Requirements for returning to work after testing positive for COVID-19?

With the increase in COVID-19 infections within the country, we have received a number of enquiries about the correct process to be followed when one has been in contact with someone who is a primary as opposed to contacts with secondary contacts. We have also realised that there is a level of uncertainty regarding the process to be followed once a person has completed the mandatory self-isolation period. In this article we will answer those questions and clear up some of the confusion regarding return to work processes.

What is the difference between a primary and secondary contact and should one worry if he/she has been in contact with a secondary contact?

The National Institute for Communicable Diseases (NICD) defines a primary or close contact as “face-to-face contact, within one metre or in a closed space, for more than 15 minutes with someone who is infected with COVID-19.” A secondary contact would be a contact of a primary contact.

Primary contacts include:

• All persons living in the same household as a COVID-19 positive person, and people working closely in the same environment as an infected person.
• Healthcare workers or other people providing direct care for a person with COVID-19, while not wearing recommended personal protective equipment (PPE).
• A contact in an aircraft sitting within two seats (in any direction) of a person infected with COVID-19, travel companions or persons providing care and crew members serving in the section of the aircraft where the person with COVID-19 was seated.

The virus is passed through face-to-face interaction or when one touches surfaces infected with the virus and then touches his/her mouth, nose or eyes. One cannot get COVID-19 directly through a third party. Your primary contact first has to have Covid-19 before you need to worry. If your primary contact has been in contact with someone who is confirmed to have Covid-19, they then need to go into quarantine.

A person with COVID-19 is considered infectious from two (2) days before, to ten (10) days after they became ill. According to the NICD, one will have a laboratory test performed if he/she develops symptoms within 10 days of his/her last close contact with a person with Covid-19 who is considered infectious, i.e. someone who is able to transmit infection.

Is one required to test negative for COVID-19 prior to returning to work?

People who have been self-quarantining, because they had contact with a confirmed person with COVID-19 and have completed their 10-day quarantine period without developing symptoms, can return to work on day 11. There is no requirement to be tested prior to returning to work. It is, however, recommended that the person continues to practice social distancing and good hygiene as a precaution and to wear a surgical mask for 21 days from the date of contact.

People who have tested positive for COVID-19, who have experienced mild illness and have recovered are not required to test prior to returning to work. They are considered safe to return to the work and can discontinue self-isolation if they are no longer infectious. This means where they had developed their first symptoms more than 10 days prior and have not experienced any new symptoms for at least 3 days (72 hours) prior to returning to work.

Although they may return to work, they are required to practice the necessary precautions that include social distancing, employing good and hand respiratory hygiene and wearing a surgical mask for 21 days from the date of the test.  Medical evaluation may be necessary to determine fitness to do their job, depending on the type of job that one does as well as the effects of the illness.

How will a person know if they have recovered from COVID- 19?

It is important to note that there is a difference between being fully recovered and being ready to come out of isolation.

One is not required to have fully recovered from COVID-19 and its effects prior to coming out of isolation.

A person who had tested positive for COVID-19 can de-isolate (come out of isolation) under the following circumstances:

• Those who had tested positive for COVID-19 and were symptomatic (i.e. those who experienced or exhibited symptoms), but had mild disease not requiring hospitalisation for COVID-19, can be de-isolated 10 days after the onset of their symptoms, provided their fever has resolved and their other symptoms are improving.
• People who had been hospitalised as a result of COVID-19 and experienced moderate to severe disease, can be de-isolated 10 days from the date when they no longer require supplementary oxygen and are otherwise clinically stable.
• Those who had tested positive for COVID-19 but were asymptomatic, can be de-isolated 10 days after their test.
• Those who had been required to quarantine due to a close contact with someone who had tested positive for COVID-19 and were asymptomatic, can be de-isolated 10 days after their last contact with a person with COVID-19. No laboratory tests may be required during the quarantine, unless the person develops symptoms.

It is important to note that repeat testing is NOT required in order to de-isolate or in order for one to return to work. Testing prior to return to work may be required where a person remains asymptomatic, in quarantine after a high-risk exposure to a confirmed COVID-19 person and only when that person will be returning early to work, e.g. on day 8 after the exposure.

Can an employee return to work if they are still showing symptoms after the 10 days? Are they not putting their co-workers at risk?

It is common for some to continue to have symptoms of COVID-19 for longer than the recommended 10-day period. Full recovery may take several weeks for some people, especially for symptoms such as fatigue, cough and loss of sense of smell (anosmia).  Those who are still symptomatic at the end of their isolation period can be de-isolated provided that their fever has resolved and their symptoms have improved. However, if symptoms persist, the worker is required to obtain medical assessment by a health practitioner.

What if a person tests negative for COVID-19 but the symptoms are still there…what now?

A person can have a false negative test result if they have very little traces of the virus in them or perhaps when the specimen was taken inappropriately. Where a person presents symptoms of COVID-19, i.e. cough, fever, shortness of breath, etc. but they test negative, they should consult their health practitioner for further assessment.

What if one continues testing positive after 4 weeks without any new symptoms being experienced?

Some people can test positive for COVID-19 long after the self-isolation period has passed and even after they are no longer infectious. A positive PCR test, in these instances, does not equate to an infectious, viable virus. Those who had tested positive may be de-isolated without the need for repeat PCR tests, provided the person’s fever has resolved and their symptoms have improved. Those with mild disease may be de-isolated 10 days after symptom onset, while those with severe disease may be de-isolated 10 days after supplementary oxygen is discontinued.

Although we all need to be cautious and implement the necessary health and safety guidelines to ensure our safety as well as that of our colleagues and loved ones, it is not necessary to place additional self-imposed requirements which are not in line with the directives issued by the authorities on employees/co-workers who had been in self-isolation or quarantine.

Requiring employees to self-isolate as a result of secondary contacts; requiring employees to re-test for COVID-19 after the requisite self-isolation period has lapsed and where there are no new symptoms present; or discriminating against or requiring employees to only return back to work when they are fully recovered from COVID-19 is not according to regulations and places an undue burden on employees as well as the limited health resources of both employees and our country.

Do not hesitate to contact MISA on 011 476 3920 or at training@ms.org.za if you have any questions regarding return to work procedures or the Sick Accident and Maternity Pay Fund (SAF) COVID-19 sick leave benefit for MISA members.

This article contains information from the NICD:

https://www.nicd.ac.za/diseases-a-z-index/covid-19/