Managing COVID Positive Patients and Office Staff

Managing COVID Positive Patients and Office Staff

Following a recent surge of concerned member calls, the IDA and IDA COVID-19 Task Force have compiled the following resource to better advise dental offices struggling with a COVID positive staff member or patient.

A Few Key Points:

  • The lunch room/staff lounge can be one of the most dangerous places in your office for the simple reason that it is an area where employees typically remove or discard their PPE at the end of the workday or while eating lunch.
  • The CARES Act and FFCRA can be difficult laws to navigate. If you need help determining whether your employees are entitled to COVID pay, reach out to the IDA COVID-19 Tasks Force Staff Liaison Alex Sumner.

 

An Ounce of Prevention is Better Than A Pound of Cure: A Summary of ADA, IDA, and CDC Guidelines

Practice enhanced patient screening controls including: asking questions regarding potential COVID exposure and any COVID-like symptoms they may be experiencing.

  • Remove all toys and magazines from the waiting room; block off waiting room chairs to encourage patients to socially distance.  Or alternatively, have patients wait in their car and call office staff when they arrive to be escorted directly to the examination room.
  • Ensure that all staff and patients wear appropriate PPE while in the building.
  • Use non-aerosol generating tools and procedures wherever possible.

 

Encourage staff to self-monitor and report any COVID symptoms. If possible, suggest that your employees practice social distancing during lunch time, in the break room, or during any other work situation where PPE is likely to be removed.

What should I do if a patient or staff member reports an exposure or positive test?

First, stay calm: the ADA and IDA have fielded numerous calls of this nature, you are not alone. Remember these two critical points:

  • PPE is a two-way protection system; it is designed to protect staff from patients as well as patients from staff.
  • The CDC defines ‘close contact’ with a COVID-positive individual as “someone who was within six feet of an infected individual [without appropriate PPE] for a total of 15 minutes or more over a 24-hour period. (Amended October 21, 2020.)

If your office is notified of a positive test result of a staff member or patient the following steps are advised:

  • Determine whether there was any close contact (defined above) between the positive individual and any other staff or patients.
  • If there was an exposed contact, encourage the individual(s) to self-monitor for symptoms and seek testing.
  • If there was no close contact exposure, employees should still be encouraged to closely monitor themselves for symptoms as part of the enhanced infection control procedures described above.
  • If you become aware that a patient was in close contact with a COVID positive individual in your office, you are strongly encouraged to contact him or her and suggest that they monitor symptoms or otherwise seek testing.

 

When can dental staff return to practice after receiving a COVID-19 positive test result?

Per the CDC, a “test-based strategy [for returning to work] is no longer recommended…because, in the majority of cases, it results in excluding from work HCP who continue to shed detectable SARS-CoV-2 RNA but are no longer infectious.”

Instead, the CDC recommends the following approach:

Symptom-based strategy for determining when HCP can return to work

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

Note:  HCP who are not severely immunocompromised and were asymptomatic throughout their infection may return to work when at least 10 days have passed since the date of their first positive viral diagnostic test.

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

  • At least 10 days and up to 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
  • Consider consultation with infection control experts[3]

For more information, contact IDA Director of Public Affairs and Legal Counsel Alexandra Sumner.

CARES Act and FFCRA: Who do I have to pay and for how long?

The CARES and Families First Coronavirus Response Acts are ever-changing and complex. As of this writing, the FFCRA provides for a one-time 80 hour leave for nonexempt employees who have contracted (or are caring for someone who has contracted) COVID-19. The dental office team can be broken into two main categories:

  • Exempt: anyone who “provides diagnostic services, preventive services, treatment services, or other services that are integrated with and necessary to the provision of patient care and, if not provided, would adversely impact patient care.” (US Department of Labor.)
    Examples of employees who are exempt from the 80 hour leave requirement include: dentists, dental hygienists, and dental assistants.
  • Nonexempt: other non-healthcare members of the staff.
    Examples of employees who are entitled to the 80 hours leave: office managers and front office staff.

While you are not required, you may still choose to pay your exempt employees for the 80 hours of COVID-19 time. If you choose to do so, you are encouraged to adopt a standard office policy rather than evaluate who you will pay on a case-by-case basis. If you choose not to pay exempt employees, they are entitled to submit an unemployment claim through the state, which will affect your provider experience account.

Speak with your accountant or financial representative to determine which strategy is most appropriate for your business.

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