at least 24 days.  Employees may not be able to separate if they are caring for an ill household member or due to the physical characteristics of the house such as only 1 available bathroom