United States: CDC Explains "We Are Learning More About COVID-19 Every Day" As CDC Issues Revised Guidance Expanding The Definition Of Close Contact Exposure And High-Risk Medical Conditions

In recent months, the Centers for Disease Control and Prevention (CDC) has continued to revise and refine its prior guidance defining close contact exposure and expand its list of medical conditions that pose an increased risk of severe illness from coronavirus disease 2019 (COVID-19).  In this new guidance, the CDC reminds the public and officials that COVID-19 is a new virus and government officials and scientists are learning more about COVID-19 every day.  Employers can expect the ever-changing COVID-19 landscape to continue to shift as as a result of an increased understanding of COVID-19. Employers should have a plan in place to respond to confirmed COVID-19 cases in the workplace by implementing contact tracing policies that comply with the latest CDC guidelines. In addition, employers should be prepared to address employees' risk concerns as the CDC continues to refine its list of individuals at high risk. 

CDC expands the definition of close contact exposure to COVID-19

With the number of cases of COVID-19 surging across the United States as the holidays approach, employers should prepare for confirmed COVID-19 cases in workplaces and confirm that their contact tracing policies comply with the latest guidance from the U.S. Centers of Disease Control and Prevention (CDC).  On October 22, 2020, the CDC updated its guidance to expand its definition of close contact exposure to identify those who are considered at risk of contracting COVID-19.¹  According to this revised guidance, a close contact exposure is any person who was within six feet of an infected individual for a cumulative total of 15 minutes or more over a 24-hour period during the 48 hours before the infected individual exhibited symptoms or, if asymptomatic, 48 hours before the COVID-19 test was administered.  Under this new definition, a close contact exposure occurs even if the interactions were brief and spread out over a 24-hour period, provided the combined total is 15 minutes. 

For many employers, the CDC's revised guidance of close contact exposure will complicate contact tracing in the workplace and increase the number of employees who should be excluded from the workplace for a 14-day quarantine period.²   Previously, because the CDC defined close contact as those who were within six feet of a COVID-19 infected individual for 15 minutes consecutively, employees who had several brief encounters with the infected individuals within six feet of an infected individuals, each less than 15 minutes, would not be considered a close contact exposure.  Under the revised CDC guidance, an employer should consider each encounter an employee has within six feet of an infected individual and calculate the combined total amount of time that employee was exposed over the course of a 24-hour period (during 48-hours before symptoms or, if asymptomatic, before a positive COVID-19 test).  For example, under the revised definition, an employee who was within six feet of an infected person on three encounters of five minutes each, or ten encounters of two minutes each, is now considered to have had a close contact exposure and must quarantine.  While employers should interview the infected individual to determine who they had close contact during the timeframe while they may have been infectious, given the variables of the updated guidance, employers may resort to reviewing video surveillance or electronic security records (i.e. security access point records) to confirm an infected employee's contact with others in the workplace.  The revised CDC guidance identifies other factors to consider when defining close contact exposure, including "proximity (closer distance likely increases exposure risk), the duration of exposure (longer exposure time likely increases exposure risk), whether the infected individual has symptoms (the period around onset of symptoms is associated with the highest levels of viral shedding),  if the infected person was likely to generate respiratory aerosols (e.g., was coughing, singing, shouting), and other environmental factors (crowding, adequacy of ventilation, whether exposure was indoors or outdoors)." ³

Significantly, the CDC cautions that an employee would be considered a close contact exposure even if both employees were using face covering.  Thus, the determination of close contact exposure should be made irrespective of whether the person with COVID-19 or others were wearing a mask. Given this updated guidance, employers should continue to exercise precaution to eliminate the spread of COVID-19 in the workplace and take the following steps:

• Review and revise the employer's COVID-19 prevention and response policies and procedures.
• Educate employees concerning the revised definition of a close contact exposure and caution employees to stay in their work area and limit any unnecessary wandering at work. 
• Instruct employees to refrain from any nonessential in-person contact with others however brief and to conduct meetings by video conferencing or telephone.
• If in person meetings are necessary and social distancing is not feasible, employers should consider staggering meeting days and limiting meetings to less than 15 minutes.

For more information, read our Steps Employers Should Take When Responding to an Employee's COVID-19 Diagnosis, COVID-19 FAQ for Employers, and our guide to Developing Workplace Policies and Procedures to Combat Covid-19 .

CDC revises lists of medical conditions that place individuals at increased risk of severe illness due to COVID-19. 

The CDC continues to refine its list of underlying medical conditions that either potentially increases or increases the risk of severe illness from COVID-19 for adults of any age.⁴  Spotlighting the CDC's rapidly evolving knowledge of COVID-19, the CDC has updated its guidance on high risk conditions twice in the last month.  The CDC guidance provides a list of underlying health conditions that place individuals (of any age) at an increased risk of severe COVID-19 illness (high risk) and those conditions that potentially increase a person's risk for a severe illness form COVID-19 (potential high risk).  In early October, the CDC listed cancer and smoking on the high-risk list and clarified the difference between obesity (BMI>30), which is on the high-risk list and being overweight, which is considered a potential high risk. 

Most recently, on November 2, 2020, the CDC moved pregnancy from a potential risk to the high-risk list. The CDC noted that recent data supports increased risk of severe illness during pregnancy from COVID-19.

The CDC's summary of recent changes clarifies that the list is a "living document that may be updated at any time, subject to potentially rapid change as the science evolves." With an ever-changing list of high-risk conditions, employers should be prepared to address employee concerns about workplace exposure and be prepared to respond to any requests for leave or another accommodation. For more information, read our article on EEOC Answers Questions About COVID-19 Issues in the Workplace.

Conclusion

The recent flurry of activity by the CDC in revising its guidance is expected to continue.  Scientists will likely continue to learn more about COVID-19 and our knowledge of this virus will evolve.  Employers are encouraged to frequently consult the CDC guidance concerning COVID-19 and revise their COVID-19 procedures and protocols accordingly. 

Footnotes

1. https://www.cdc.gov/coronavirus/2019-ncov/php/contact-tracing/contact-tracing-plan/appendix.html#contact (accessed November 18, 2020); See also, https://www.cdc.gov/coronavirus/2019-ncov/php/open-america/non-healthcare-work-settings.html (accessed November 18, 2020).

2. Employers may permit critical infrastructure workers to work onsite following a close contact exposure as long as the exposed workers remain asymptomatic. The CDC's critical infrastructure guidelines can be found here.

3.  Id.

4. https://www.cdc.gov/coronavirus/2019-ncov/need-extra-precautions/people-with-medical-conditions.html (accessed November 18, 2020).

The content of this article is intended to provide a general guide to the subject matter. Specialist advice should be sought about your specific circumstances.