If you’ve been exposed, the first step is to fill out Occupational Health’s Screening Form. Occupational Health will contact you with next steps.
For common scenarios, such as someone in your household tested positive or a friend tested positive, and next steps, please see Occupational Health’s Screening Guide.
If you have:
- A fever with or without respiratory symptoms that is higher than 100.0 degrees Fahrenheit
- New or worsening baseline respiratory symptoms (with or without fever), such as cough, shortness of breath, or sore throat
- Stay home
- If at work:
- Notify your supervisor so you can stop all patient care activities
- Continue wearing your mask
- Maintain cough etiquette by coughing into your elbow
- Fill out the online COVID 19 Screening Form to receive additional guidance and direction.
- Go home as soon as you can with your supervisor’s assistance
If you have been exposed to COVID-19 but have NO symptoms:
- Continue wearing your mask
- Notify your supervisor
- Fill out the online COVID 19 Screening Form
- Stay at home ONLY if directed to by Occupational Health
- Continue patient care activities if cleared by Occupational Health
- Self-monitor for development of symptoms
You must receive approval from Occupational Health before you can return to work.
If uncertain whether you are able to return to work, contact Occupational Health (214-645-5300).
Occupational Health Services is available seven days a week, from 8 a.m.-5 p.m. You will receive a response within four business hours.
Visit Occupational Health’s intranet site for more information and contacts (Link requires VPN to access off-campus.)
Last updated Aug. 5, 2020
Several factors influence the chance of contracting COVID-19 either at work or outside of work. First, was personal protective equipment (PPE) worn, and worn correctly? Second, what was the duration, distance, environment, and behavior associated with the exposure?
- Duration: The amount of time of close contact or exposure. Anything over 15 minutes, including aggregated over multiple interactions, is significant.
- Distance: Physical proximity to another person. There is a gradient of risk, with distances of less than 6 feet being associated with the highest risk.
- Environment: Location of the interaction. Was it indoors or outdoors? If indoors, was it in a crowded or poorly ventilated area? Was it in a space with appropriate physical distancing and good ventilation? Outdoors is even safer.
- Behavior: Shouting or singing, vigorous breathing related to high-intensity exercise, or medical procedures that are aerosol-generating can all increase the risk of generating respiratory droplets, which increases the chance of transmission.
Remember, PPE – i.e., masking – and other non-pharmacologic interventions (NPIs) – hand hygiene and social distancing – can greatly reduce the risk of infection.
The current understanding is that the infectious period begins 48 hours prior to symptom onset/diagnosis and extends for 10 days afterward, assuming that the patient is not immunocompromised and has mild to moderate illness. For those who remain asymptomatic, the contagious period includes 48 hours prior to the positive test until 10 days after the positive test. This infectious period may be longer in special circumstances, such as for those who are critically ill or immunocompromised. An increasing amount of data shows that the highest-risk period of transmission starts one to two days prior to symptom onset.
Close contact and transmission related to respiratory droplets pose the highest risks of contracting COVID-19 from person-to-person. While contracting COVID-19 from objects in the environment remains a potential risk, it is not considered a major contributor based on currently available data. Some data indicates that depending on the surface or material, the SARS-CoV-2 virus can be detected in the environment for up to six days.
Fortunately, the virus is sensitive to standard cleaning and disinfecting products. We recommend that after each patient encounter, in order to provide safety, you follow the standard cleaning protocols for the environment as recommended by our Infection Prevention teams. In addition, diligent hand hygiene with either soap and water or alcohol-based hand rub with at least 60% alcohol is important to reduce your risk of transmission. Of note, the Environmental Protection Agency (EPA) has a list of environmental disinfectants that are effective against SARS-CoV-2.
Age, obesity, and diabetes are the main factors that impact the severity of COVID-19 disease. Generally, those who are younger have a milder disease, although there are exceptions. As patients advance in age, the chances of severe illness or death increase, particularly for those over 65. Irrespective of age, some preexisting medical conditions also appear to be associated with more severe disease; those with the strongest evidence to suggest an increased risk are the following: obesity (BMI >30), diabetes, serious cardiac disease, COPD, chronic kidney disease, sickle cell disease, and those with active malignancy or who are immunocompromised from organ transplant. Some other chronic medical conditions may also carry an increased risk, but data on the subject is more limited.
Based on the best available evidence to date from the Centers for Disease Control and Prevention (CDC) and advisory guidance from the American College of Obstetricians and Gynecologists (ACOG), women who are pregnant do not appear to be at higher risk of getting COVID-19 than the general public. However, they may have an increased risk of severe illness associated with the virus, including hospital and ICU admission, compared with women who are not pregnant; however, there does not appear to be an increased risk of death. There may also be an increased risk of adverse pregnancy outcomes, such as preterm birth, in mothers with COVID-19. There are limitations to the available data at the moment, but we are following this topic closely. Currently, ACOG and CDC emphasize that pregnant health care workers can continue to work safely as long as they have access to and use the appropriate PPE and other recommended safety precautions. They advise, as do we, that any employee who is pregnant discuss with their supervisor if they have specific concerns about performing a high-risk activity on a suspected or confirmed COVID-positive patient.
A molecular or PCR (Polymerase Chain Reaction)-based test is our primary method for detecting active infection with SARS-CoV-2. At UTSW, we have several of these tests, including the ID NOW COVID-19 test, which uses isothermal nucleic acid amplification and is principally run on nasopharyngeal or nasal swabs. The advantage of this test is rapid result turnaround, so it is primarily used in the Clements University Hospital (CUH) Emergency Department for symptomatic patients. However, while it has a high specificity so that a positive test is reliable, it has a lower sensitivity, especially in asymptomatic individuals. There is a 10% chance or higher that you could have a false negative result even if you have COVID-19 so all negative tests are automatically “reflexed” to repeat testing with a PCR test to confirm the negative result is correct.
Additionally, we have several different PCR-based platforms at UTSW, including the Abbott m2000, the Abbott Alinity, and the Cepheid Xpert PCR tests. Each of these tests has very good sensitivity and specificity. The lab takes into consideration some factors that guide which platform to use: turnaround time, specimen kit availability, and types of samples that can be run on each test.
We recommend that you use the available electronic health record decision support and other resources made available by the clinical lab to help determine the best test for a particular patient. Also, if a patient’s first test returns negative but there is a high clinical suspicion for COVID-19, you should consider whether retesting is appropriate.
One of the recurring observations with SARS-CoV-2 is that due to the high sensitivity of the PCR tests, patients may remain PCR-positive for a prolonged period after infection and even after symptoms and clinical disease resolve. While the majority of patients may become PCR-negative after two to four weeks from symptom onset, some recovered patients continue to have SARS-CoV-2 RNA detected in upper respiratory specimens up to 12 weeks after symptom onset. However, attempts to detect live virus by culture or “replication-competent” virus in these individuals has not demonstrated live, infectious virus beyond nine days in normal hosts and 21 days in those with severe illness.
There is commercially available SARS-CoV-2 antibody testing for different types of antibodies, including IgG, IgM, and IgA. UTSW currently offers the Abbott Architect IgG antibody test, which, based on manufacturer testing and our own internal validation, has a high sensitivity and specificity of greater than 99%. However, at this point, it is unknown how a positive antibody test correlates with long-term immune protection against reinfection from SARS-CoV-2. Based on this knowledge gap, antibody testing is not currently recommended for determining when it is safe for someone to return to work or be removed from isolation. An institutional task force reviewed the available literature and made recommendations on potential indications for antibody testing, which would include:
- A complementary role to PCR testing for clinical diagnosis in acute disease with symptoms present for more than seven days;
- Confirmation of prior COVID infection in someone who had a compatible illness but was not able to be tested;
- Diagnosis of late-term complications that might be related to prior COVID-19 infection;
- Identifying potential donors for convalescent plasma from among those who have recovered from COVID-19.
For more information on antibody testing, please refer to this report on the UTSW COVID-19 website.
To determine when a COVID-positive patient can discontinue isolation precautions, UT Southwestern uses the CDC’s time- and symptom-based criteria, which consider the date of diagnosis (symptom onset versus positive test result for asymptomatic individuals) as well as resolution of fever and other symptoms. The UT Southwestern COVID-19 testing FAQ provides more information on the process.
For COVID-positive employees, Occupational Health uses similar time- and symptom-based criteria before clearing employees to return to work. If an employee does not feel physically ready to return to duty once the Occupational Health criteria to return to work are met, they can discuss with their supervisor, in consultation with Human Resources, options for their individual circumstances.
The CDC no longer recommends a test-based strategy to determine when an individual is no longer infectious.
To date, CDC data indicates that there are no definitively confirmed cases of live-virus SARS-CoV-2 reinfection in patients who have recovered. Most of the cases reporting reinfection have involved individuals who recovered from COVID-19 and then developed symptoms again, with a resulting positive PCR test, or whose COVID-19 PCR testing went from negative to positive in subsequent tests. A PCR test can be positive, but it does not distinguish between live virus – virus that is infectious and can spread to another person – or dead virus/residual viral RNA that is not infectious. There is some concern that antibodies may begin to go away after eight to 12 weeks; however, it is unknown when an individual might become susceptible to reinfection. Experience with other human coronaviruses suggests a period of 90 days before susceptibility to reinfection.
Therefore, in individuals who were diagnosed with COVID and are currently asymptomatic, it is not recommended to repeat a PCR for a period of 90 days, even if they have close contact with a COVID-positive individual. In those who develop new symptoms during this 90-day period, it is recommended that a medical evaluation for other causes be conducted. If this fails to identify another plausible etiology for the new symptoms, then you may consider consulting with Infectious Diseases and/or Infection Prevention to determine whether retesting to exclude reinfection is warranted.
The primary reasons that an employee should contact Occupational Health are the following:
- You have developed symptoms that could be due to COVID-19. These may include fever or chills, or new or worsening symptoms such as cough, shortness of breath, nausea/vomiting/diarrhea, loss of taste or smell, muscle aches, headache, sore throat, or congestion/runny nose. If at home, you are encouraged to stay at home, complete the online Occupational Health Screening form, and notify your supervisor. Someone from Occupational Health will contact you with next steps. If at work, you are asked to notify your supervisor so that you can discontinue any patient care, complete the online screening form, and then proceed home until you are able to be fully assessed by the Occupational Health team.
- You have had contact with an employee or patient who tested positive for COVID-19. Again, the first step is to complete the online Occupational Health Screening form and to notify your supervisor of any absence. Occupational Health will contact you with the next steps, including a risk assessment to determine the nature of your exposure, if you need to self-quarantine and when you can return to work.
Please review our Occupational Health information on the UTSW COVID-19 website for more information.
- First, Occupational Health will determine if the exposure happened during the infectious or contagious period for the COVID-positive source.
- Second, Occupational Health will determine if the exposure involved an aerosol-generating procedure such as intubation, open suctioning, BiPAP/CPAP, etc., and whether the employee was wearing all the recommended PPE, including an N95 respirator (or PAPR), eye protection, gown, and gloves.
- Third, we will determine if the exposure involved what is defined as “prolonged close contact” – either more than 15 minutes within a distance of 6 feet or direct contact with respiratory secretions. If it was prolonged close contact either in the workplace or at home, then we will assess whether the employee was wearing the appropriate PPE, including surgical mask and eye protection. As long as you wear your mask and eye protection as advised in your patient and employee encounters, there should not be a high-risk exposure in the workplace. Please review our Eye Protection for Employees FAQ for more information.
With regard to testing, UTSW is currently offering and encouraging testing for all employees involved in a community or workplace exposure, regardless of risk assessment, at Day 1 and again at Day 7. The Day 1 test can be useful in assessing at baseline whether an employee was already an asymptomatic carrier of the virus. The Day 7 test can then be useful for determining if a transmission has occurred related to the specific exposure. Please note that the testing is voluntary, irrespective of the risk of the exposure, but also that a decision about self-quarantine is ultimately made based on our risk assessment and not based solely on a negative test result.
If an employee is found to have a high-risk exposure based on the factors above, the general duration of self-quarantine is 14 days. This time frame is based on the incubation period from exposure to development of infection, which ranges between two and 14 days, with an average of about five to six days. This self-quarantine duration could change if the employee develops symptoms, tests positive for COVID-19, or has another high-risk exposure to a COVID-positive individual during this time period.
You should not come to work if you are exposed to a household contact, intimate partner, or someone in the home whom you provide care for without using PPE. Instead, notify Occupational Health by completing the online Occupational Health Screening form. Someone will contact you with next steps. You also can refer to our online Occupational Health Screening Guide for additional information on this or other common scenarios.
A member of the Occupational Health contact tracing team will contact an employee and conduct an interview to assess the level of any potential exposure. This will include questions about their patterns at work, including their usual practices in wearing their masks and other PPE, and any potential exposure to COVID-positive individuals outside of work. Based on the results, they will be assigned a risk assessment – either “high risk” or “not high risk” – and given direction on whether they can return to work or need to self-quarantine. They also will be offered (and encouraged to have) testing on Day 1 and Day 7 if desired, although this testing result, if negative, will not negate the risk assessment and self-quarantine decision.
For an exposure involving a COVID-positive patient, Occupational Health is permitted to disclose some basic information about the positive patient to those involved in the patient’s care who were part of an exposure – keeping in mind that this information is still protected by HIPAA.
For an exposure involving a COVID-positive employee, due to confidentiality requirements under the Americans with Disabilities Act and guidance from the Equal Employment Opportunity Commission (EEOC), and in order to protect our employees’ privacy, Occupational Health is more restricted in what information can be disclosed. If the source employee consents, their COVID status can be disclosed to their immediate supervisor or manager to assist with compiling a list of other employees who might have had close contact as part of an appropriate health care response. However, neither Occupational Health nor managers are permitted to disclose the identity of or any medical details about the source employee to others.
Important: Please refer to the COVID-19 Document Library on the Health System Portal (HSP) for the latest information.
Need an empathetic listening ear or some help processing? The hotline is open to the entire UTSW community.
Contact Us: 214-645-5686 or behavioralhealthresponseteam@UTSouthwestern.edu
Hours: 7:30 a.m. to 6 p.m. daily. Members of the Psychology and Psychiatry Department will answer calls and emails throughout the week.
Find practical coping skills for the top emotional concerns you are facing today in Stress Management for Providers (PDF).
As part of your employee benefits package, UT Southwestern Medical Center provides an Employee Assistance Program. This program is designed to assist employees who may be dealing with personal problems that affect their relationships at home and at work.
- 24 hour, 7 days a week access
- Up to four counseling sessions per problem/issue
- Eligible to dependents and family members who currently live within the employee’s home
- Critical Incident Stress Debriefings (CISD)
- EAP orientations
- Educational seminars
- Multiple locations
- Referrals to community resources
- Supervisory trainings and consultations
Toll-free Phone: 800-386-9156
The COVID-19 Virtual Care Clinic provides quick access to one of our expert clinicians for a COVID-19 screening. A virtual visit is likely scheduled for the same day.
Your family members:
- Do not have to be current patients of UT Southwestern
- Will provide their insurance to be billed, and our UT Southwestern staff will work with your insurance company if prequalification is needed.
The virtual visit will consist of a screening to discuss:
- Potential exposure
- Previous medical history
The visit will not always include a COVID-19 test. If there is a need for formal testing:
- Patients 12 years of age and older may be referred to the Drive-up Testing Site at the Paul M. Bass Administrative and Clinical Center, Lot No. 18. It is open seven days a week, 9 a.m. to 6 p.m.
- Patients under 12 years of age may be provided a referral for testing in partnership with Children’s Health, with additional information provided at time of telehealth visit and referral.
If you have any questions or a family member wants to request a virtual visit, please call 214-645-9296.
We are available Monday through Friday, 8 a.m. to 5 p.m.
UT Southwestern specialists may refer their patients to the Virtual Care Clinic – even if the patient does not have a primary care physician.
To place the referral, enter order #101900 (COVID-19 Referral Support Clinic Referral/Consult).
Once the referral is received, your patient will be contacted to schedule a virtual visit with a clinician in General Internal Medicine or Family Medicine. This clinic will support the patient’s episode of care including the communication of test results, if applicable, and ongoing symptom management.