Provider FAQs

Updated: February 12, 2021

Infection Control

Should healthcare workers wear eye protection (i.e. face shield or goggles) in addition to masking?

Yes, because there is widespread community transmission of COVID-19 in Santa Clara County, healthcare workers should use universal eye protection with any clinical encounter. See CDC’s Interim Infection Prevention and Control Recommendations.

*Per CDC, healthcare workers include “all paid and unpaid persons (e.g., doctors, nurses, laboratory workers, facility or maintenance workers, clinical trainees, volunteers) serving in healthcare settings who have the potential for direct or indirect exposure to patients or their infectious secretions and materials.”

Can face shields be used instead of masks in healthcare settings?

No. Face shields are not a substitute for face masks (surgical or N95) but rather should be worn in conjunction with masks when eye protection is needed.

When should exemptions for face coverings be allowed for patients?

In general, Public Health does not recommend issuing face mask exemptions. Special occupations such as fire and police may be considered for exemption while doing particular tasks. Otherwise, if a patient cannot wear a mask (even if for medical reasons), that person should be working from home or in a single office and not visiting grocery stores, restaurants, or retail establishments.​​

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Screening and Healthcare Worker Testing

How should healthcare workers be screened for symptoms?

Each healthcare facility's employee health program should have COVID-19 screening procedures in place, and employees should follow their employer's screening procedures. In general, symptom screening should occur prior to every shift, as well as mid-shift if the shift is longer than 10 hours. Temperature screening is not required.

How often should healthcare workers be tested?

Testing should occur at least once a month and more frequently if possible. Mandatory healthcare worker testing should be considered in acute care hospitals. Additionally, more frequent (weekly) testing is currently required in skilled nursing facilities.

What is the guidance from Santa Clara County regarding healthcare workers returning from travel outside the county?

The Mandatory Directive on Travel is no longer in effect. HCWs who have traveled should follow CDC’s travel recommendations and requirements, including restriction from work when recommended for any traveler. In general, fully vaccinated HCWs who are asymptomatic do not need to be excluded from work or quarantine after a high-risk exposure. Some exceptions may apply. Work exclusion may still be considered for fully vaccinated HCWs who have underlying immunocompromising conditions. HCWs who work in congregate settings (e.g. long-term care facilities) should please refer to CDPH All Facilities Letter dated March 23, 2021.

Non-vaccinated or partially vaccinated HCWs should still avoid non-essential travel and continue to follow CDC guidance for Potential Exposure at Work, as well as CDPH All Facilities Letter dated March 23, 2021, which provides guidance for HCWs based on vaccination status.

What do I do when a healthcare worker I employ declines flu vaccination?

All healthcare workers who decline vaccination must sign a declination form Healthcare employers must track the number of healthcare workers who submit a signed declination form, and provide a report to the Health Officer by November 15, 2020 on the percentage of Healthcare Workers who received influenza vaccination and the percentage of workers who submitted a signed declination. For more information, please see the September 4, 2020 Health Officer Order - Healthcare Workers Required To Receive an Annual Flu Vaccination.

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Patient Testing

Who should healthcare providers test?

Healthcare providers should offer testing to the following individuals:

  1. All Symptomatic Persons* regardless of age, hospitalization status, comorbidities, or other risk factors for COVID-19;
  2. All persons, with or without COVID-19 Symptoms*, who report that they have been exposed to a confirmed case of COVID-19;
  3. All persons who are referred by the County Public Health Department to their provider for COVID-19 diagnostic testing;
  4. All persons, with or without COVID-19 symptoms, who are “Essential Workers” as defined by the COVID-19 Diagnostic Testing Emergency Regulation of the California Department of Managed Health Care, 28 C.C.R. § 1300.67.01(b)(5), also currently available at: https://wpso.dmhc.ca.gov/regulations/docs/regs/50/1594998444637.pdf.

*Symptomatic persons include anyone who has any symptom consistent with COVID-19, including fever or chills, cough, shortness of breath or difficulty breathing, fatigue, muscle or body aches, headache, sore throat, loss of taste or smell, nausea/vomiting or diarrhea.

See the September 16, 2020 Health Officer Testing Order for more information.

Should all patients be tested for COVID-19 a day prior to elective surgery?

If testing capacity exists, we recommend testing patients a day or two prior to their elective surgery.​

Should all patients be tested for COVID-19 upon hospital admission?

We recommend testing all patients for COVID-19 upon hospital admission, regardless of presence of symptoms. In addition, we recommend testing anytime during hospital admission if an individual develops symptoms consistent with COVID-19 or has a suspected exposure to a confirmed COVID-19 case.

Who is responsible for notifying patients about their COVID-19 test results?

The physicians who order COVID-19 tests are responsible for notifying their patients of their test results, regardless of where the tests are conducted.

What is the appropriate test to diagnose an acute COVID-19 infection?

The CDPH COVID-19 Testing Task Force has provided guidance regarding Testing for COVID-19: PCR, Antigen, and Serology. The document includes information around the types of tests available and their reliability, as well as guidelines around interpretation. While PCR testing has been the mainstay for diagnosing acute COVID-19 infection, antigen testing may be appropriate in certain situations (i.e. symptomatic individuals in whom point of care testing is necessary). CDPH has also published a Diagnostic Algorithm for SARS COV-2 to provide further guidance on when to use a PCR test versus an antigen test.

For a list of commercially available COVID-19 diagnostic tests with regulatory status information, please see here.

What are antigen tests, in what situations are these useful, and what are their limitations?

Antigen tests directly detect fragments of SARS-CoV-2 viral protein (as opposed to viral RNA detected by nucleic acid amplification tests [NAAT aka PCR tests]).The main advantages of antigen tests are fast turnaround time, simple to perform point-of-care use, , and lower cost.

Antigen tests are generally less sensitive (more false negatives) compared to PCR testing, particularly among asymptomatic individuals.  The specificity of antigen tests is generally high (few false positives). However, specificity decreases when the manufacturer's directions are not strictly adhered to or if the test is used in communities with low COVID-19 prevalence. 

Among symptomatic individuals, the test is ideally performed within 5-12 days of symptom onset. 

Antigen tests can be used for diagnostic, screening, and surveillance testing.  However, the interpretation of the test and the need for confirmatory PCR (aka NAAT) depends on several factors including the presence of symptoms, exposure to a confirmed COVID-19 case, and test positivity percent in the community.

For more information, please refer to the following resources:

When do I need to order a PCR test after an antigen test?

A positive antigen test result in an asymptomatic individual has the potential to be a false positive. For non-SNF (Skilled Nursing Facility) settings, please refer to the table below:

Presence of Symptoms

Test Result

Required Action

Symptomatic individuals

Positive antigen test

Do not need confirmatory PCR. Follow guidance for COVID-19 case.

Symptomatic individuals

Negative antigen test

Should receive a confirmatory PCR testing because there is potential for false negative antigen test results. Patient should be excluded from work and isolate until PCR results return.

Asymptomatic individuals

Positive antigen test

Should receive a confirmatory PCR because there is potential for false positive antigen test results. Patient should be excluded from work and isolate until PCR results return.

Asymptomatic individuals

Negative antigen test

Do not need confirmatory PCR testing in most non-SNF, non-outbreak settings


Seeking vaccination for myself | Interested in Enrolling to be a COVID-19 Vaccine Provider |  Counseling and treating patients

See CDPH Diagnostic Algorithm for SARS COV-2 for additional information

In SNF settings, recommendations on confirmatory PCR testing are dependent on presence of symptoms and presence of an active outbreak within the facility, For additional information on antigen testing in SNFs, please see CDC’s Guidance on the Use of SARS-CoV-2 Antigen Testing in Long Term Care Facilities.

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What is serology for COVID-19, what are the limitations, and how can it be useful at this time?

COVID-19 serology test detects the presence of IgM and IgG antibodies, which reflects the body’s immune response to the infection. Because it takes 2-3 weeks for the body to make antibodies, serology tests are not useful for detection of early infection. In addition, some persons may not mount an antibody response at all. For these reasons, serology should not be used as the sole basis to diagnose COVID-19.

What information is available about At-Home Testing for COVID-19?

The CDC has published a guide for patients on the use of at-home collection kits or at-home tests for COVID-19. Some are available by prescription only (Lucira COVID-19 all-in-one kit) and others are available over-the-counter (Ellume COVID-19 Home Test). Abbot’s BinaxNOW COVID-19 test must be performed only with the supervision of a telehealth provider. CDC recommends these tests be used for individuals who are symptomatic and cannot receive testing from a healthcare provider. The ability of these tests to correctly identify positive samples ranges from 91-96%, depending on which test is used and whether the individual is symptomatic or asymptomatic. The ability of these tests to identify negative samples ranges from 96-100%, depending on which test is used and whether the individual is symptomatic or asymptomatic


How does nasal or mid-turbinate specimen collection compare to traditional ​nasopharyngeal (NP) testing?

Existing published scientific data suggest sampling the anterior nares or mid-turbinate has similar sensitivity to a nasopharyngeal test.

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Re-Infection and Immunity

Should I report patients who tested positive after being fully vaccinated?

Providers should report patients who test positive for COVID-19 after being fully vaccinated. Fully vaccinated is defined as: ≥ 14 days following receipt of the second dose in a 2-dose series, or ≥14 days following receipt of one dose of a single-dose vaccine. Follow the same procedure as for reporting non-vaccinated cases by using the Case Report Form here, and include information regarding the patient’s vaccination history.

What are the current recommendations regarding persistent positives and reinfection?

Persistent Positives: For persons who are asymptomatic following recovery from COVID-19, Santa Clara County Department of Public Health does not recommend retesting within 3 months after the date of symptom onset. Should such a person test positive for COVID-19 3 or more months after recovery, clinicians should consider the possibility of reinfection.

Reinfection: Confirmed and suspected cases of reinfection of the virus that causes COVID-19 have been reported, but remain rare. SARS-CoV-2 reinfection is a rapidly evolving area of research, and there is currently no widely accepted definition of what constitutes SARS-CoV-2 reinfection. To help better understand the potential for reinfection and to create a standardized case definition of SARS-CoV-2 reinfection, CDC developed proposed criteria for further investigation.

Please see diagram below to aid in decision making.

Persistent Positive/Re-infection Diagram (PDF)

Among individuals in whom you suspect persistent or recurrent infection, which isolates should be sent to Public Health Lab (PHL) for additional testing at the State level?

The California Department of Public Health is evaluating potential cases of COVID-19 reinfections. They request that COVID-19 specimen meeting the following criteria be sent to PHL for additional testing.

Specimen Submission Criteria

Cases in which first and second episodes are 45 – 90 are days apart:

  • A previous RT-PCR confirmed COVID-19 case
  • Met criteria for ending isolation
  • Positive RT-PCR test 45-90 days after initial diagnosis.
  • New or recurrent symptoms consistent with COVID-19 (without alternate explanation for symptoms)

Cases in which first and second episodes are > 90 days apart:

  • A previous, RT-PCR confirmed COVID-19 case
  • Met criteria for ending isolation
  • Positive RT-PCR test more than 90 days after prior diagnosis
  • Symptoms may or may not accompany the second episode.

Additionally, the specimen from the suspected reinfection (second episode) must have a PCR – Ct value threshold ≤ 33 in order to ensure that there is sufficient viral load to perform testing.

If you have cases that meet the above criteria, please call the Public Health Department at (408) 885-4214, ext. 3 (ask for Provider Branch) to arrange for specimen submission.

Why did CDC recently extend the period of isolation to 20 days for persons with COVID-19 who are severely ill or immunocompromised?

For most persons with COVID-19, viral cultures of upper respiratory specimens are negative when specimens are collected more than 10 days after symptom onset. In some persons with severe disease or immunocompromised state, viral culture of specimens collected between 10 and 20 days after symptom onset have been positive. This is the basis for the recommendation to isolate such persons for up to 20 days.

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Treatment and Management

How should I manage my patient with COVID-19?

Please see CDC’s clinical guidance page for more information.

A number of investigational drugs that are approved for other conditions are currently being studied in clinical trials for the treatment of COVID-19. For more information, please see NIH COVID-19 Treatment Guidelines.

When is the use of remdesivir indicated? 

As of July 24, 2020, The NIH COVID-19 Treatment Guidelines Panel (Panel) recommends prioritizing remdesivir for limited use in hospitalized patients with COVID-19 who require supplemental oxygen but who do not require oxygen delivery through a high-flow device, noninvasive ventilation, invasive mechanical ventilation, or extracorporeal membrane oxygenation (ECMO) (BI).

For patients with mild to moderate COVID-19 symptoms, the Panel does not have a recommendation either for or against the use of remdesivir in treatment. For more information, please see NIH COVID-19 Treatment Guidelines for remdesivir.

What are the indications for use of hydroxychloroquine?

Based on the results of several clinical trials showing lack of efficacy of Hydroxychloroquine +/- Azithromycin, the NIH COVID-19 Treatment Guidelines Panel recommends against the use of this medication for prevention or treatment of COVID-19. For more information, please see NIH COVID-19 Treatment Guidelines.

What are the indications for use of steroids in the treatment of COVID-19? What is the recommended dose and duration of therapy? 

Patients with severe COVID-19 develop a systemic inflammatory response that can lead to lung injury and multisystem organ dysfunction. It has been proposed that the anti-inflammatory effects of corticosteroids might prevent or reduce these effects.

Please see the NIH Therapeutic Management of Patients with COVID-19 for recommendations on use of dexamethasone with or without remdesivir in certain hospitalized patients. For more information about the use of corticosteroids in patients with COVID-19, please see NIH guidance here.

What are the indications for the use of monoclonal antibody therapy in the treatment of COVID-19?

Antibody therapy should be considered in patients with mild to moderate COVID-19 who are not hospitalized. For more information please see the NIH treatment guidelines.

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Isolation for Confirmed Cases

Have the County of Santa Clara Public Health Department’s recommendations on isolation changed?

Effective September 22, 2020, Santa Clara County (SCC) aligned with California Department of Public Health (CDPH) recommendations on isolation. Isolation should last at least 10 days since symptom onset; AND at least 24 hours since resolution of fever without the use of fever-reducing medications; AND other symptoms have improved. See the Isolation and Quarantine table.

Do patients who test positive for COVID-19 have to be cleared by the Public Health Department or re-tested at the end of their isolation period before they can stop isolating

Patients are no longer considered contagious if they meet the criteria detailed in the Return to Work and School Letter. The patient does not need a medical note or a negative test to return to work as long as the criteria detailed are met.

In contrast, symptomatic, non-close contacts ARE required to have a negative test or medical note to return to work or school 24 hours after resolution of fever and improvement of other symptoms. Individuals who refuse testing and/or evaluation should be treated as a COVID-19 case and can return based on the usual isolation criteria of 10 days after symptom onset and 24 hours after resolution of fever and improvement of other symptoms.

Does the 10 day isolation recommendation apply to all individuals?

Severely ill and immunocompromised individuals (e.g., currently receiving chemotherapy, or recent organ transplant), or who had critical illness (e.g., required intensive care) may shed detectable SARS-CoV-2 RNA for up to 20 days, and therefore may need prolonged isolation. Discontinuation of isolation policies in hospital settings should be determined by the individual institution.

The timeframe from symptom onset could be extended to up to 20 days for individuals who are severely immunocompromised. For more information, please refer to CDC website, and CDPH website.

Should patients be isolated again if they previously tested positive outside of Santa Clara County and later tested positive again after returning to Santa Clara County?

We advise isolating again unless the patient provides documentation (e.g., doctor’s note or lab result) of a positive test dated within the last 3 months.

How do I assist a homeless patient who has been identified as a case to receive housing accommodations including support for isolation?

Refer to “Homeless Referrals Including Support for Isolation and Quarantine” under Resources for Patients.

How do I refer a patient who is housed but is unable to self-isolate (e.g., they share a room where they cannot adequately physically distance or a bathroom or kitchen facility that they cannot adequately disinfect)?

Refer to “Isolation and Quarantine Support Referrals for Housed Patients” under Resources for Patients.

Quarantine Guidance for Fully Vaccinated People

Do people who have been vaccinated still need to quarantine after being exposed to a COVID-19 Case?

According to CDC’s definition, people are considered fully vaccinated:

  • ≥14 days following receipt of the second dose in a 2-dose vaccine series (such as Pfizer or Moderna), or
  • ≥14 days following receipt of one dose of a single-dose vaccine (such as Johnson & Johnson)

Fully vaccinated individuals are recommended to follow CDC guidance. In general, fully vaccinated individuals who have been exposed to COVID-19 case and are asymptomatic do not need to quarantine or get tested. Exceptions and other considerations may apply. Please see CDC guidance for more information.

Do people still need to follow the public health orders and directives after they have been fully vaccinated?

Yes. At this time, unless a public health order or directive says otherwise, a person’s vaccination status does not exempt them from State and County public health orders and directives. The County will evaluate new data and evidence regarding the effects of vaccination as they become available, and may adjust this policy in the future.

Should people still get tested, wear a mask, and avoid indoor gatherings and breakrooms if they have been fully vaccinated?

Fully vaccinated individuals are recommended to follow CDC guidance. In general, fully vaccinated individuals who have been exposed to COVID-19 case and are asymptomatic do not need to quarantine or get tested.  Fully vaccinated asymptomatic individuals may also gather indoors with other fully vaccinated individuals of any age. Exceptions and other considerations may apply. Please see CDC guidance for more information.

What is the guidance around travel for people who have been fully vaccinated?

The Mandatory Directive on Travel is no longer in effect. Fully vaccinated individuals are recommended to follow CDC guidance for domestic and international travel. In general, for domestic travel, fully vaccinated individuals who do not have COVID-19 symptoms do not need to get tested before or after travel, or quarantine after travel. For international travel, fully vaccinated individuals should follow CDC recommendations, and may still need to test or quarantine depending on requirements issued by the destination authority.

For individuals who have not been fully vaccinated, non-essential travel should still be avoided to reduce the risk of virus transmission. Non-vaccinated travelers should still get tested before and after travel, and quarantine after travel, unless traveling for essential purposes. Please see CDPH Travel Advisory for detailed guidance.

What is the quarantine guidance for fully vaccinated healthcare workers?

Fully vaccinated Healthcare Workers (HCWs) should follow CDC guidance for healthcare settings,  as well as their employer’s guidance. Fully vaccinated is defined as: ≥14 days following receipt of the second dose in a 2-dose series, or ≥14 days following receipt of one dose of a single-dose vaccine. In general, fully vaccinated HCWs who are asymptomatic do not need to be excluded from work or quarantine after a high-risk exposure. Some exceptions may apply. Work exclusion may still be considered for HCWs who have underlying immunocompromising conditions. HCWs who have traveled should follow CDC’s travel recommendations and requirements, including restrictions from work, when recommended for any traveler. HCWs who work in congregate settings (e.g. long-term care facilities) please see CDPH All Facilities Letter dated March 23, 2021.

Non-vaccinated or partially vaccinated HCWs should continue to follow CDC guidance for Potential Exposure at Work, as well as CDPH All Facilities Letter dated March 23, 2021, which provides guidance for HCWs based on vaccination status.

See section below on Healthcare Worker Cases and Exposures for more information.

What is the quarantine guidance for fully vaccinated inpatients and residents in healthcare facilities?

*Fully vaccinated inpatients and residents in healthcare settings should continue to follow CDPH quarantine guidance for healthcare settings following an exposure to someone with suspected or confirmed COVID-19; outpatients should be cared for using appropriate Transmission-Based Precautions.

For more information, see CDC webpage on COVID-19 Vaccines.

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Quarantine for Close Contacts

What changes have been made to County of Santa Clara Public Health Department’s general quarantine recommendations?

The County has revised quarantine guidance to align with the California Department of Public Health. All close contacts are recommended to be tested on Day 6 or later from last exposure if asymptomatic (and immediately if symptomatic). If testing is done earlier than 6 days after the last exposure to the COVID positive person, the contact should get tested again towards the end of the 10 day quarantine period. Asymptomatic close contacts may discontinue quarantine after Day 10 from last exposure but should continue monitoring for symptoms for a full 14 days.

  • The general quarantine guidance above applies to healthcare workers under normal circumstances, and HCWs who have routine workplace exposures that are not high risk should continue to follow their employer’s guidance for returning to work. However, if critical staffing shortages exist, healthcare workers may follow the recommendations outlined below.

    Healthcare workers who have been exposed to a COVID-19 positive person in the household or in the community, or during a high-risk exposure in the workplace (e.g., not wearing required PPE), may continue to work or return to work during the quarantine period (which, for this scenario, is defined as 10 days from the date of last exposure to the COVID-19 positive person) under the following conditions:
  • The HCW remains asymptomatic.
  • The HCW undergoes the following testing regimen:
    • A COVID-19 test is done immediately upon learning of their exposure and the test result is negative. 
    • The HCW remains off work until this initial COVID-19 test is resulted.
    • Thereafter, during the remainder of the quarantine period, the HCW’s COVID-19 status shall be monitored with daily rapid antigen tests or RT-PCR tests every 3 days. Test type and frequency will depend on the facility’s testing availability and schedules.
  • The HCW wears an N95 respirator and all other required PPE at all times while at work during the quarantine period.
  • The HCW does not eat, drink, or unmask around others at any time, regardless of social distancing.
  • The HCW continues to monitor COVID-19 symptoms daily. If the HCW develops symptoms, the HCW should leave work, contact their manager/employee health, and be tested.
  • The HCW maximizes social distancing (even beyond 6 feet) wherever possible with both patients and co-workers, and maintains excellent hand hygiene at all times. 
  • The HCW does not work with severely immunocompromised patients or individuals (e.g., cancer, organ transplants).
  • The HCW’s work duties are assigned in a manner that minimizes the number of different patients cared for by the HCW.
  • The HCW is still under home quarantine for 10 days after last exposure except to go to work. The HCW must not carpool, taxi, or rideshare.

Do patients who tested positive for COVID need to subsequently quarantine after their isolation period if their household contact becomes positive?

No, they would not need to subsequently quarantine for an additional 10 days from their last exposure to the newly infectious household contact.

For the purposes of contact tracing, should the date of symptom onset be based only on fever or cough?

COVID-19 illness can begin with symptoms other than fever or cough, such as chills, night sweats, sore throat, shortness of breath, nausea, vomiting, diarrhea, fatigue, myalgias, headaches, change in mental status, or loss of sense of taste or smell. Use the earliest date of these symptoms for date of symptom onset. Patients are considered contagious starting two days before symptom onset through the last day of their recommended isolation period.

How do I assist a homeless patient who has been identified as a close contact to receive housing accommodations including support for quarantine?

Refer to “Homeless Referrals Including Support for Isolation and Quarantine” under Resources for Patients.

How do I refer a patient who is housed but is unable to quarantine (e.g., they share a room where they cannot adequately physically distance or a bathroom or kitchen facility that they cannot adequately disinfect)?

Refer to “Isolation and Quarantine Support Referrals for Housed Patients” under Resources for Patients.

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Healthcare Worker Cases and Exposures

How do you manage healthcare workers who test positive (confirmed COVID-19 case)?

Public Health recommends that healthcare workers follow County isolation guidance. Isolation should last at least 10 days since symptom onset; AND at least 24 hours since resolution of fever without the use of fever-reducing medications; AND other symptoms have improved. If the worker is asymptomatic, they should isolate for 10 days from the date their positive test was collected. Please see the Isolation and Quarantine Protocols for more information.

How do you manage healthcare workers who were exposed but are asymptomatic?

Fully Vaccinated Healthcare Workers

Fully vaccinated Healthcare Workers (HCWs) should follow CDC guidance for healthcare settings, as well as their employer’s guidance. Fully vaccinated is defined as: ≥14 days following receipt of the second dose in a 2-dose series, or ≥14 days following receipt of one dose of a single-dose vaccine. In general, fully vaccinated HCWs who are asymptomatic do not need to be excluded from work or quarantine after a high-risk exposure. Some exceptions may apply. Work exclusion may still be considered for HCWs who have underlying immunocompromising conditions. HCWs who have traveled should follow CDC’s travel recommendations and requirements, including restrictions from work, when recommended for any traveler. HCWs who work in congregate settings (e.g. long-term care facilities) please see CDPH All Facilities Letter dated March 23, 2021.

Non-vaccinated or Partially Vaccinated Healthcare Workers

Non-vaccinated or partially vaccinated HCWs should continue to follow CDC guidance for Potential Exposure at Work, as well as CDPH All Facilities Letter dated March 23, 2021, which provides guidance for HCWs based on vaccination status.

Mitigation Strategies During Critical Staffing Shortages

HCWs who are not fully vaccinated after experiencing a higher risk exposure in the workplace or identified as a close contact in the community should continue to follow County guidance for quarantine. However, during times of critical staffing shortage, healthcare facilities are recommended to follow CDC staffing shortage mitigation strategies and guidance on Potential Exposure at Work, as well as CDPH guidance. In general, to alleviate critical staffing shortage, asymptomatic HCWs who are not fully vaccinated may return to work after Day 7 from date of last exposure if they received negative PCR test result from specimen collected after Day 5. See CDPH All Facilities Letter for more information.

The following recommendations may also be considered for HCWs who have not been fully vaccinated, in the context of returning them to work during their quarantine periods to mitigate critical staffing shortage.

  • The HCW remains asymptomatic.
  • The HCW undergoes the following testing regimen:
    • A COVID-19 test is done immediately upon learning of their exposure and the test result is negative. 
    • The HCW remains off work until this initial COVID-19 test is resulted.
    • Thereafter, during the remainder of the quarantine period, the HCW’s COVID-19 status shall be monitored with daily rapid antigen tests or RT-PCR tests every 3 days. Test type and frequency will depend on the facility’s testing availability and schedules.
  • The HCW wears an N95 respirator and all other required PPE at all times while at work during the quarantine period.
  • The HCW does not eat, drink, or unmask around others at any time, regardless of social distancing.
  • The HCW continues to monitor COVID-19 symptoms daily. If the HCW develops symptoms, the HCW should leave work, contact their manager/employee health, and be tested.
  • The HCW maximizes social distancing (even beyond 6 feet) wherever possible with both patients and co-workers, and maintains excellent hand hygiene at all times. 
  • The HCW does not work with severely immunocompromised patients or individuals (e.g., cancer, organ transplants).
  • The HCW’s work duties are assigned in a manner that minimizes the number of different patients cared for by the HCW.
  • The HCW is still under home quarantine for 10 days after last exposure except to go to work. The HCW must not carpool, taxi, or rideshare.

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Skilled Nursing Facilities

Note: When there is a difference between local, state, and federal guidelines or health orders; or difference with other regulatory agency guidelines, including guidelines for testing, quarantine, and isolation, the most restrictive guideline or order must be followed.

Do hospitals need approval from PHD before discharging or releasing a suspected or confirmed COVID-19 patient to a skilled nursing facility?

No. Proposed discharge of a confirmed COVID-19 case to a Long-Term Care Facility (including Skilled Nursing Facilities) or other congregate setting no longer requires notification or approval of the Public Health Department.

What are the testing requirements for discharges from hospitals to skilled nursing facilities?

Hospitals should test patients who will be newly transferred to a skilled nursing facility. Ideally, test results would be available prior to transfer but skilled nursing facilities cannot require a negative test prior to accepting a new admission.

For patients who are hospitalized for COVID-19 and have fulfilled the isolation period, no further testing or repeat quarantine is needed prior to transfer to the skilled nursing facility.

Testing is also not required for patients being readmitted to skilled nursing facilities after hospitalization or ambulatory care (e.g., emergency department or clinic), assuming there is no active COVID-19 transmission at the hospital.

What are the quarantine requirements for new admissions to skilled nursing facilities?

Skilled nursing facilities are required to quarantine new admissions for 10 days, and to test at the beginning and end of the quarantine period. Days spent in the acute care hospital may count towards the quarantine period at the skilled nursing facility if:

  • there is no suspected or confirmed COVID-19 transmission at the hospital and
  • the hospital tests all patients upon admission and has designated COVID-19 unit(s) with dedicated staff and minimal cross-over.

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Dental Facilities

I run a dental facility – should I continue to provide cleanings and non-urgent dental services to patients?

Dentists should follow the CDC’s guidance on dental services.

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